| 21. |
- Brorsson, Annika, et al.
(author)
-
My family dies from heart attacks. How hypercholesterolaemic men refer to their family history
- 1995
-
In: Family Practice. - : Oxford University Press (OUP). - 1460-2229 .- 0263-2136. ; 12:4, s. 433-437
-
Journal article (peer-reviewed)abstract
- Patients often worry considerably about biomedically mild and self-limiting conditions. A previous study on non-selected primary care patients showed that this could be partly explained by frequent associations with cases of serious illness in their family histories. This study further investigated these phenomena in middle aged men with a recent diagnosis of hypercholesterolaemia. Sixty-three out of 453, 35-45-year-old male participants were diagnosed with moderate hypercholesterolaemia (6.5-7.7 mmol/l) in a health survey and received 20-30 minutes of life-style counselling. These sessions were audio-taped, transcribed and analysed with respect to the subjects' references to their family histories. Of the 63 men, 28 (45%) mentioned their family history. The main content category in these talks was perceived threat or risk, comprising the seriousness of the event in the family history on one hand and its believed relevance on the other. Fatal, serious or premature disease was discussed. Prevailing lay knowledge and beliefs about hypercholesterolaemia, risk factors and disease causation seemed to determine what conditions in the family history were judged relevant by the men. Several of the men referred to heredity and several regarded emotional closeness important. In a few cases the event referred to mainly functioned as an illustration or example of lay knowledge and beliefs. This study provides support for the view that the family history can play an important role for how asymptomatic patients interpret their risk factors for disease. This is important for the development of consultation skills.
|
|
| 22. |
- Brorsson, Annika, et al.
(author)
-
Serious, frightening and interesting conditions: differences in values and attitudes between first-year and final-year medical students.
- 2002
-
In: Medical Education. - : Wiley. - 0308-0110. ; 36:6, s. 555-560
-
Journal article (peer-reviewed)abstract
- CONTEXT AND OBJECTIVE: During medical education and training, the values and attitudes of medical students are shaped both by knowledge and by role models. In this study, the aim was to compare the views of first- and final-year students concerning patients with different medical conditions. PARTICIPANTS AND METHOD: In the spring of 1998 all first- and final-year medical students at Göteborg and Lund Universities, Sweden, were invited to answer a questionnaire. A total of 20 medical conditions were to be rated on visual analogue scales, according to three aspects: their perceived seriousness, the student's own fear of them and interest in working with these conditions in the future. RESULTS: The overall response rate was 75%. Concerning seriousness, there was a high degree of concordance between the first- and final-year students. Concerning their own fear, the concordance was less pronounced. When the conditions were rated from the aspect of interest, for the final-year students, gastric or duodenal ulcer replaced infection with Ebola virus for the first-year students, among the five highest-ranked conditions. The correlations between seriousness and fear were lower among the final-year students, but this reached statistical significance only in a few cases. DISCUSSION: A reasonable interpretation of the results is that the values and attitudes of the students were influenced by increased knowledge, as well as by role models encountered during the clinical parts of the training. Conditions less likely to be contracted become less feared, and conditions with effective treatment become more interesting; and the converse was true for each of these changes.
|
|
| 23. |
- Buschard, Karsten, et al.
(author)
-
Low serum concentration of sulfatide and presence of sulfated lactosylceramid are associated with Type 2 diabetes. The Skaraborg Project
- 2005
-
In: Diabetic Medicine. - : Wiley. - 0742-3071 .- 1464-5491. ; 22:9, s. 1190-8
-
Journal article (peer-reviewed)abstract
- AIMS: The glycosphingolipid sulfatide (sulfated galactosyl-ceramide) increases exocytosis of beta-cell secretory granules, activates K(ATP)-channels and is thereby able to influence insulin secretion through its presence in the islets. A closely related compound, sulfated lactosylceramide (sulf-lac-cer), is present in the islets during fetal and neonatal life when, as in Type 2 diabetes, insulin is secreted autonomically without the usual first phase response to glucose. The aim was to examine whether serum concentrations of these glycolipids are associated with Type 2 diabetes. METHODS: A case-control study, comprising 286 women and 283 men, was designed using a population-based sample of patients with Type 2 diabetes and a population survey. RESULTS: Low serum concentrations of sulfatide were associated with Type 2 diabetes, independent of traditional risk factors for diabetes in a sex-specific analysis: odds ratio (OR) 2.1 (95% confidence interval 1.1, 3.9) in men, and 2.3 (1.2, 4.3) in women, comparing the lowest and the highest tertiles. Type 2 diabetes was also associated with detectable amounts of sulf-lac-cer in serum: OR 1.7 (0.9, 3.4) in men, and 7.6 (3.8, 15.2) in women. After adjustment for confounding from other diabetes risk factors, these associations remained basically unchanged. The connections between sulfatide and Type 2 diabetes, and sulf-lac-cer and Type 2 diabetes were independent of each other. Insulin resistance (HOMA-IR) was negatively correlated with sulfatide concentration and positively correlated with sulf-lac-cer (both P < 0.0001, independently). CONCLUSIONS: We report a new, robust and highly significant independent association between Type 2 diabetes and serum concentrations of sulfatide in both sexes, and sulf-lac-cer in females. The associations were also independent of other known diabetes risk factors.
|
|
| 24. |
- Buschard, Karsten, et al.
