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Träfflista för sökning "hsv:(MEDICIN OCH HÄLSOVETENSKAP) hsv:(Klinisk medicin) hsv:(Allmän medicin) "

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  • Magnil, Maria, 1952-, et al. (författare)
  • Course, risk factors, and prognostic factors in elderly primary care patients with mild depression: A two-year observational study
  • 2013
  • Ingår i: Scandinavian Journal of Primary Health Care. - 0281-3432 .- 1502-7724. ; 31:1, s. 20-25
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective. The aim of this study was to observe course, risk factors, and prognostic factors in a primary care cohort aged 60 with mild to moderate depression during two-year follow-up. Design. Observational study. Setting. Primary care. Subjects and method. During an 11-month period all (n 302) consecutive patients aged 60 and above attending a primary care centre in Gothenburg, Sweden were screened by a nurse for depressive symptoms with the Primary Care Evaluation of Mental Disorders, Patient Questionnaire (PRIME-MD PQ) and the Montgomery- Å sberg Depression Rating Scale, self- rated version (MADRS-S) and by a GP with a patient-centred consultation model. In the second step, the GPs diagnosed depression in screen-positives by use of the PRIME-MD Clinical Evaluation Guide (PRIME-MD CEG). All patients with mild to moderate depression were followed up for two years to assess course with several MADRS-S score assessments. Main outcome measures. Risk factors, prognostic factors, and symptoms at baseline and after two years were tested with logistic regression, using the DSM-IV and MADRS-S (cut-off 13) respectively. Course patterns were observed and described. Results. A total of 54 patients were diagnosed with depression. Follow-up revealed declining median MADRS-S scores and three course patterns: remitting, stable, and fl uctuating. History of depression, signifi cant life events, lacking leisure activities, and use of sedatives were risk factors for depression, all previously known. An important fi nding was that lacking leisure activities also increased the risk of depressive symptoms after two years (odds ratio 12, confi dence interval 1.1 – 136). Conclusion. It is desirable to identify elderly individuals with less severe depression. Three course patterns were observed; this fi nding requires further study of the clinical characteristics related to the different patterns. Awareness of risk factors may facilitate identifi cation of those at highest risk of poor prognosis.
  • Magnil, Maria, 1952-, et al. (författare)
  • Prevalence of depressive symptoms and associated factors in elderly primary care patients: a descriptive study
  • 2008
  • Ingår i: Primary Care Companion to The Journal of Clinical Psychiatry. - 1523-5998. ; 104:6, s. 462-468
  • Tidskriftsartikel (refereegranskat)abstract
    • ACKGROUND: Depressive symptoms are common in older adults. A majority will be seen in primary care. The aim was to study the prevalence of and to explore factors associated with depressive symptoms in elderly primary care patients. METHOD: In consecutive patients aged 60 years and older attending a Swedish primary care center between February and December of 2003, depressive symptoms were identified as >/= 13 points on the Montgomery-Asberg Depression Rating Scale-Self-Rated version (MADRS-S). Somatic symptoms measured according to PRIME-MD, age, socioeconomic status, gender, somatic diagnoses, and medication were analyzed in relation to presence of depressive symptoms. RESULTS: Forty-six of 302 patients (15%) rated themselves in the depressed range. There were no differences between depressed and nondepressed patients concerning socioeconomic status, other illnesses, or medication except for use of sedatives/hypnotics being more common (OR = 2.7, 95% CI = 1.3 to 5.6) in depressed patients. Patients in the group scoring >/= 13 on the MADRS-S were more likely to have become widowed during the last year (OR = 6.0, 95% CI = 1.7 to 20.8) or to have indicated significant life events (OR = 4.3, 95% CI = 2.0 to 9.0), but were less likely to report having leisure time activities (OR = 0.2, 95% CI = 0.08 to 0.41) or perception of good health (OR = 0.1, 95% CI = 0.05 to 0.3). Patients being treated for depression did not have increased depression scores (OR = 1.4, 95% CI = 0.66 to 3.1). CONCLUSION: In a group of unselected primary care elderly patients, the prevalence of depressive symptoms was high. Use of sedatives/hypnotics was remarkably common in patients with depressive symptoms. Patients with ongoing treatment of depression did not have increased depression scores, indicating the good prognosis for treated depression in the elderly.
