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Israni M, Nicholson B, Mahlaoui N, Obici L, Rossi-Semerano L, Lachmann H, Hayward G, Avramovič MZ, Guffroy A, Dalm V, Rimmer R, Solis L, Villar C, Gennery AR, Skeffington S, Nordin J, Warnatz K, Korganow AS, Antón J, Cattalini M, Amin T, Berg S, Soler-Palacin P, Burns SO, Campbell M. Current Transition Practice for Primary Immunodeficiencies and Autoinflammatory Diseases in Europe: a RITA-ERN Survey. J Clin Immunol 2023; 43:206-216. [PMID: 36222999 PMCID: PMC9840587 DOI: 10.1007/s10875-022-01345-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 08/07/2022] [Indexed: 01/21/2023]
Abstract
BACKGROUND Due to the absence of curative treatments for inborn errors of immunity (IEI), children born with IEI require long-term follow-up for disease manifestations and related complications that occur over the lifespan. Effective transition from pediatric to adult services is known to significantly improve adherence to treatment and long-term outcomes. It is currently not known what transition services are available for young people with IEI in Europe. OBJECTIVE To understand the prevalence and practice of transition services in Europe for young people with IEI, encompassing both primary immunodeficiencies (PID) and systemic autoinflammatory disorders (AID). METHODS A survey was generated by the European Reference Network on immunodeficiency, autoinflammatory, and autoimmune diseases Transition Working Group and electronically circulated, through professional networks, to pediatric centers across Europe looking after children with IEI. RESULTS Seventy-six responses were received from 52 centers, in 45 cities across 17 different countries. All services transitioned patients to adult services, mainly to specialist PID or AID centers, typically transferring up to ten patients to adult care each year. The transition process started at a median age of 16-18 years with transfer to the adult center occurring at a median age of 18-20 years. 75% of PID and 68% of AID centers held at least one joint appointment with pediatric and adult services prior to the transfer of care. Approximately 75% of PID and AID services reported having a defined transition process, but few centers reported national disease-specific transition guidelines to refer to. CONCLUSIONS Transition services for children with IEI in Europe are available in many countries but lack standardized guidelines to promote best practice.
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Affiliation(s)
- Muskan Israni
- Department of Immunology, Royal Free London NHS Foundation Trust, London, UK
| | - Bethany Nicholson
- Department of Immunology, Royal Free London NHS Foundation Trust, London, UK
| | - Nizar Mahlaoui
- Pediatric Immuno-Haematology and Rheumatology Unit, Necker Enfants Malades University Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France ,French National Reference Center for Primary Immune Deficiencies (CEREDIH), Necker Enfants Malades University Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Laura Obici
- Fondazione IRCCS Policlinico San Matteo, Centro Per Lo Studio E La Cura Delle Amiloidosi Sistemiche, Pavia, Italy
| | - Linda Rossi-Semerano
- Department of Pediatric Rheumatology, National Reference Centre for Auto-Inflammatory Diseases and Amyloidosis of Inflammatory Origin (CEREMAIA), Bicêtre hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Le Kremlin Bicêtre, France
| | - Helen Lachmann
- Division of Medicine, National Amyloidosis Centre, University College London, London, UK
| | - Georgia Hayward
- Paediatric and Adult Rheumatology, Leeds General Infirmary and Chapel Allerton Hospital, Leeds, UK
| | - Mojca Zajc Avramovič
- Department for Allergology, Rheumatology and Clinical Immunology, University Children’s Hospital Ljubljana, Ljubljana, Slovenia
| | - Aurelien Guffroy
- Department of Clinical Immunology and Internal Medicine, Tertiary Center for Primary Immunodeficiency, National Reference Center for Systemic Autoimmune Diseases (CNR RESO), Hôpitaux Universitaires de Strasbourg, 67000 Strasbourg, France ,Université de Strasbourg, INSERM UMR - S1109, 67000 Strasbourg, France
| | - Virgil Dalm
- Department of Internal Medicine, Division of Clinical Immunology, Erasmus University Medical Center, Rotterdam, the Netherlands ,Department of Immunology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Rachel Rimmer
- Rare Autoinflammatory Conditions Community – UK (RACC – UK), Oxford, UK ,http://www.raccuk.com
| | - Leire Solis
- International Patient Organisation for Primary Immunodeficiencies (IPOPI), Brussels, Belgium
| | | | - Andrew R. Gennery
- Paediatric Haematopoietic Stem Cell Transplant Unit, Great North Children’s Hospital (GNCH), Royal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne, NE1 4LP UK ,Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, NE2 4HH UK
| | | | - Julia Nordin
- International Patient Organisation for Primary Immunodeficiencies (IPOPI), Brussels, Belgium
| | - Klaus Warnatz
- Center for Chronic Immunodeficiency, Medical Center, Faculty of Medicine, University of Freiburg, University of Freiburg, Freiburg, Germany ,Department of Rheumatology and Clinical Immunology, Division of Immunodeficiency, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Anne-Sophie Korganow
- Department of Clinical Immunology and Internal Medicine, Tertiary Center for Primary Immunodeficiency, National Reference Center for Systemic Autoimmune Diseases (CNR RESO), Hôpitaux Universitaires de Strasbourg, 67000 Strasbourg, France ,Université de Strasbourg, INSERM UMR - S1109, 67000 Strasbourg, France
| | - Jordi Antón
- Department of Pediatric Rheumatology, Pediatric Immune Dysfunction Disease Study Group (GEMDIP), Institut de Recerca Sant Joan de Déu, Sant Joan de Déu Hospital, Barcelona, Spain
| | - Marco Cattalini
- Pediatrics Clinic, University of Brescia, ASST Spedali Civili Di Brescia, Brescia, Italy
| | - Tania Amin
- Department of Paediatric Rheumatology, Leeds Children’s Hospital, Leeds Teaching Hospitals Trust, Leeds, UK
| | - Stephan Berg
- Department of Pediatrics, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden ,Department of Pediatrics, Queen Silvia Children’s Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Pere Soler-Palacin
- Pediatric Infectious Diseases and Immunodeficiencies Unit, Hospital Universitari Vall d’Hebron, Universitat Autonoma de Barcelona, Bellaterra, Spain ,Jeffrey Modell Diagnostic and Research Center for Primary Immunodeficiencies, Barcelona, Catalonia Spain
| | - Siobhan O. Burns
- Department of Immunology, Royal Free London NHS Foundation Trust, London, UK ,University College London Institute of Immunity and Transplantation, London, UK
| | - Mari Campbell
- Department of Immunology, Royal Free London NHS Foundation Trust, London, UK ,University College London Institute of Immunity and Transplantation, London, UK
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Solís L, Nordin J, Prevot J, Mahlaoui N, Sánchez-Ramón S, Ali A, Cassignol E, Seymour JW, Pergent M. The PID Life Index: an interactive tool to measure the status of the PID healthcare environment in any given country. Orphanet J Rare Dis 2022; 17:11. [PMID: 34998414 PMCID: PMC8742924 DOI: 10.1186/s13023-021-02161-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 12/19/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The "Primary Immunodeficiencies (PIDs) principles of care" were published in 2014 as the gold standard for care of patients with PIDs, setting a common goal for stakeholders to ensure that patients with PID have access to appropriate care and good quality of life. Since then, IPOPI (the International Patient Organisation for Primary Immunodeficiencies), has been working with national PID patient organisations as well as collaborating with scientific and medical institutions and experts to bring these principles closer to the day-to-day life of individuals with PIDs. METHOD The six PID Principles of Care were revised to consider advances in the field, as well as political developments that had occurred after their initial publication in 2014. Based on this revision the list was updated, and a new principle was added. The six established principles were: diagnosis, treatment, universal health coverage, specialised centres, national patient organisations and registries. Each principle was structured and measured through a series of criteria, and was given the same weight, as they have been considered to all be equally important. Specific weights were attributed to the criteria depending on their relevance and importance to quantify the principle. The index was translated into a survey for data collection: initially involving data from selected countries for a pilot, followed by integration of data from IPOPI's national member organisations and key countries. RESULTS The PID Life Index was developed in 2020 to assess the status of the PID environment and the implementation of the 6 principles worldwide. The Index allows for benchmarking countries either according to a set of principles and criteria or based on the user's preferences. This can be displayed in an interactive map or through a data visualisation system. CONCLUSION The PID Life Index has been developed successfully and has potential to become an important source of information for PID stakeholders, to increase awareness and information as well as support advocacy initiatives on PIDs nationally, regionally or globally.
