| 1. |
- Grut, Viktor, et al.
(författare)
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Cytomegalovirus seropositivity is associated with reduced risk of multiple sclerosis : a presymptomatic case-control study
- 2021
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Ingår i: European Journal of Neurology. - : Blackwell Publishing. - 1351-5101 .- 1468-1331. ; 28:9, s. 3072-3079
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Epstein-Barr virus (EBV) and Human herpesvirus 6A (HHV-6A) are associated with increased risk of multiple sclerosis (MS). Conversely, infection with Cytomegalovirus (CMV) has been suggested to reduce the risk of MS but supporting data from presymptomatic studies are lacking. Here, we sought to increase the understanding of CMV in MS aetiology.METHODS: We performed a nested case-control study with presymptomatically collected blood samples identified through cross-linkage of MS registries and Swedish biobanks. Serological antibody response against CMV, EBV and HHV-6A was determined using a bead-based multiplex assay. Odds ratio (OR) with 95 % confidence intervals (CI) for CMV seropositivity as risk factor for MS was calculated by conditional logistic regression and adjusted for EBV and HHV-6A seropositivity. Potential interactions on the additive scale were analysed by calculating attributable proportion due to interaction (AP).RESULTS: Serum samples from 670 pairs of matched cases and controls were included. CMV seropositivity was associated with a reduced risk for MS (OR = 0.70, 95% CI 0.56-0.88, p = 0.003). Statistical interactions on the additive scale were observed between seronegativity for CMV and seropositivity against HHV-6A (AP 0.34, 95% CI 0.06-0.61) and EBV antigen EBNA-1 (amino acid 385-420) at age 20-39 years (AP 0.37, 95% CI 0.09-0.65).CONCLUSIONS: CMV seropositivity is associated with a decreased risk for MS. The protective role for CMV infection in MS aetiology is further supported by the interactions between CMV seronegativity and EBV and HHV-6A seropositivity.
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| 2. |
- Bjerkeli, Pernilla J., et al.
(författare)
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Refill Adherence in Relation to Substitution and the Use of Multiple Medications: A Nationwide Population Based Study on New ACE-Inhibitor Users
- 2016
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Ingår i: Plos One. - : Public Library of Science (PLoS). - 1932-6203. ; 11:5
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Tidskriftsartikel (refereegranskat)abstract
- Objective Generic substitution has contributed to economic savings but switching products may affect patient adherence, particularly among those using multiple medications. The aim was to analyse if use of multiple medications influenced the association between switching products and refill adherence to angiotensin-converting-enzyme (ACE) inhibitors in Sweden. New users of ACE-inhibitors, starting between 1 July 2006 and 30 June 2007, were identified in the Swedish Prescribed Drug Register. Refill adherence was assessed using the continuous measure of medication acquisition (CMA) and analysed with linear regression and analysis of covariance. The study population included 42735 individuals whereof 51.2% were exposed to switching ACE-inhibitor and 39.6% used multiple medications. Refill adherence was higher among those exposed to switching products than those not, but did not vary depending on the use of multiple medications or among those not. Refill adherence varied with age, educational level, household income, country of birth, previous hospitalisation and previous cardiovascular diagnosis. The results indicate a positive association between refill adherence and switching products, mainly due to generic substitution, among new users of ACE-inhibitors in Sweden. This association was independent of use of multiple medications.
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| 3. |
- Jonsson, Pernilla, 1978, et al.
(författare)
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Holding on to the indispensable medication –A grounded theory on medication use from the perspective of persons with medication overuse headache
- 2013
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Ingår i: Journal of Headache and Pain. - : Springer Science and Business Media LLC. - 1129-2369 .- 1129-2377. ; 14:43, s. 1-11
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Tidskriftsartikel (refereegranskat)abstract
- Background: Medication overuse headache (MOH) is a chronic headache disorder, caused by overuse of acute medication. To date, it remains unclear why some people overuse these medications. The aim of this qualitative study was to explore how individuals with MOH use medications and other strategies to manage headaches in their daily lives, and their thoughts about their own use of acute medication. Our intention was to develop a theoretical model about the development of MOH, from the perspective of those with MOH. Methods: Data collection and analysis were conducted according to grounded theory methodology. The participants were recruited via newspaper advertisements. Fourteen persons with MOH were interviewed in individual qualitative interviews. Results: The basic process leading to medication overuse was holding on to the indispensable medication. The acute medication was indispensable to the participants because they perceived it as the only thing that could prevent headaches from ruining their lives. The participants perceived headaches as something that threatened to ruin their lives. As a result, they went to great lengths trying to find ways to manage it. They tried numerous strategies. However, the only strategy actually perceived as effective was the use of acute medication and they eventually became resigned to the idea that it was the only effective aid. The acute medication thus became indispensable. Their general intention was to use as little medication as possible but they found themselves compelled to medicate frequently to cope with their headaches. They did not like to think about their medication use and sometimes avoided keeping track of the amount used. Conclusions: This qualitative study adds understanding to the process via which MOH develops from the perspective of those having MOH. Such knowledge may help bridge the gap between the perspectives of patients and health-care professionals.