(author)
-
Sulfatide and Longevity
- 2022
-
In: The journals of gerontology. Series A, Biological sciences and medical sciences. - : Oxford University Press (OUP). - 1758-535X. ; 77:9, s. 1715-1716
-
Journal article (peer-reviewed)
|
|
| 25. |
|
|
| 26. |
- Bøg-Hansen, Erik, et al.
(author)
-
Impaired glucose metabolism and obesity in Swedish patients with borderline isolated systolic hypertension: Skaraborg Hypertension and Diabetes Project
- 2001
-
In: Diabetes, Obesity and Metabolism. - : Wiley. - 1462-8902. ; 3:1, s. 25-31
-
Journal article (peer-reviewed)abstract
- AIM: To assess the prevalence of borderline isolated systolic hypertension (borderline ISH), and to examine its association with other cardiovascular risk factors. METHODS: A cross-sectional community-based study was carried out in 1993-1994 in Skara, Sweden, including 1109 randomly chosen subjects > or = 40 years old. Normotension (NT) was defined as systolic blood pressure (SBP) < 140 and diastolic blood pressure (DBP) < 90 mmHg, borderline ISH as SBP 140-159 and DBP < 90 mmHg and hypertension (HT) as SBP > or = 160 or DBP > or = 90 mmHg or ongoing treatment. RESULTS: The prevalence of borderline ISH (n = 203) by age was 4% in ages 40-49 years, 15% in ages 50-59 years, 28% in ages 60-69 years and 25% in ages 70-79 years. With borderline ISH as reference, normotensive subjects less often had fasting blood glucose > 5.5 mmol/l (odds ratio (OR): 0.4, 95% CI: 0.26-0.75), BMI > 27 kg/m2 (OR: 0.6, 95% confidence intervals (CI): 0.42-0.85) and known diabetes (OR: 0.4, 95% CI: 0.16-0.95). Hypertensive subjects more often had high density lipoprotein (HDL) cholesterol < 1.0 mmol/l (OR: 2.0, 95% CI: 1.35-2.99), a history of previous cardiovascular disease (CVD) (OR: 1.7, 95% CI: 1.01-2.72), known diabetes (OR: 2.4, 95% CI: 1.29-4.58) and microalbuminuria (men) (OR: 1.9, 95% CI: 1.15-3.11). CONCLUSION: Borderline ISH is a common condition. It is associated with a more unfavourable risk factor profile than that of normotensive subjects concerning primarily glucose metabolism and obesity. The prevalence of known diabetes increased with the degree of hypertension.
|
|
| 27. |
- Bøg-Hansen, Erik, et al.
(author)
-
Metabolic disorders associated with uncontrolled hypertension.
- 2003
-
In: Diabetes, Obesity and Metabolism. - : Wiley. - 1462-8902. ; 5:6, s. 379-387
-
Journal article (peer-reviewed)abstract
- Aim: To examine the prevalence and characteristics of uncontrolled hypertension (HT). Methods: A cross-sectional community-based study (1992-93) was carried out in Skara, Sweden, including 894 patients who consecutively underwent an annual follow-up at the hypertension outpatient clinic in primary care. Controlled HT was defined as diastolic blood pressure (DBP) <=90 mmHg and systolic blood pressure (SBP) <=160 mmHg and was used as reference. Uncontrolled DBP was defined as DBP >90 mmHg regardless of SBP level, and isolated uncontrolled SBP was defined as SBP >160 mmHg and DBP <=90 mmHg. Proportions were age-standardized using the Skara population as reference. Results: The prevalence of uncontrolled HT was 43% (isolated uncontrolled SBP 18% and uncontrolled DBP 25%). Both men and women with isolated uncontrolled SBP were older (73 years, CI: 70-75; and 73 years; CI: 72-75) than patients with controlled HT (64 years, CI: 63-66; and 65 years, CI: 64-66). Men and women with known cardiovascular disease (CVD) less often had isolated uncontrolled SBP (OR: 0.4, CI: 0.2-0.9; and OR: 0.5, CI: 0.3-0.9), whereas men and women with known diabetes more often had uncontrolled DBP (OR: 2.3, CI: 1.3-4.1; and OR: 3.3, CI: 1.9-5.7). Men with known CVD less often had uncontrolled DBP (OR: 0.5, CI: 0.3-1.0, p = 0.04), and men with fasting blood glucose >5.5 mmol/l more often had isolated uncontrolled SBP (OR: 1.9, CI: 1.0-3.5, p = 0.04). In women, the following high risk factor levels were associated with uncontrolled DBP: fasting blood glucose >5.5 mmol/l (OR: 1.4, CI: 1.1-1.8), fasting triglycerides >=1.7 mmol/l (OR: 1.4, CI: 1.1-1.8), body mass index (BMI) >30 kg/m2 (OR: 1.5, CI: 1.1-1.9), waist/hip ratio (WHR) >0.85 cm/cm (OR: 1.7, CI: 1.3-2.2), insulin resistance (homeostasis model assessment (HOMA) >third quartile) (OR: 1.4, CI: 1.1-1.9) and microalbuminuria (OR: 3.2, CI: 1.7-6.2). Conclusion: Uncontrolled DBP is in both sexes related to type 2 diabetes, whereas isolated uncontrolled SBP is related to older age. In women, uncontrolled DBP, furthermore, is related to several other CVD risk factors of the metabolic syndrome. Patients with uncontrolled DBP should be carefully evaluated for metabolic disorders.