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Affiliation(s)
- Leire Solís
- The International Patient Organisation for Primary Immunodeficiencies, Downderry, UK
| | - Julia Nordin
- The International Patient Organisation for Primary Immunodeficiencies, Downderry, UK
| | - Johan Prevot
- The International Patient Organisation for Primary Immunodeficiencies, Downderry, UK
| | - Nizar Mahlaoui
- Pediatric Immunology-Hematology and Rheumatology Unit, Necker Children's University Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France.,French National Reference Center for Primary Immune Deficiencies (CEREDIH), Necker Children's University Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Silvia Sánchez-Ramón
- Department of Clinical Immunology, Instituto de Medicina del Laboratorio and Instituto de Investigación Clínico San Carlos, Hospital Clínico San Carlos, Madrid, Spain.,Department of Immunology, ENT Ophthalmology, Complutense University School of Medicine, Madrid, Spain
| | - Adli Ali
- Clinical Immunology Unit, Department of Paediatrics, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia.,Institute of IR4.0, Universiti Kebangsaan Malaysia, Bangi, Malaysia
| | | | - John W Seymour
- The International Patient Organisation for Primary Immunodeficiencies, Downderry, UK.,Department of Counseling and Student Personnel, Minnesota State University, Mankato, MN, USA
| | - Martine Pergent
- The International Patient Organisation for Primary Immunodeficiencies, Downderry, UK.
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Nordin J, Solís L, Prévot J, Mahlaoui N, Chapel H, Sánchez-Ramón S, Ali A, Seymour JW, Pergent M. The PID Principles of Care: Where Are We Now? A Global Status Report Based on the PID Life Index. Front Immunol 2021; 12:780140. [PMID: 34868053 PMCID: PMC8637458 DOI: 10.3389/fimmu.2021.780140] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 10/29/2021] [Indexed: 11/13/2022] Open
Abstract
A global gold standard framework for primary immunodeficiency (PID) care, structured around six principles, was published in 2014. To measure the implementation status of these principles IPOPI developed the PID Life Index in 2020, an interactive tool aggregating national PID data. This development was combined with a revision of the principles to consider advances in the field of health and science as well as political developments since 2014. The revision resulted in the following six principles: PID diagnosis, treatments, universal health coverage, specialised centres, national patient organisations and registries for PIDs. A questionnaire corresponding to these principles was sent out to IPOPI’s national member organisations and to countries in which IPOPI had medical contacts, and data was gathered from 60 countries. The data demonstrates that, regardless of global scientific progress on PIDs with a growing number of diagnostic tools and better treatment options becoming available, the accessibility and affordability of these remains uneven throughout the world. It is not only visible between regions, but also between countries within the same region. One of the most urgent needs is medical education. In countries without immunologists, patients with PID suffer the risk of remaining undiagnosed or misdiagnosed, resulting in health implications or even death. Many countries also lack the infrastructure needed to carry out more advanced diagnostic tests and perform treatments such as hematopoietic stem cell transplantation or gene therapy. The incapacity to secure appropriate diagnosis and treatments affects the PID environment negatively in these countries. Availability and affordability also remain key issues, as diagnosis and treatments require coverage/reimbursement to ensure that patients with PID can access them in practice, not only in theory. This is still not the case in many countries of the world according to the PID Life Index. Although some countries do perform better than others, to date no country has fully implemented the PID principles of care, confirming the long way ahead to ensure an optimal environment for patients with PID in every country.