  • Mayne, S., et al. (författare)
  • Confusion Strongly Associated with Antibiotic Prescribing Due to Suspected Urinary Tract Infections in Nursing Homes
  • 2018
  • Ingår i: Journal of the American Geriatrics Society. - 0002-8614. ; 66:2, s. 274-281
  • Tidskriftsartikel (refereegranskat)abstract
    • ObjectivesTo quantify the prevalence of documented urinary tract infection (UTI), nonspecific symptoms, and antibiotic treatment of suspected UTI in nursing homes (NHs) in the tropics and to describe the typical resident likely to receive antibiotic treatment for suspected UTI and factors associated with the development of confusion, fatigue, and restlessness. MeasurementsChartreviews of NH residents between August 28, 2015, and June 21, 2016, to determine the prevalence of documented UTI, new or worsening nonspecific and specific symptoms that are specific or nonspecific to the urinary tract, antibiotic use, medical conditions, and medication factors. ResultsUTI accounted for 33% of all current infections treated with antibiotics and 40% of all infections treated with antibiotics within the last 30days. One in 5 NH residents had received antibiotics within the last 30days, of which 45% were for UTI. The most significant factors independently associated with antibiotics for UTI were urinary catheter (OR=13, 95% CI=2.4-67, P=.003), urinary frequency (OR=10, 95% CI=2.2-47, P=.003), fever (OR=10, 95% CI=1.3-85, P=.028), new-onset hypotension (OR=10, 95% CI=1.4-73, P=.024), and confusion (OR=8.9, 95% CI=3.1-26, P<.001). Of these, confusion was the most prevalent factor in the population. ConclusionUTI is commonly documented in NH residents, with new or worsening confusion being one of the strongest factors associated with antibiotic treatment for suspected UTI.
  • Mayne, Sean., et al. (författare)
  • The scientific evidence for a potential link between confusion and urinary tract infection in the elderly is still confusing - A systematic literature review
  • 2019
  • Ingår i: BMC Geriatrics. - 1471-2318. ; 19, s. 1-15
  • Forskningsöversikt (refereegranskat)abstract
    • Context: Non-specific symptoms in elderly patients such as confusion is often suspected to be caused by a urinary tract infection (UTI) and it continues to be the most common reason for suspecting a UTI despite many other plausible causes. This leads to significant over diagnosis of UTI, increased inappropriate antibiotic use and potentially harmful outcomes through misdiagnosis. This problem is particularly prevalent in nursing homes settings. Objective: Clarify the correlation between lower UTI or bacteriuria and concurrent confusion. Setting: Any care setting for elderly (hospital, community and long term care facility). Design: A systematic literature review Main And Secondary Outcome Measures: A review of the literature was conducted assessing the association between confusion and UTI in the elderly. PubMed, Scopus and PsychInfo were searched with the following terms: confusion, delirium, altered mental status, acute confusional state, urinary tract infection, urine infection, urinary infection and bacteriuria. Inclusion criteria and methods were specified in advance and documented in the protocol, which was published with PROSPERO (registration ID CRD42015025804). Quality assessment was conducted independently by two authors. Data was extracted using a standardised extraction tool and a qualitative synthesis of evidence was made. Results: 1702 original records were identified of which 22 were included in the final analysis. Following this review, it appears that insufficient evidence is available to accurately determine if UTI and confusion are associated. Conclusion: The potential link between UTI and non-specific symptoms in elderly patients remain confusing. More epidemiological studies are unlikely to resolve this problem. The next logical step to clarify this issue should be a randomized controlled trial comparing the effect of antibiotics versus placebo using validated criteria for both UTI and confusion.
  • Peter, Borenstein, et al. (författare)
  • Cognitive symptoms, cervical range of motion and pain as prognostic factors after whiplash trauma
  • 2010
  • Ingår i: ACTA NEUROLOGICA SCANDINAVICA. - 0001-6314. ; 122:4, s. 278-285
  • Tidskriftsartikel (refereegranskat)abstract
    • Objectives - To evaluate pain, cervical range of motion (CROM) and cognitive symptoms as predictors for poor prognosis defined as sick leave 3 years later. Material and methods - In 97 patients CROM, pain intensity and cognitive symptoms were measured immediately following trauma, at 6 months and 3 years. Patients were also asked at 3 years if they had been on sick leave the last 6 months. Results - Pain intensity and reduced CROM were not clinically useful as predictors of later sick leave. The best predictors were presence within 96 h after injury of the two cognitive symptoms 'being easily distracted' (odds ratio 8.7-50) and 'easily irritated' (odds ratio 5.3-31). Conclusions - Initial pain and reduced CROM may be related to minor tissue damage which often heals while late functionality is more dependent on other factors such as cognitive dysfunction. For patients with whiplash-associated disorders two simple questions should be asked; 'Are you currently easily irritated?' and 'Are you currently easily distracted (e.g. is it difficult for you to follow a conversation if several people are talking in the room at the same time)?'. An affirmative answer to any of these questions indicates an increased risk for poor prognosis defined as sick leave 3 years later. © 2009 Blackwell Munksgaard.