|
|
| 28. |
- Bøg-Hansen, Erik, et al.
(author)
-
Predictors of acute myocardial infarction mortality in hypertensive patients treated in primary care.
- 2007
-
In: Scandinavian Journal of Primary Health Care. - : Informa UK Limited. - 0281-3432 .- 1502-7724. ; 25:4, s. 237-243
-
Journal article (peer-reviewed)abstract
- Objective. To explore risk factors for acute myocardial infarction (AMI) mortality in hypertensive patients treated in primary care. Design. Community-based cohort study. Setting. Hypertension outpatient clinic in primary health care. Subjects. Patients who consecutively underwent an annual follow-up during 1992-1993 (n =894; 377 men and 517 women). Methods. All events of fatal AMI were ascertained by record linkage to the National Mortality Register to December 31, 2002. Gender-specific predictors for AMI mortality were analysed by Cox regression. Main outcome measure. AMI mortality. Results. During a mean follow-up of 8.7 years 32 cases (8.5%) of fatal AMI were observed in men and 31 cases (6.0%) were observed in women. Most important predictors for AMI mortality in men were microalbuminuria (HR 3.8, CI 1.8-8.0) and left ventricular hypertrophy (HR 4.0, CI 1.7-9.4), whilst in women type 2 diabetes (HR 4.8, CI 2.4-9.8) was an important predictor. In hypertensive patients without diabetes male gender was associated with high AMI mortality (HR 2.7, CI 1.4-5.3), but in patients with both hypertension and type 2 diabetes the higher risk in men disappeared (HR 0.8, CI 0.4-1.7). Conclusion. Cardiovascular disease risk factors remain strong predictors of AMI mortality in hypertensive patients but with a different pattern in the two genders. Markers of organ damage are more important predictors in men, whereas markers of impaired glucose metabolism are more important predictors in women.
|
|
| 29. |
- Bøg-Hansen, Erik, et al.
(author)
-
Risk factor clustering in patients with hypertension and non-insulin-dependent diabetes mellitus. The Skaraborg Hypertension Project
- 1998
-
In: Journal of Internal Medicine. - 1365-2796. ; 243:3, s. 223-232
-
Journal article (peer-reviewed)abstract
- OBJECTIVES: To assess the coexistence of hypertension and diabetes, associations with cardiovascular risk factors and the achievement of current treatment goals. DESIGN: A community-based, cross-sectional, observational study. SETTING: Hypertension and diabetes outpatient clinics in primary health care, Skara, Sweden. SUBJECTS: All patients (n = 1116; 488 men, 628 women) who performed an annual follow-up from May 1992 to September 1993. MAIN OUTCOME MEASURES: Hypertension, non-insulin-dependent diabetes mellitus (NIDDM), blood pressure, fasting B-glucose, lipids, HbAlc, body mass index (BMI), waist hip ratio (WHR). RESULTS: Hypertension alone was found in 286 men and 430 women, hypertension and NIDDM combined in 102 men and 102 women, and NIDDM alone in 100 men and 96 women. Taking new cases into account, the proportion of hypertension among NIDDM patients was 57%, and the proportion of NIDDM among hypertensives was 26%. Men and women with both hypertension and NIDDM had a higher systolic blood pressure and women also had a higher diastolic blood pressure (men 168/88 mmHg, women 165/86 mmHg) than those with hypertension alone (men 152/87 mmHg, women 156/82 mmHg) (P < or = 0.001). Cardiovascular risk factors accumulated in patients with both hypertension and NIDDM (triglycerides, BMI and WHR). A diastolic blood pressure < or = 90 mmHg was achieved by 71% men and 84% women with hypertension. HbAlc < 7.5% was attained by 71% men and 70% women with NIDDM. CONCLUSIONS: A considerable coexistence of hypertension and NIDDM was demonstrated. Cardiovascular risk factors clustered in patients with both diseases and their blood pressure was less controlled. These patients thus comprised a clinically defined group at high risk. By current guidelines, control of hypertension and NIDDM seemed appropriate.
|
|
| 30. |
|
|