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Affiliation(s)
- Julia Nordin
- The International Patient Organisation for Primary Immunodeficiencies, Downderry, United Kingdom
| | - Leire Solís
- The International Patient Organisation for Primary Immunodeficiencies, Downderry, United Kingdom
| | - Johan Prévot
- The International Patient Organisation for Primary Immunodeficiencies, Downderry, United Kingdom
| | - Nizar Mahlaoui
- Pediatric Immunology-Hematology and Rheumatology Unit, Necker Children's University Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France.,French National Reference Center for Primary Immune Deficiencies (CEREDIH), Necker Children's University Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Helen Chapel
- Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Silvia Sánchez-Ramón
- Department of Clinical Immunology, Instituto de Medicina del Laboratorio (IML) and Instituto de Investigación Clínico San Carlos (IdISSC), Hospital Clínico San Carlos, Madrid, Spain.,Department of Immunology, ENT and Ophthalmology, Complutense University School of Medicine, Madrid, Spain
| | - Adli Ali
- Clinical Immunology Unit, Department of Paediatrics, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia.,Institute of IR4.0, Universiti Kebangsaan Malaysia, Bangi, Malaysia
| | - John W Seymour
- The International Patient Organisation for Primary Immunodeficiencies, Downderry, United Kingdom.,Department of Counseling and Student Personnel, Minnesota State University, Mankato, MN, United States
| | - Martine Pergent
- The International Patient Organisation for Primary Immunodeficiencies, Downderry, United Kingdom
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Mathioudaki A, Nordin J, Kastbom A, Söderkvist P, Eriksson P, Cedergren J, Lindblad-Toh K, Meadows J. Allele frequency spectrum of known ankylosing spondylitis associated variants in a Swedish population. Scand J Rheumatol 2021; 51:21-24. [PMID: 34169791 DOI: 10.1080/03009742.2021.1916202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Objective: The genetic predisposition to ankylosing spondylitis (AS) has been most widely studied in cohorts with European ancestry. However, within Europe, disease prevalence is higher in Sweden. Given this, we aimed to characterize known AS susceptibility variants in a homogeneous Swedish data set, assessing reproducibility and direction of effect.Method: The power to detect association within an existing Swedish targeted sequencing study (381 controls; 310 AS cases) was examined, and a set of published associations (n = 151) was intersected with available genotypes. Association to disease was calculated using logistic regression accounting for population structure, and HLA-B27 status was determined with direct polymerase chain reaction genotyping.Results: The cases were found to be 92.3% HLA-B27 positive, with the data set showing ≥ 80% predictive power to replicate associations, with odds ratios ≥ 1.6 over a range of allele frequencies (0.1-0.7). Thirty-four markers, representing 23 gene loci, were available for investigation. The replicated variants tagged MICA and IL23R loci (p < 1.47 × 10-3), with variable direction of effect noted for gene loci IL1R1 and MST1.Conclusion: The Swedish data set successfully replicated both major histocompatibility complex (MHC) and non-MHC loci, and revealed a different replication pattern compared to discovery data sets. This was possibly due to population demographics, including HLA-B27 frequency and measured comorbidities.
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Affiliation(s)
- A Mathioudaki
- Science for Life Laboratory, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - J Nordin
- Science for Life Laboratory, Department of Medical Biochemistry and Microbiology, Uppsala University, Uppsala, Sweden
| | - A Kastbom
- Department of Rheumatology, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - P Söderkvist
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - P Eriksson
- Department of Rheumatology, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - J Cedergren
- Department of Rheumatology, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - K Lindblad-Toh
- Science for Life Laboratory, Department of Medical Biochemistry and Microbiology, Uppsala University, Uppsala, Sweden.,Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Jrs Meadows
- Science for Life Laboratory, Department of Medical Biochemistry and Microbiology, Uppsala University, Uppsala, Sweden
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5
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Eriksson D, Bianchi M, Landegren N, Nordin J, Dalin F, Mathioudaki A, Eriksson GN, Hultin-Rosenberg L, Dahlqvist J, Zetterqvist H, Karlsson Å, Hallgren Å, Farias FHG, Murén E, Ahlgren KM, Lobell A, Andersson G, Tandre K, Dahlqvist SR, Söderkvist P, Rönnblom L, Hulting AL, Wahlberg J, Ekwall O, Dahlqvist P, Meadows JRS, Bensing S, Lindblad-Toh K, Kämpe O, Pielberg GR. Extended exome sequencing identifies BACH2 as a novel major risk locus for Addison's disease. J Intern Med 2016; 280:595-608. [PMID: 27807919 DOI: 10.1111/joim.12569] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND Autoimmune disease is one of the leading causes of morbidity and mortality worldwide. In Addison's disease, the adrenal glands are targeted by destructive autoimmunity. Despite being the most common cause of primary adrenal failure, little is known about its aetiology. METHODS To understand the genetic background of Addison's disease, we utilized the extensively characterized patients of the Swedish Addison Registry. We developed an extended exome capture array comprising a selected set of 1853 genes and their potential regulatory elements, for the purpose of sequencing 479 patients with Addison's disease and 1394 controls. RESULTS We identified BACH2 (rs62408233-A, OR = 2.01 (1.71-2.37), P = 1.66 × 10-15 , MAF 0.46/0.29 in cases/controls) as a novel gene associated with Addison's disease development. We also confirmed the previously known associations with the HLA complex. CONCLUSION Whilst BACH2 has been previously reported to associate with organ-specific autoimmune diseases co-inherited with Addison's disease, we have identified BACH2 as a major risk locus in Addison's disease, independent of concomitant autoimmune diseases. Our results may enable future research towards preventive disease treatment.
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Affiliation(s)
- D Eriksson
- Department of Medicine (Solna), Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden.,Department of Endocrinology, Metabolism and Diabetes Karolinska University Hospital, Stockholm, Sweden
| | - M Bianchi
- Science for Life Laboratory, Department of Medical Biochemistry and Microbiology, Uppsala University, Uppsala, Sweden
| | - N Landegren
- Department of Medicine (Solna), Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden.,Science for Life Laboratory, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - J Nordin
- Science for Life Laboratory, Department of Medical Biochemistry and Microbiology, Uppsala University, Uppsala, Sweden
| | - F Dalin
- Department of Medicine (Solna), Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden.,Science for Life Laboratory, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - A Mathioudaki
- Science for Life Laboratory, Department of Medical Biochemistry and Microbiology, Uppsala University, Uppsala, Sweden
| | - G N Eriksson
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - L Hultin-Rosenberg
- Science for Life Laboratory, Department of Medical Biochemistry and Microbiology, Uppsala University, Uppsala, Sweden
| | - J Dahlqvist
- Science for Life Laboratory, Department of Medical Biochemistry and Microbiology, Uppsala University, Uppsala, Sweden
| | - H Zetterqvist
- Science for Life Laboratory, Department of Medical Biochemistry and Microbiology, Uppsala University, Uppsala, Sweden.,Science for Life Laboratory, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Å Karlsson
- Science for Life Laboratory, Department of Medical Biochemistry and Microbiology, Uppsala University, Uppsala, Sweden
| | - Å Hallgren
