| 41. |
- Lökk, Johan, et al.
(författare)
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Shifts in B12 opinions in primary health care of Sweden.
- 2001
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Ingår i: Scandinavian Journal of Public Health. - 1403-4948 .- 1651-1905. ; 29:2, s. 122-128
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Tidskriftsartikel (refereegranskat)abstract
- AIMS: The diagnosis and management of vitamin B12 deficiency varies between countries and within countries. The aim of the study was to map current attitudes and values behind clinical decision-making in Swedish primary health care, which has a unique B12 tradition: two patients out of three are treated with oral high-dose cyanocobalamin. Most patients with B12-associated problems are managed in primary health care by general practitioners (GPs). METHODS: The study was designed to elucidate possible opinion shifts among GPs during the period 1996-1998. GPs (n=499), stratified and randomized, received a questionnaire with 24 statements on B12-associated clinical and laboratory problems, to be evaluated by a visuo-analogue scale. RESULTS: The majority of GPs in primary health care in Sweden accepted homocysteine and methylmalonic acid (MMA) as markers for functional deficiency of vitamin B12. The evaluation of classical markers of B12 deficiency was wary and balanced. There was a consensus of the need for B12 therapy to risk groups such as patients with atrophic gastritis or previous gastric surgery. The answers also appeared to reflect an improvement of professional knowledge and competence concerning B12-associated problems among Swedish GPs between 1996 and 1998. CONCLUSIONS: The overriding conclusion was that B12-associated opinions of Swedish GPs were stable within the period studied, with marginal improvements of knowledge and competence.
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| 42. |
- Lökk, Johan, et al.
(författare)
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Vitamin B12 in primary health care and geriatrics - attitudes, knowledge, competence.
- 2001
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Ingår i: International Journal of Geriatric Psychiatry. - : Wiley. - 0885-6230 .- 1099-1166. ; 16:10, s. 987-992
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: The objective of the study was to test attitudes, knowledge and competence of Swedish general practitioners and geriatricians concerning B12-associated problems in 1998. METHODS: Postal questionnaires were sent to a random sample of 485 GPs and a total sample of 613 geriatricians. The response rates were 70% in the GP group and 69% in the geriatrician group. The questionnaire contained 24 statements to be evaluated by a visuo-analogue scale. RESULTS: There were small numerical differences between the two physician groups. The geriatricians were more aware of risk groups for B12 deficiency. GPs were less categorical concerning low hit rate in the laboratory testing of clinical conclusions. There were statistical differences in both directions for statements on pitfalls in laboratory diagnostics. GPs were somewhat less prone to give risk groups prophylactic B12 therapy. CONCLUSIONS: GPs and geriatricians appeared to be familiar with the current debate on B12-associated problems, suggesting that health care quality will be unaffected by patient transfer from hospital care to primary health care. Copyright 2001 John Wiley & Sons, Ltd.
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| 43. |
- Made, Curt, 1941-
(författare)
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Alpine ski sport injuries in Swedish Lapland
- 2009
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Downhill skiing is associated with recreation, youth, speed, aerials and crowded courses which carry increased risk of injuries. The aim of this study was to evaluate downhill sport injuries in a Swedish ski resort. Material and methodsIn a case-control study ongoing 1989/90–2006/07, 3,696 injured skiers were registered. After informed consent the injured were assessed by a physician and asked to answer a questionnaire concerning skier, skiing and injury. ResultsAfter three years 481 injured skiers (41% females, mean age 23) were assessed. The injury rate was 1.13/1,000 skier days. Knee injury was most common (28%), followed by head/neck (13%) and lower leg (11%). Fractures were less common (23%) than sprains (44%). Among skiers below the age of 20, fractures outnumbered sprains. Helmet usage was high among children (<10 years; 83%), but very rare in adults. The injured skiers rarely tested positive for alcohol (1.1%, uninjured 5.0%) and no effect on skiing or injury rates were registered.A one-year follow-up about the ski injury outcome shows that the mean sick leave was 40 days and that 29% still had symptoms.94 injured telemark skiers were assessed over 11 years (females 36%, mean age 28). The ankle was the most common injury location (28%), followed by knee injury (19%) and injuries of head/neck (17%). Beginners suffered most ankle injuries (37%). The use of high-shafted boots increased (24% to 67%), while injuries to the ankle/foot diminished from 35% to 22%.568 snowboard injured were studied over 10 years (females 34%, mean age 19). Snowboard riding increased strongly during the period (<5% to 26%). The injury rate was 3/1,000 skier days. Injuries were mostly located in the upper extremities (54%). Head/neck accounted for 17%. Wrist fracture was the most common diagnosis (20%). Beginners had a higher incidence of lower arm/wrist injuries while advanced riders had more head/neck injuries.1,833 injured alpine skiers were evaluated over 16 years (females 45%, mean age 24). The injury rate was the lowest of all downhill ski sports (1.1/1,000 skier days). The lower extremity was the most common injury location (51%), the knee being the most commonly injured body part. Knee injuries affected females (39%) more often than males (23%). Head/neck injury came second (12%). Lower leg injury was most frequent in children (<10 y; 32%). Sprains were more common (43%) than fractures (22%). Beginners took fewer risks, had more falls and were injured relatively often. Helmet usage increased (25% to 58%). Helmet users reduced their risk of head injury. The severity of injury (AIS 3–6) decreased (3,4% to 1,6%).The over all results (18 years) showed similar injury incidences to the separate studies but a few specific diagnoses, e.g. knee injuries showed variations. ConclusionThe injury rate was highest in snowboarding and lowest in alpine skiing. Knee injury, especially in females, was the most common injury, the upper extremity in snowboarding and the lower extremity in telemark skiing. Helmet usage increased rapidly. Helmets have a protective effect. Ski safety work should focus on risk groups. Lift owners need to take the responsibility for ski safety work.