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| 4. |
- Hedenrud, Tove, 1967, et al.
(författare)
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Medication Overuse Headache: Self-Perceived and Actual Knowledge Among Pharmacy Staff
- 2014
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Ingår i: Headache. - : Wiley. - 0017-8748 .- 1526-4610. ; 54:6, s. 1019-1025
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Tidskriftsartikel (refereegranskat)abstract
- Objective The aim of this study was to investigate knowledge about medication overuse headache (MOH) among pharmacy staff. Background MOH is a public health problem both in Sweden and in many other countries. Persons with MOH have limited contact with health care, and medications used are to large extent over-the-counter (OTC) medications. Therefore, pharmacists have an important role in, eg, advising these individuals about their medication use. Little is, however, known about the actual level of knowledge about MOH among pharmacy staff, which determines the quality of their advice to MOH sufferers. Methods A total of 326 questionnaires were distributed to 44 pharmacies in Gothenburg, Sweden. The questionnaire included background questions, questions about advice on headache treatment, source of knowledge about MOH, and questions on self-perceived and actual knowledge on MOH. Results The response rate was 70%. A majority of the pharmacy staff (90.6%) considered themselves to have knowledge about MOH to some or a greater extent. Almost half had learned about MOH through their university/vocational education. Only 8.6% knew that all 5 headache medications listed in the questionnaire can cause development of MOH, but 40% responded correctly on which treatment advice one can give a person with MOH. Actual knowledge on treatment advice differed significantly between groups of self-perceived knowledge. Conclusion The knowledge on MOH is insufficient among pharmacy staff, but with the proper knowledge, pharmacy staff is well positioned to effect both primary and secondary prevention of MOH. We suggest not only increasing educational efforts about MOH within pharmacy programs but also continuing education at the pharmacies for all staff. Further, it is also important to increase knowledge among pharmacy customers.
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| 5. |
- Jonsson, Pernilla, 1978, et al.
(författare)
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Sociodemographic differences in medication use, health-care contacts and sickness absence among individuals with medication-overuse headache
- 2012
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Ingår i: Journal of Headache and Pain. - : Springer Science and Business Media LLC. - 1129-2369 .- 1129-2377. ; 13:4, s. 281-290
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Tidskriftsartikel (refereegranskat)abstract
- The objective of this study was to analyse sociodemographic differences in medication use, health-care contacts and sickness absence among individuals with medication-overuse headache (MOH). A cross-sectional, population survey was conducted, in which 44,300 Swedes (a parts per thousand yen15 years old) were interviewed over telephone. In total, 799 individuals had MOH. Of these, 47 % ( = 370) only used over-the-counter medications. During the last year, 46 % ( = 343) had made a headache-related visit to their physician and 14 % ( = 102) had visited a neurologist. Among individuals aged < 30 years, the number of days/month with headache was greater than the number of days with medication use, whereas the opposite was true for those a parts per thousand yen30 years. Both the proportion using prophylactic medication and the proportion having consulted a neurologist were smaller among those who only had elementary school education than among those with higher education ( = 0.021 and = 0.046). Those with a lower level of education also had a higher number of days/month with headache and with medication use than those with a higher educational level ( = 0.011 and = 0.018). The MOH-sufferers have limited contacts with health-care and preventive measures thus need to include other actors as well. Particular efforts should be directed towards those with low educational levels, and more research on medication use in relation to age is required.
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| 6. |
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| 7. |
- Ayres-de-Campos, Diogo, et al.