- Department of Medicine (Solna), Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden.,Science for Life Laboratory, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - F H G Farias
- Science for Life Laboratory, Department of Medical Biochemistry and Microbiology, Uppsala University, Uppsala, Sweden
| | - E Murén
- Science for Life Laboratory, Department of Medical Biochemistry and Microbiology, Uppsala University, Uppsala, Sweden
| | - K M Ahlgren
- Science for Life Laboratory, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - A Lobell
- Science for Life Laboratory, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - G Andersson
- Department of Animal Breeding and Genetics, Swedish University of Agricultural Sciences, Uppsala, Sweden
| | - K Tandre
- Science for Life Laboratory, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - S R Dahlqvist
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - P Söderkvist
- Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - L Rönnblom
- Science for Life Laboratory, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - A-L Hulting
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - J Wahlberg
- Department of Endocrinology, Department of Medical and Health Sciences, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - O Ekwall
- Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - P Dahlqvist
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - J R S Meadows
- Science for Life Laboratory, Department of Medical Biochemistry and Microbiology, Uppsala University, Uppsala, Sweden
| | - S Bensing
- Department of Endocrinology, Metabolism and Diabetes Karolinska University Hospital, Stockholm, Sweden.,Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - K Lindblad-Toh
- Science for Life Laboratory, Department of Medical Biochemistry and Microbiology, Uppsala University, Uppsala, Sweden.,Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - O Kämpe
- Department of Medicine (Solna), Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden.,Department of Endocrinology, Metabolism and Diabetes Karolinska University Hospital, Stockholm, Sweden.,Science for Life Laboratory, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - G R Pielberg
- Science for Life Laboratory, Department of Medical Biochemistry and Microbiology, Uppsala University, Uppsala, Sweden
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Jungebluth P, Holzgraefe B, Lim ML, Duru A, Lundin V, Sjöqvist S, Jones P, Wood M, Luedde T, Teixeira A, Hermanson O, Winqvist O, Kalzén H, Nordin J, Wiklander O, EL Andaloussi S, Alici E, Dienemann H. Intratracheale Anwendung von autologen Stammzellen in Patienten mit ARDS. Zentralbl Chir 2015. [DOI: 10.1055/s-0035-1559948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Rigault M, Aldering G, Kowalski M, Copin Y, Antilogus P, Aragon C, Bailey S, Baltay C, Baugh D, Bongard S, Boone K, Buton C, Chen J, Chotard N, Fakhouri HK, Feindt U, Fagrelius P, Fleury M, Fouchez D, Gangler E, Hayden B, Kim AG, Leget PF, Lombardo S, Nordin J, Pain R, Pecontal E, Pereira R, Perlmutter S, Rabinowitz D, Runge K, Rubin D, Saunders C, Smadja G, Sofiatti C, Suzuki N, Tao C, Weaver BA. CONFIRMATION OF A STAR FORMATION BIAS IN TYPE Ia SUPERNOVA DISTANCES AND ITS EFFECT ON THE MEASUREMENT OF THE HUBBLE CONSTANT. ACTA ACUST UNITED AC 2015. [DOI: 10.1088/0004-637x/802/1/20] [Citation(s) in RCA: 149] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Tseng HF, Liu A, Sy L, Marcy SM, Fireman B, Weintraub E, Baggs J, Weinmann S, Baxter R, Nordin J, Daley MF, Jackson L, Jacobsen SJ. Safety of zoster vaccine in adults from a large managed-care cohort: a Vaccine Safety Datalink study. J Intern Med 2012; 271:510-20. [PMID: 22026504 DOI: 10.1111/j.1365-2796.2011.02474.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
OBJECTIVES The aim of this study was to examine a large cohort of adults who received the zoster vaccine for evidence of an increased risk of prespecified adverse events requiring medical attention. DESIGN Two self-comparison approaches, including a case-centred approach and a self-controlled case series (SCCS) analysis were used. SETTING Eight managed-care organizations participating in the Vaccine Safety Datalink project in the United States. SUBJECTS A total of 193 083 adults aged 50 and older receiving a zoster vaccine from 1 January 2007 to 31 December 2008 were included. MAIN OUTCOME MEASURES Prespecified adverse events were identified by aggregated International Classification of Diseases, Ninth Revision (ICD-9) codes in automated health plan datasets. RESULTS The risk of allergic reaction was significantly increased within 1-7 days of vaccination [relative risk = 2.13, 95% confidence interval (CI): 1.87-2.40 by case-centred method and relative rate = 2.32, 95% CI: 1.85-2.91 by SCCS]. No increased risk was found for the following adverse event groupings: cerebrovascular events; cardiovascular events; meningitis; encephalitis; and encephalopathy; and Ramsay-Hunt syndrome and Bell's palsy. CONCLUSIONS The results of this study support the findings from the prelicensure clinical trials, providing reassurance that the zoster vaccine is generally safe and well-tolerated with a small increased risk of allergic reactions in 1-7 days after vaccination.
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Affiliation(s)
- H F Tseng
- Kaiser Permanente, Southern California, Pasadena, CA 91101, USA
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9
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K Daly, Giebink G, Knox J, Lindgren B, Haggerty B, Nordin J, Ferrieri P. Effect Of Maternal Vaccination On Infant Early Otitis Media. Ann Epidemiol 2008. [DOI: 10.1016/j.annepidem.2008.08.094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Nichol KL, Nordin J, Mullooly J. Influence of clinical outcome and outcome period definitions on estimates of absolute clinical and economic benefits of influenza vaccination in community dwelling elderly persons. Vaccine 2005; 24:1562-8. [PMID: 16300868 DOI: 10.1016/j.vaccine.2005.10.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2005] [Revised: 09/22/2005] [Accepted: 10/07/2005] [Indexed: 11/28/2022]
Abstract
Studies assessing the clinical and economic benefits of vaccination in the elderly have used different clinical outcomes (e.g. hospitalizations for pneumonia or influenza versus hospitalizations for respiratory and cardiovascular causes) and different outcome periods (e.g. peak versus total influenza season) on which to base estimates of clinical effectiveness and cost effectiveness. We explored the implications of these varying approaches by comparing two health economic analysis models of influenza vaccination of community-dwelling elderly persons. We developed computerized models using clinical data from 3 large US HMOs for the 1998-1999 and 1999-2000 influenza seasons. The primary health economic model used a broad definition of clinical events and outcome period and included hospitalizations for all respiratory and cardiovascular events that occurred during the entire influenza season. The alternative model used more restrictive definitions and included pneumonia or influenza hospitalizations occurring during the peak influenza season. The results of Monte Carlo simulation showed that, with the more inclusive primary model, influenza vaccination resulted in net medical care cost savings due to fewer respiratory or cardiovascular hospitalizations of Dollars 71/person vaccinated (5th-95th percentile Dollars 32-118) and net savings of Dollars 809/year of life saved (5th-95th percentile Dollars 331-1450). In contrast, the alternate model found costs of Dollars 3.50/person vaccinated (5th-95th percentile Dollars -11 to 5) and net costs of Dollars 91/year of life saved (5th-95th percentile Dollars -309 to 126). Our findings confirm that influenza vaccination of the elderly is most likely cost saving and supports policies and programs that advocate routine immunization of all persons 65 and older. They also highlight how different outcome definitions can influence the results of health economic analyses.
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Affiliation(s)
- K L Nichol
- VA Medical Center, Minneapolis, MN 55417, USA.