  • Polster, Annikka, et al. (författare)
  • Heart rate variability characteristics of patients with irritable bowel syndrome and associations with symptoms
  • 2018
  • Ingår i: Neurogastroenterology and Motility. - 1350-1925. ; 30:7
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Disturbed brain-gut interactions are assumed to be of importance for symptom generation in patients with irritable bowel syndrome (IBS). The autonomic nervous system (ANS) is part of the bidirectional brain-gut communication, but previous studies in IBS show diverging results. We aimed to identify subgroups of IBS patients with distinct ANS characteristics differentiating them from healthy controls (HC), and to study associations between ANS status and symptoms. Methods: Heart rate variability (HRV) was measured in IBS patients and HC (Holter monitoring: supine and standing positions with controlled respiration and ambulatory 24-hour period). Frequency (5 minutes, supine, standing) and time domains (24 hours, day, night) were analyzed. Validated questionnaires were used to measure gastrointestinal and psychological symptoms in patients. Patients and HC were compared on a univariate and multivariate level (principal component analysis [PCA] and orthogonal partial least squares discriminatory analysis (OPLS-DA)). Key Results: We analyzed 158 IBS patients (Rome III) and 39 HC. Patients differed significantly from HC in HRV parameters during daytime and in standing position. In the PCA, a majority of patients overlapped with HC, but the weighted means differed (P &lt;.01). A subset of patients (n = 30; 19%) with an aberrant global HRV profile was identified through PCA and OPLS-DA; these patients reported more severe symptoms of frequent (P &lt;.05) and loose stools (P =.03), as well as urgency (P =.01). Conclusions and Inferences: Altered ANS function was demonstrated in patients with IBS, and this might be of particular relevance for symptoms in a subset of the patients.
  • Sawyer, Emily, et al. (författare)
  • Defining short and long sleep duration for future paediatric research: A systematic literature review
  • 2019
  • Ingår i: Journal of Sleep Research. - 0962-1105 .- 1365-2869. ; 28:6
  • Forskningsöversikt (refereegranskat)abstract
    • © 2019 European Sleep Research Society Short and long sleep patterns in children have been associated with a range of poor health outcomes. However, there is no consensus regarding the definitions of these abnormal sleep parameters in childhood for use in paediatric research. Given that there is a clear lack of definitions for sleep duration throughout paediatric sleep literature, this review aimed to establish recommendations for standard cut-offs of short and long sleep for children aged 1–16 years to enable homogeneity in future studies of paediatric sleep duration. Four databases were systematically searched to identify prospective studies that defined short or long sleep patterns in children. Included papers (38) were assessed for methodological quality, and their definitions were extracted to examine the current applied cut-offs in the literature for short or long sleep duration. The definitions were analysed in a regression model to summarize applied cut-offs from subjective data into cut-offs for short and long sleep duration. These models were fitted to reference values of three commonly cited paediatric population studies to establish new definitions of sleep duration for future use in research. Across the age groups there was little consensus in applied cut-offs for short and long sleep duration. This study found the best compromise for short sleep was defined as the 2.5th centile (hours = 0.25*age + 11) and long sleep as the 97.5th centile (hours = 0.017*age 2  − 0.68*age + 16) of sleep duration in children. Recommendations for the hourly cut-offs of short and long sleep duration based on these percentiles were described.
  • Stecksén, Anna, et al. (författare)
  • Thrombolytic therapy rates and stroke severity : an analysis of data from the Swedish Stroke Register (Riks-Stroke) 2007-2010
  • 2012
  • Ingår i: Stroke. - New York : American Heart Association. - 0039-2499. ; 43:2, s. 536-538
  • Tidskriftsartikel (refereegranskat)abstract
    • Background and Purpose: We tested the hypothesis that higher proportions of patients with minor stroke being treated with thrombolysis contribute to increasing overall rates of thrombolysis.Methods: We included 1743 ischemic stroke patients (age 18–80 years) treated with thrombolysis, recorded in the Swedish stroke register Riks-Stroke between 2007 and 2010. Minor stroke was defined as National Institutes of Health Stroke Scale score ≤5.Results: The proportion with minor stroke among patients treated with thrombolysis increased from 22.1% in 2007 to 28.7% in 2010 (P=0.021). The rate of increase did not differ significantly between men and women, age groups, or hospital types (university hospitals, other large hospitals, or community hospitals). Hospitals with high proportions of thrombolysis patients with minor stroke were more likely to have high thrombolysis frequencies (R=0.55; P&lt;0.001).Conclusions: In recent years, an increase in the proportion of patients with minor stroke treated with thrombolysis has contributed to rising overall thrombolysis rates in Sweden. At the hospital level, high rates of thrombolysis are associated with a high proportion of minor stroke being treated.