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| 44. |
- McMurray, John J, et al.
(författare)
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Effect of valsartan on the incidence of diabetes and cardiovascular events
- 2010
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Ingår i: New England Journal of Medicine. - 0028-4793 .- 1533-4406. ; 362:16, s. 1477-1490
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: It is not known whether drugs that block the renin-angiotensin system reduce the risk of diabetes and cardiovascular events in patients with impaired glucose tolerance. METHODS: In this double-blind, randomized clinical trial with a 2-by-2 factorial design, we assigned 9306 patients with impaired glucose tolerance and established cardiovascular disease or cardiovascular risk factors to receive valsartan (up to 160 mg daily) or placebo (and nateglinide or placebo) in addition to lifestyle modification. We then followed the patients for a median of 5.0 years for the development of diabetes (6.5 years for vital status). We studied the effects of valsartan on the occurrence of three coprimary outcomes: the development of diabetes; an extended composite outcome of death from cardiovascular causes, nonfatal myocardial infarction, nonfatal stroke, hospitalization for heart failure, arterial revascularization, or hospitalization for unstable angina; and a core composite outcome that excluded unstable angina and revascularization. RESULTS: The cumulative incidence of diabetes was 33.1% in the valsartan group, as compared with 36.8% in the placebo group (hazard ratio in the valsartan group, 0.86; 95% confidence interval [CI], 0.80 to 0.92; P<0.001). Valsartan, as compared with placebo, did not significantly reduce the incidence of either the extended cardiovascular outcome (14.5% vs. 14.8%; hazard ratio, 0.96; 95% CI, 0.86 to 1.07; P=0.43) or the core cardiovascular outcome (8.1% vs. 8.1%; hazard ratio, 0.99; 95% CI, 0.86 to 1.14; P=0.85). CONCLUSIONS: Among patients with impaired glucose tolerance and cardiovascular disease or risk factors, the use of valsartan for 5 years, along with lifestyle modification, led to a relative reduction of 14% in the incidence of diabetes but did not reduce the rate of cardiovascular events. (ClinicalTrials.gov number, NCT00097786.)
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| 45. |
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| 46. |
- Nilsson, Mats, et al.
(författare)
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Medical intelligence in Sweden. Vitamin B12 : oral compared with parenteral?
- 2005
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Ingår i: Postgraduate medical journal. - : Oxford University Press (OUP). - 0032-5473 .- 1469-0756. ; 81:953, s. 191-193
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Sweden is the only country in which oral high dose vitamin B12 has gained widespread use in the treatment of deficiency states. OBJECTIVE: The aim of the study was to describe prescribing patterns and sales statistics of vitamin B12 tablets and injections in Sweden 1990-2000.Design, setting, and sources: Official statistics of cobalamin prescriptions and sales were used. RESULTS: The use of vitamin B12 increased in Sweden 1990-2000, mainly because of an increase in the use of oral high dose vitamin B12 therapy. The experience, in statistical terms a "total investigation", comprised 1,000,000 patient years for tablets and 750,000 patient years for injections. During 2000, 13% of residents aged 70 and over were treated with vitamin B12, two of three with the tablet preparation. Most patients in Sweden requiring vitamin B12 therapy have transferred from parenteral to oral high dose vitamin B12 since 1964, when the oral preparation was introduced. CONCLUSION: The findings suggest that many patients in other post-industrial societies may also be suitable for oral vitamin B12 treatment.
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| 47. |
- Nilsson, Mats, et al.
(författare)
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Sex differences in cobalamin (vitamin B12) opinions of Swedish physicians.