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11
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Yih KW, Abrams A, Danila R, Green K, Kleinman K, Kulldorff M, Miller B, Nordin J, Platt R. Ambulatory-care diagnoses as potential indicators of outbreaks of gastrointestinal illness--Minnesota. MMWR Suppl 2005; 54:157-62. [PMID: 16177708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023] Open
Abstract
INTRODUCTION Syndromic surveillance's capability to augment existing surveillance for community-acquired gastrointestinal disease is unknown. OBJECTIVE The objective of this study was to evaluate the capability of a syndromic surveillance system to detect outbreaks of gastrointestinal disease. METHODS A retrospective analysis was conducted comparing ambulatory care data from a health plan with a set of 110 gastrointestinal-disease outbreaks identified by the Minnesota Department of Health during 2001-02. Unusual clusters of illness (i.e., signals) in the health-plan data were identified by analyzing daily counts of gastrointestinal illness using an adjusted space-time scan statistic. Concordance was defined as < or =5 km between outbreak and signal and the signal occurring within 1 week of the outbreak. RESULTS During 104 weeks, the number of signals was roughly what would have been expected by chance, suggesting that the modeling did a good job of estimating the expected counts of illness and that false alarms would not have occurred much more often than the number predicted at the various thresholds. During the same period, the health department identified 110 eligible gastrointestinal outbreaks. Apparent associations of the three statistically most unusual concordant signals with outbreaks of viral or bacterial gastrointestinal illness were ruled out by the health department on the basis of detailed knowledge of the circumstances and low numbers of affected persons seeking medical care. CONCLUSION No previously known gastrointestinal outbreaks were identified by this surveillance system. However, relatively few recognized outbreaks resulted in patients seeking medical care, and the sensitivity of this system to detect outbreaks of real significance to public health remains to be determined. Prospective evaluation probably will be required to understand the usefulness of syndromic surveillance systems to enhance existing disease surveillance.
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Affiliation(s)
- Katherine W Yih
- Department of Ambulatory Care and Prevention, Harvard Medical School and Harvard Pilgrim Health Care, Boston, Massachusetts 02215, USA.
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Yih WK, Caldwell B, Harmon R, Kleinman K, Lazarus R, Nelson A, Nordin J, Rehm B, Richter B, Ritzwoller D, Sherwood E, Platt R. National Bioterrorism Syndromic Surveillance Demonstration Program. MMWR Suppl 2004; 53:43-9. [PMID: 15714626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023] Open
Abstract
The National Bioterrorism Syndromic Surveillance Demonstration Program identifies new cases of illness from electronic ambulatory patient records. Its goals are to use data from health plans and practice groups to detect localized outbreaks and to facilitate rapid public health follow-up. Data are extracted nightly on patient encounters occurring during the previous 24 hours. Visits or calls with diagnostic codes corresponding to syndromes of interest are counted; repeat encounters are excluded. Daily counts of syndromes by zip code are sent to a central data repository, where they are statistically analyzed for unusual clustering by using a model-adjusted SaTScan approach. The results and raw data are displayed on a restricted website. Patient-level information stays at the originating health-care organization unless required by public health authorities. If a cluster surpasses a threshold of statistical aberration chosen by the corresponding public health department, an electronic alert can be sent to that department. The health department might then call a clinical responder, who has electronic access to records of cases contributing to clusters. The system is flexible, allowing for changes in participating organizations, syndrome definitions, and alert thresholds. It is transparent to clinicians and has been accepted by the health-care organizations that provide the data. The system's data are usable by local and national health agencies. Its software is compatible with commonly used systems and software and is mostly open-source. Ongoing activities include evaluating the system's ability to detect naturally occurring outbreaks and simulated terrorism events, automating and testing alerts and response capability, and evaluating alternative data sources.
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Affiliation(s)
- W Katherine Yih
- Department of Ambulatory Care and Prevention, Harvard Medical School/Harvard Pilgrim Health Care, 133 Brookline Ave., 6th Floor, Boston, MA 02215, USA.
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Nichol KL, Nordin J, Mullooly J, Lask R. Influence of advancing age on influenza vaccination effectiveness among community dwelling elderly. ACTA ACUST UNITED AC 2004. [DOI: 10.1016/j.ics.2004.02.036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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14
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Nordin J, Mullooly J, Poblete S, Strikas R, Petrucci R, Wei F, Rush B, Safirstein B, Wheeler D, Nichol KL. Influenza vaccine effectiveness in preventing hospitalizations and deaths in persons 65 years or older in Minnesota, New York, and Oregon: data from 3 health plans. J Infect Dis 2001; 184:665-70. [PMID: 11517426 DOI: 10.1086/323085] [Citation(s) in RCA: 191] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2001] [Revised: 04/26/2001] [Indexed: 11/03/2022] Open
Abstract
This study developed methods and determined the impact of influenza vaccination on elderly persons in 3 large health plans: Kaiser Permanente Northwest, HealthPartners, and Oxford Health Plans. Data for the 1996-1997 and 1997-1998 seasons were extracted from administrative databases. Subjects were health plan members > or = 65 years old. Comorbid conditions collected from the preceding year were used for risk adjustment with logistic regression. The virus-vaccine match was excellent for year 1 and fair for year 2. Both years, during peak and total periods, vaccination reduced all causes of death and hospitalization for pneumonia and influenza: hospitalizations were reduced by 19%-20% and 18%-24% for years 1 and 2, respectively, and deaths were reduced by 60%-61% and 35%-39% for the same periods. These results show that all elderly persons should be immunized annually for influenza. The methods used in this study are an efficient cost-effective way to study vaccine impact and similar questions.
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Affiliation(s)
- J Nordin
- HealthPartners Research Foundation, Minneapolis, MN 55440-1524, USA
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15
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Strebel P, Nordin J, Edwards K, Hunt J, Besser J, Burns S, Amundson G, Baughman A, Wattigney W. Population-based incidence of pertussis among adolescents and adults, Minnesota, 1995-1996. J Infect Dis 2001; 183:1353-9. [PMID: 11294666 DOI: 10.1086/319853] [Citation(s) in RCA: 142] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2000] [Revised: 02/07/2001] [Indexed: 11/03/2022] Open
Abstract
To estimate the incidence of pertussis, a prospective study was done among members of a managed care organization in Minneapolis/St. Paul, Minnesota. Of 212 patients 10-49 years old enrolled from January 1995 through December 1996, 8 were found to be culture positive, 10 were found to be positive by polymerase chain reaction assay, 13 had a > or =2-fold increase in IgG or IgA to pertussis toxin (PT), and 18 had IgG to PT in a single serum specimen > or =3 SD above the mean of an age-matched control group. At least 1 positive laboratory test result for pertussis infection was found in 27 (13%) patients, among whom the duration of cough illness was a median of 42 days (range, 27-66 days). On the basis of any positive laboratory result, the estimated annual incidence of pertussis was 507 cases per 100,000 person-years (95% confidence interval, 307-706 cases). Bordetella pertussis infection may be a more common cause of cough illness among adolescents and adults than was recognized previously.