  • Steinke, E., et al. (författare)
  • Determinants of sexual dysfunction and interventions for patients with obstructive sleep apnoea : a systematic review
  • 2016
  • Ingår i: International journal of clinical practice (Esher). - 1368-5031. ; 70:1, s. 5-19
  • Forskningsöversikt (övrigt vetenskapligt)abstract
    • AimsObstructive sleep apnoea (OSA) may negatively affect a couple's sexual relationship. This systematic review evaluated what characteristics are determinants of sexual function and dysfunction in women and men with OSA, and what interventions are shown to be effective.MethodsA systematic literature review was conducted using PubMed, CINAHL, Cochrane and TRIP, and articles published between January 2004 and December 2014 in English; original research; adults ≥ 18 years; and both experimental and non-experimental designs. The Effective Public Health Practice Project Quality Assessment Tool for Quantitative Studies was used to assess study quality. Of 21 studies, six studies (no randomised control trials, RCTs) included women and 15 (with six RCTs) studies included men. Extracted data were scrutinised and adjusted until consensus was reached; suitable quantitative data were pooled in statistical meta-analysis.ResultsSexual function was affected similarly in both genders, but effective interventions were reported only for men. In some studies, OSA severity and medications contributed to greater sexual dysfunction. In women, menopausal status, hormone levels and SaO2 &lt; 90% were determinants of sexual dysfunction, while for men factors included BMI, hormonal status and inflammatory markers. Continuous positive airway pressure (CPAP) not only improved clinical measures such as excessive daytime sleepiness but also the erectile and orgasmic function. Nevertheless, sildenafil was superior CPAP with regard to erectile dysfunction.ConclusionsThe findings illustrate important contributors to sexual dysfunction; however, firm generalisations cannot be made. There were limited RCTs and none for women, indicating further RCTs are needed to determine how OSA affects sexual function.
  • Sundvall, Par-Daniel, et al. (författare)
  • Antimicrobial resistance in urinary pathogens among Swedish nursing home residents remains low: a cross-sectional study comparing antimicrobial resistance from 2003 to 2012
  • 2014
  • Ingår i: BMC Geriatrics. - 1471-2318. ; 14:1
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: There are several risk factors for the colonisation, infection and spreading of antibiotic resistant bacteria among elderly residents of nursing homes. An updated estimate of the native prevalence of antimicrobial resistance in uropathogens among Swedish nursing home residents is needed. Methods: Urine specimens were collected for culture and antimicrobial susceptibility testing against mecillinam, ampicillin, cefadroxil, trimethoprim, nitrofurantoin and quinolones from the residents of 32 and 22 nursing homes, respectively. The residents were capable of providing a voided urine sample in 2003 and 2012. In 2012 urine specimens were also collected from residents with urinary catheters. Any antibiotic treatment during the previous month was registered in 2003 as well as hospitalisation and any antibiotic treatment during the previous six months in 2012. Results: The proportion of positive urine cultures was 32% (207/651) in voided urine specimens in 2003, 35% (147/421) in 2012, and 46% (27/59) in urine samples from catheters in 2012. Escherichia coli (E. coli) was the most commonly occurring bacteria. Resistance rates in E. coli (voided urine specimens) in 2012 were; ampicillin 21%, trimethoprim 12%, mecillinam 7.7%, ciprofloxacin 3.4%, cefadroxil 2.6% and nitrofurantoin 0.85%. There were no significant changes in the average resistance rates in E. coli for antibiotics tested 2003-2012. In 2012, two isolates of E. coli produced extended spectrum beta-lactamase enzymes (ESBL) and one with plasmid mediated AmpC production. Any antibiotic treatment during the previous month increased the risk for resistance in E. coli, adjusted for age and gender; for mecillinam with an odds ratio (OR) of 7.1 (2.4-21; p = 0.00049), ampicillin OR 5.2 (2.4-11; p = 0.000036), nalidixic acid OR 4.6 (1.4-16; p = 0.014) and trimethoprim OR 3.9 (1.6-9.2; p = 0.0023). Hospitalisation during the previous six months increased the risk for antibiotic resistance in E. coli to ampicillin, ciprofloxacin and any antimicrobial tested, adjusted for age, gender and antibiotic treatments during the previous six months. Conclusions: The average rates of antimicrobial resistance were low and did not increase between 2003 and 2012 in E. coli urinary isolates among Swedish nursing home residents. Antibiotic treatment during the previous month and hospitalisation during the previous six months predicted higher resistance rates.
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