- 2002
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Ingår i: Nordic Journal of Psychiatry. - : Informa UK Limited. - 0803-9488 .- 1502-4725. ; 56:4, s. 299-303
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Tidskriftsartikel (refereegranskat)abstract
- The aim of the study was to elucidate possible sex differences in knowledge, competence and attitudes behind decision-making on cobalamin-associated problems (vitamin B(12)). The study was conducted by postal questionnaires to Swedish physicians in 1996-98. The participants were recruited by random sampling of general practitioners (1996, 1998), and a total sampling of geriatricians (1998). The overall response rate was 71%. The study group comprised 480 female physicians and 526 male physicians. The responses to 24 statements in the questionnaire were measured by means of visual analogue scales. Group differences were evaluated by medians and shapes of distributions. The female doctors appeared to value patient-related symptoms and signs more than male doctors. Conversely, male doctors relied on laboratory tests more than female doctors. As reflected by questionnaire answers, female doctors appeared to be more informed than male doctors on cobalamin-associated clinical problems. Group differences between the sexes were marginal from a numerical point of view. It is suggested that the statistical differences observed should be regarded as negligible until confirmed by further studies.
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| 48. |
- Salmen, Lennart, et al.
(författare)
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Enzymatic chip treatment for TMP - Prospects
- 2014
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Ingår i: International Mechanical Pulping Conference, IMPC 2014, part of PulPaper 2014 Conference. - : PI.
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Konferensbidrag (refereegranskat)abstract
- In order to evaluate enzyme pre-treatments of chips as means of lowering the energy demand in mechanical pulping, impregnation and refining trials were performed. Wing refining showed that property development was similar to that of reference pulps in the case of pectinase and xylanase while for chips treated with mannanase a less favourable development of the tensile index was noted. Considering the highly increased possibility for enzymatic interactions reached with greater disintegration of chips it could well be that the possibilities for enzymes to attack desired fibre wall structures may have been too few even in the case of Impressafiner treated material used here.
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| 49. |
- Sandström, Herbert, et al.
(författare)
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Angioid streaks are part of a familial syndrome of dyserythropoietic anaemia (CDA III)
- 1997
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Ingår i: British Journal of Haematology. - : Wiley. - 0007-1048 .- 1365-2141. ; 98:4, s. 845-849
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Tidskriftsartikel (refereegranskat)abstract
- Congenital dyserythropoietic anaemia type III (CDA III) is a rare disease inherited in an autosomal dominant way and characterized by mild to moderate haemolytic anaemia. Most patients are adapted to their disease and have no or few complaints. Bone marrow examination shows a characteristic picture with erythroid hyperplasia and multinucleate erythroblasts. 20% of patients in a Swedish family affected with the CDA III condition have monoclonal gammopathy or multiple myeloma. By linkage and recombination analysis in the same family, the gene linked to the CDA III condition (CDAN3) has been located to chromosome 15q22. In this paper we report the observation of visual disturbances with macular degeneration and angioid streaks in six patients with CDA III and discuss the apparent association between CDA III, angioid streaks and monoclonal gammopathy. We suggest that this triad forms a previously unreported syndrome.
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| 50. |
- Sandström, Herbert, et al.
(författare)
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Congenital dyserythropoietic anemia type III.
- 2000
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Ingår i: Haematologica. - 0390-6078 .- 1592-8721. ; 85:7, s. 753-7
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND AND OBJECTIVES: Congenital dyserythropoietic anemia type III (CDA-III) is a group of very rare disorders characterized by similar bone marrow morphology. The clinical picture is characterized by hemolytic anemia and dramatic bone marrow changes dominated by active erythropoiesis with big multinucleated erythroblasts. The aim of this review is to describe the clinical manifestations, laboratory findings, and management CDA-III.EVIDENCE AND INFORMATION SOURCES: The present review critically examines relevant articles and abstracts published in journals covered by the Science Citation Index and Medline. The authors have performed several studies on CDA-III.STATE OF ART AND PERSPECTIVES: The clinical and laboratory manifestations of CDA-III indicate that the gene responsible for it, which has been mapped to chromosome 15q22, is expressed not only in erythroblasts during mitosis but also in B-cells, and in cells of the retina. Preliminary results indicate genetic and phenotypic similarities between a Swedish and an American family, both with an autosomally dominant inherited form of CDA-III. It is possible that the genetic lesion is identical in these families, but the different phenotypes and modes of inheritance reported among some other cases of CDA-III are probably the results of other genetic lesions. At present, the function of the gene responsible for the Swedish (V sterbotten) variant of CDA-III (CDAN3) is unknown and it is an important goal to characterize and clone this gene in order to study its function.
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