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Affiliation(s)
- P Strebel
- National Immunization Program, Centers for Disease Control and Prevention, Bldg. 12, Room 2223, Corporate Square Blvd., Atlanta, GA 30333, USA.
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Brattström C, Säwe J, Jansson B, Lönnebo A, Nordin J, Zimmerman JJ, Burke JT, Groth CG. Pharmacokinetics and safety of single oral doses of sirolimus (rapamycin) in healthy male volunteers. Ther Drug Monit 2000; 22:537-44. [PMID: 11034258 DOI: 10.1097/00007691-200010000-00006] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A phase I study was conducted to determine the pharmacokinetics, safety, and tolerability of sirolimus, a new immunosuppressive drug, in 45 healthy men between 19 and 36 years of age. Nine subjects in each group were randomly assigned to receive single oral doses of either sirolimus (n = 6) or placebo (n = 3) in group I (0.3 mg/m2), group II (1 mg/m2), group III (3 mg/m2), group IV (5 mg/m2) and group V (8 mg/m2). No serious adverse events occurred during the study. Twenty-eight of the 45 volunteers (62%) reported an adverse event; 19 of 30 (63%) were in the sirolimus group and 9 of 15 (60%) were in the placebo group (ns). Asthenia was the most common adverse event, occurring in 7 of 30 (23%) in the sirolimus group compared with 6 of 15 (40%) in the placebo group (ns). Absorption occurred within 1 hour in all volunteers. Whole blood peak concentration and area under the concentration-time curve increased proportionally with dose. Mean (+/- SD) whole blood terminal disposition half-life (t1/2), apparent oral dose clearance (Cl/F), and volume of distribution (Vss/F) were 82 +/- 12 hours, 278 +/- 117 mL/h x kg and 23 +/- 10 L/kg, respectively. Distribution of sirolimus into formed blood elements was extensive, with a mean whole blood-to-plasma ratio of 36. Single oral doses of sirolimus (0.3 to 8 mg/m2) solution were well tolerated in healthy male volunteers.
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Affiliation(s)
- C Brattström
- Division of Transplantation Surgery, Department of Surgery, Huddinge Hospital, Sweden
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17
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Gleizes V, Chick G, Plante-Bordeneuve P, Merlaud L, Nordin J. [Acute compartment syndrome in the thigh: 3 cases]. Rev Chir Orthop Reparatrice Appar Mot 2000; 86:407-13. [PMID: 10880942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
We report three cases of compartment syndrome in the thigh related to drug intoxications. Compartment syndrome is an uncommon condition often diagnosed late as it may occur in unconscious patients. The typical clinical presentation begins with pain of the lower limb refractory to major antagesics. The condition then progresses with sensoromotor involvement of the sciatic nerve. Rapid onset of acute renal failure in the setting of a crush syndrome may be life-threatening with a long-term risk of major sensoromotor sequelae. Surgical treatment with aponeurotomy is required rapidly to limit sequelae.
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Affiliation(s)
- V Gleizes
- Service de Chirurgie Orthopédique et Traumatologique, CHU Kremlin-Bicêtre, 78, rue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France
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18
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France E, Nordin J. Preparing for the new vaccines. Healthplan 1999; 40:53-4, 57-9. [PMID: 10622968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
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Abstract
The purposes of this study were to compare universal blood lead screening for young children versus targeting by a risk assessment questionnaire and to examine the cost implications of each approach. Costs reflect the total number of blood tests required and cost of specimen collection, handling, and testing per elevated case. The setting included the metropolitan areas of Minneapolis and St. Paul, Minnesota. Children (N=9603) from 17 community organizations had blood tests. In addition, each child's parent or guardian completed a questionnaire assessing potential risk for lead poisoning. Four different screening approaches are presented. Each screening approach is presented with associated costs of overall screening and cost per child identified at blood levels of >/=10 microg/dl (N=1140) and >/=15 microg/dl (N=317). Based on the screening strategy selected and an estimate of $17 per blood test, total screening costs ranged from $91,596 to $165,945. The cost per child identified with elevated lead levels ranged from $361 to $523 at >/=15 and $105 to $146 at >/=10. Nine to 13% of children would not have been detected by policies other than universal screening. A geographically based approach was able to detect 90% of children with elevated blood levels at two-thirds the cost of universal screening. Blood tests would be taken for all children living within city limits. Those residing elsewhere would be tested only if answers to questionnaire items pertaining to age of housing, prior history of lead poisoning, or eating paint chips indicated risk. The new CDC guidelines suggest that screening be based on an assessment of housing, population demographics, and community risk and resources. This paper presents such an assessment.
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Affiliation(s)
- S J Rolnick
- Group Health Foundation, HealthPartners, Minneapolis, Minnesota
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20
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Nordin J, Baken L, Carlson R, Hering J. Age-specific rates of serological immunity in patients with a negative history for varicella infection. Infect Control Hosp Epidemiol 1998; 19:823-4. [PMID: 9831936 DOI: 10.1086/647738] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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21
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Persson P, Nordin J, Rosenqvist J, Lövgren L, Öhman LO, Sjöberg S. Comparison of the Adsorption of o-Phthalate on Boehmite (gamma-AlOOH), Aged gamma-Al2O3, and Goethite (alpha-FeOOH). J Colloid Interface Sci 1998; 206:252-266. [PMID: 9761651 DOI: 10.1006/jcis.1998.5668] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
This work is concerned with the adsorption of o-phthalate (1,2-benzenedicarboxylate) at the water-metal (hydr)oxide interface. Previously published infrared spectroscopic, potentiometric, and adsorption data characterizing the boehmite (gamma-AlOOH) system are compared with new data collected for o-phthalate adsorption on aged gamma-Al2O3 and goethite (alpha-FeOOH). The study focuses on identifying bonding mechanisms, stoichiometries, and stabilities of the formed complexes, and comparing these among the three systems. Furthermore, the effects of ionic strength and composition of the ionic medium are investigated. The infrared spectroscopic data provided direct, molecular-level evidence for the existence of two dominating surface complexes on all three solids. One was shown to be a deprotonated outer-sphere species and the other was an inner-sphere surface complex. The inner-sphere complexes on the three solids were structurally related, and they were tentatively assigned to a mononuclear, chelating structure involving both carboxylate groups. The outer-sphere complexes were shown to increase in relative importance at high pH and low ionic strengths, while low pH and high ionic strengths favored the inner-sphere complexes. The information gained from the infrared spectroscopic investigations was used as qualitative input in the formulation of the surface complexation models. New models, based on the extended constant capacitance approach, were presented for the o-phthalate/aged gamma-Al2O3 and o-phthalate/goethite systems. Copyright 1998 Academic Press.
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Affiliation(s)
- P Persson
- Department of Inorganic Chemistry, Umeå University, Umeå, S-901 87, Sweden
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22
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Tybring G, Nordin J, Widén J. High-performance liquid chromatography-mass spectrometry for the quantification of nortriptyline and 10-hydroxynortriptyline in plasma. J Chromatogr B Biomed Sci Appl 1998; 716:382-6. [PMID: 9824256 DOI: 10.1016/s0378-4347(98)00299-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
A highly sensitive and selective method for the quantification of nortriptyline and its major 10-hydroxy metabolite in plasma is described. The method is based on liquid-liquid extraction in combination with acid dehydration of the 10-hydroxy metabolite to the less polar 10,11-dehydronortriptyline. Deuterium labelled internal standards ([2H4]NT and [2H3]10-OH-NT) were used and the compounds were separated by reversed-phase HPLC and detected using atmospheric pressure chemical ionisation and mass spectrometry. The limit of quantification was 0.8 ng/ml for both compounds. A 1-ml volume of plasma was used for analysis in the concentration range 0.8-32 ng/ml. The within- and between-day coefficients of variation were 11% in the low, 1.6 ng/ml range, and 7% at 8 ng ml/ml. Using this method it was possible to quantify plasma concentrations for 168 h following a single oral dose of 25 mg of nortriptyline with good accuracy and precision.
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Affiliation(s)
- G Tybring
- Department of Medical Laboratory Sciences and Technology, Huddinge University Hospital, Sweden
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23
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Dalén P, Dahl ML, Bernal Ruiz ML, Nordin J, Bertilsson L. 10-Hydroxylation of nortriptyline in white persons with 0, 1, 2, 3, and 13 functional CYP2D6 genes. Clin Pharmacol Ther 1998; 63:444-52. [PMID: 9585799 DOI: 10.1016/s0009-9236(98)90040-6] [Citation(s) in RCA: 217] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To investigate the disposition and effects of nortriptyline and its major metabolite 10-hydroxy-nortriptyline line in panels of white subjects with different CYP2D6 genotypes, including those with duplicated and multiduplicated CYP2D6*2 genes and to evaluate the contribution of the number of functional C gamma P2D6 alleles to the metabolism of nortriptyline, used here as a model drug for CYP2D6 substrates. METHODS Oral single doses of 25 to 50 mg nortriptyline were given to five poor metabolizers of debrisoquin (INN; debrisoquine) with no functional CYP2D6 gene, five extensive metabolizers with one functional CY2D6 gene, five extensive metabolizers with two functional CYP2D6 genes, five ultrarapid metabolizers with duplicated CYP2D6*2 genes, and one ultrarapid metabolizer with 13 copies of the CYP2D6*2 gene. Plasma kinetics of nortriptyline and 10-hydroxynortriptyline were analyzed. Anticholinergic effects (inhibition of salivation and accommodation disturbances), sedation, blood pressure, and effect on supine and erect pulse rate were measured. RESULTS There was a clear relation between the C gamma P2D6 genotype and the plasma kinetics of nortriptyline and 10-hydroxynortriptyline. The proportion between the apparent oral clearances of nortriptyline in the groups with 0, 1, 2, 3, and 13 functional genes was 1:1:4:5:17. The proportions between AUC(nortriptyline) to AUC(10-hydroxynortriptyline) ratios in the groups with 0, 1, 2, 3, and 13 functional genes were 36:25:10:4:1. Oral plasma clearance of nortriptyline and AUC(nortriptyline) to AUC(10-hydroxynortriptyline) ratio both correlated significantly with the debrisoquin metabolic ratio (rS = -0.89, p = 0.0001; rS = 0.92, p = 0.0001). Although ultrarapid metabolizer subjects were given double the nortriptyline dose (50 mg), inhibition of salivation was not more pronounced compared with the other genotype groups given 25 mg nortriptyline. CONCLUSION The results of this study show the quantitative importance of the CYP2D6 genotype, especially the presence of multiple functional CYP2D6 genes for the pharmacokinetics of nortriptyline and 10-hydroxynortriptyline. Genotyping of subjects with multiple copies of functional genes may be of great value for differentiating ultrarapid metabolizers from patients who do not comply with the prescription and for assuring adequate drug choice and dosage for these patients.
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Affiliation(s)
- P Dalén
- Department of Medical Laboratory Sciences and Technology, Karolinska Institute, Huddinge University Hospital, Sweden.
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Nordin J, Rolnick S, Ehlinger E, Nelson A, Arneson T, Cherney-Stafford L, Griffin J. Lead levels in high-risk and low-risk young children in the Minneapolis-St Paul metropolitan area. Pediatrics 1998; 101:72-6. [PMID: 9417154 DOI: 10.1542/peds.101.1.72] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVES To determine distribution of lead levels among children in a low-risk area; to validate a prescreening questionnaire; and to determine if universal lead screening is necessary in children in this area. DESIGN Blood lead levels and questionnaires were obtained on eligible patients. Data were analyzed using stepwise regression analysis. SETTING Community clinics and a health maintenance organization (HMO) in the Minneapolis-St Paul metropolitan area. PATIENTS A total of 9603 children at well-child visits, age 6 months to 6 years at community clinics, and 6 months to 3 years at the HMO. OUTCOME MEASURES Whole blood lead levels (WBLs) and questionnaires. RESULTS The total sample rate of WBLs at >/=10 microg/dL was 12%, at >/=15 microg/dL was 31/2%, and at >/=20 microg/dL was 1.2%. At both 10 microg/dL and 15 microg/dL, the non-HMO group was at higher risk. For both groups, risk factors included living in the central cities, and living in housing built before 1950. For the non-HMO group a history of the child eating paint chips, or the child or a sibling having previous lead poisoning were also risk factors. CONCLUSIONS Not all children need lead screening. Children living in the central cities, or with the risk factors of living in housing built before 1950 or a previous history of lead poisoning should be screened.
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Affiliation(s)
- J Nordin
- HealthPartners, Department of Pediatrics, St Paul, Minnesota 55107, USA
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25
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Tybring G, Nordin J, Bergman T, Bertilsson L. An S-mephenytoin cysteine conjugate identified in urine of extensive but not of poor metabolizers of S-mephenytoin. Pharmacogenetics 1997; 7:355-60. [PMID: 9352570 DOI: 10.1097/00008571-199710000-00003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
A conjugate of S-mephenytoin excreted in urine of extensive but not of poor metabolizers of S-mephenytoin has previously been reported. This conjugate, which is easily hydrolysed back to S-mephenytoin, has now been isolated and identified in urine from one extensive metabolizer after a single dose of 100 mg racemic mephenytoin. High performance liquid chromatography purification, followed by gas chromatographic, mass spectrometric and amino acid analyses showed that the isolated compound is a cysteine conjugate of S-mephenytoin. The significant mass spectrometric ions have been confirmed in three additional extensive metabolizers of S-mephenytoin, but were not detectable in urine from three poor metabolizer subjects. The exact structure of the conjugate is unknown, but we suggest that an S-N bond between cysteine and S-mephenytoin is formed via an oxidative radical mechanism catalyzed by CYP2C19.
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Affiliation(s)
- G Tybring
- Department of Medical Laboratory Sciences and Technology, Karolinska Institute, Huddinge University Hospital, Sweden
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26
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Nordin J, Wikström I, Bronner U, Gustafsson LL, Ericsson O. Liquid chromatography-tandem mass spectrometry applied to a study of the metabolism of pentamidine. Discussion of possibilities and problems. J Chromatogr A 1997; 777:73-9. [PMID: 9297840 DOI: 10.1016/s0021-9673(97)00159-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Tandem mass spectrometry is usually employed to achieve rapid screening or structure elucidation. We have used liquid chromatography-tandem mass spectrometry in order to detect metabolites of the antiprotozoal drug pentamidine in urine. Samples of urine from rat and man were analysed both by direct injection and after solid-phase extraction. The present paper discusses advantages and disadvantages of using direct injection of urine samples, optimization of chromatographic conditions with regard to the performance of the mass spectrometer, automation and stability of the entire system.
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Affiliation(s)
- J Nordin
- Department of Medical Laboratory Sciences and Technology, Karolinska Institute, Huddinge University Hospital, Sweden
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Abstract
BACKGROUND In August 1992 the medical director of the 19 Group Health medical clinics (now part of HealthPartners) in Minnesota chartered a continuous quality improvement (CQI) team to improve the pediatric (two-year-old) immunization rates. THE TEAM'S WORK: The team created a process flow for the current immunization process, collected data on the process, determined the causes of late or missed immunizations, collected data on children not up-to-date with immunization, analyzed the data, acted on recommendations, and obtained buy-in. The chief reasons for the child's not being up-to-date on immunizations included missed opportunities (when the child is in the clinic receiving care, perhaps for an acute illness, and could have safely received the immunization but did not), no previous visits or chart, and parents instructed to have their child return at two years. INTERVENTION Recommendations pertained to missed opportunities, record keeping, and enhanced patient and provider responsibility. For example, providers were given algorithms for catch-up of patients not on schedule or with incomplete immunizations. Another CQI team was launched to address and simplify the myriad locations in a medical record for recording information on immunizations. An automated vaccine administration record is now being piloted at two clinics. RESULTS Immunizations have increased from a mean of 53.5% before the team started to meet to a mean of 86.5% for the most recent four quarters for which data are available. CONCLUSIONS A problem is best addressed by the very people who will have to bring about the necessary changes for the desired improvements.
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Affiliation(s)
- E Carlin
- HealthPartners, Minneapolis, MN 55440-1309, USA
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Bronner U, Ericsson O, Nordin J, Wikström I, Abdi YA, Hall JE, Tidwell RR, Gustafsson LL. Metabolism is an important route of pentamidine elimination in the rat: disposition of 14C-pentamidine and identification of metabolites in urine using liquid chromatography-tandem mass spectrometry. Pharmacol Toxicol 1995; 77:114-20. [PMID: 8584501 DOI: 10.1111/j.1600-0773.1995.tb00999.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
This study assesses the contribution of metabolism for the disposition of pentamidine in the rat. With the use of 14C-labelled compound, the excretion of radioactivity in urine and faeces has been studied in four rats during 44 days after a single intravenous injection of the drug. The urinary and faecal excretion of the radioactivity were of equal importance; 22 +/- 2% (mean +/- S.D.) and 25 +/- 4% being detected in urine and faeces, respectively. The activity in organs and tissues at 44 days after drug administration was also measured and amounted to 21 +/- 5% of the administered dose. Using HPLC the proportion of metabolites in urine in relation to unchanged pentamidine increased with time after dose, being 76 +/- 15% (mean +/- S.D.) of the total excreted radioactivity on day 1 and 97 +/- 1% on day 6. HPLC--tandem mass spectometry was used for identification of metabolites in urine obtained from four rats given unlabelled pentamidine. Using synthetic reference compounds and the selective MS/MS mode four oxidized metabolites of pentamidine were identified either by direct injection into the system or by analyses of extracted urine. Thus, a substantial part of pentamidine is excreted as metabolites in urine.
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Affiliation(s)
- U Bronner
- Unit of Tropical Pharmacology, Karolinska Institute, Huddinge University Hospital, Sweden
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Nordin J. Varicella vaccine recommendations. Minn Med 1995; 78:21-3. [PMID: 7666839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- J Nordin
- Department of Pediatrics, University of Minnesota Medical School, USA
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Nordin J. A Minnesota perspective on childhood lead poisoning. Minn Med 1992; 75:20-3. [PMID: 1435645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Maguire GC, Nordin J, Myers MG, Koontz FP, Hierholzer W, Nassif E. Infections acquired by young infants. Am J Dis Child 1981; 135:693-8. [PMID: 7270510 DOI: 10.1001/archpedi.1981.02130320007003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Infections occurring among hospitalized young infants were surveyed for 24 months. Almost 10% of the 7,339 infants received antimicrobial therapy for five or more days for suspected community-acquired infections. Infants admitted directly to the normal-newborn nursery acquired infections at a rate of 0.6 per 100, whereas infants admitted to intensive care nurseries acquired infections at a rate of 16.9 per 100 infants. Bacteremia in association with nosocomial infection occurred frequently. The pathogens associated with community-acquired and nosocomial infections are different. Species of streptococci and relatively antibiotic-susceptible Enterobacteriaceae predominate as pathogens associated with infections in previously nonhospitalized infants. Organisms acquired in the hospital tend to be more antibiotic resistant.
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Nordin J. Effective Science Advising. Science 1974; 186:393. [PMID: 17737113 DOI: 10.1126/science.186.4162.393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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