(författare)
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European Association of Perinatal Medicine (EAPM), European Board and College of Obstetricians and Gynaecologists (EBCOG), European Midwives Association (EMA). Joint position statement : Substandard and disrespectful care in labour - because words matter
- 2024
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Ingår i: European Journal of Obstetrics, Gynecology, and Reproductive Biology. - : Elsevier. - 0301-2115 .- 1872-7654. ; 296, s. 205-207
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Tidskriftsartikel (refereegranskat)abstract
- Substandard or disrespectful care during labour should be of serious concern for healthcare professionals, as it can affect one of the most important events in a woman's life. Substandard care refers to the use of interventions that are not considered best -practice, to the inadequate execution of interventions, to situations where bestpractice interventions are withheld from patients, or there is lack of adequate informed consent. Disrespectful care refers to forms of verbal and non-verbal communication that affect patients' dignity, individuality, privacy, intimacy, or personal beliefs. There are many possible underlying causes for substandard and disrespectful care in labour, including difficulties in modifying behaviours, judgmental or paternalistic attitudes, personal interests and individualism, and a human tendency to make less arduous, less difficult, or less stressful clinical decisions. The term "obstetric violence" is used in some parts of the world to describe various forms of substandard and disrespectful care in labour, but suggests that it is mainly carried out by obstetricians and is a serious form of aggression, carried out with the intent to cause harm. We believe that this term should not be used, as it does not help to identify the underlying problem, its causes, or its correction. In addition, it is generally seen by obstetricians and other healthcare professionals as an unjust and offensive term, generating a defensive and less collaborative mindset. We reach out to all individuals and institutions sharing the common goal of improving women's experience during labour, to work together to address the underlying causes of substandard and disrespectful care, and to develop common strategies to deal with this problem, based on mutual comprehension, trust and respect
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| 8. |
- Jonsson, Pernilla, 1978, et al.
(författare)
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Epidemiology of medication overuse headache in the general Swedish population
- 2011
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Ingår i: Cephalalgia. - : SAGE Publications. - 0333-1024 .- 1468-2982. ; 31:9, s. 1015-1022
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Tidskriftsartikel (refereegranskat)abstract
- Aims: The aim was to estimate the prevalence of medication overuse headache (MOH) in Sweden and to analyze the occurrence of this disorder in different population groups. Methods: A total of 44,300 randomly selected individuals (55% women), aged 15 years and above, were interviewed in a national telephone survey, using a standardized questionnaire including the International Headache Society criteria for MOH and questions about sociodemographic factors, headache history and medication use. Results: In Sweden, 3.2% (95% confidence interval (CI) 3.1–3.4), n¼1428) suffer from chronic daily headache (CDH) and out of those, 56% (n¼799) have MOH. The prevalence of MOH is 1.8% (95% CI 1.7–1.9). The mean age of onset was higher among men than women as well as among those with tension-type headache as primary headache compared to those who originally had migraine. A multivariate analysis showed that socioeconomic factors such as having a low level of education and/or a low household income were associated with MOH. Conclusions: This is the first Swedish population-based study of MOH and we conclude that MOH is a significant public health problem in Sweden, as it is in other parts of the world.
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| 9. |
- Linde, Mattias, 1966, et al.
(författare)
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Adherence to migraine prophylaxis at a Swedish tertiary clinic. A cross-sectional study of influence of disease features
- 2007
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Ingår i: The 13th Congress of the International Headache Society, Stockholm, juni 2007.
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Konferensbidrag (refereegranskat)abstract
- Introduction The efficacy of mainly the more recently developed prophylactic treatments of migraine have been well established in a large number of randomised controlled trials. However, such trials tend to focus on the effects of the drug in an ideal setting and rather underestimate the impact of non-compliance, which generally escapes detection by the physician. This poorly understood phenomenon was further looked at in a naturalistic setting. Methods A consecutive sample of 175 migraineurs (85% women, mean age 4512, range 19-79 years) with a current prescription of pharmacological prophylaxis were studied at a Swedish headache specialist clinic. Adherence was self-reported with the Medication Adherence Report Scale (MARS, possible range of scores 5-25). Logistic regression analysis was performed to analyze the association between MARS and frequency of attacks, number of days with migraine per month, attack duration, presence of prodrome (68%), presence of aura (41%, some or all attacks), mean intensity of pain, and recovery between attacks. Results The mean frequency of migraine was 6.5 days / month, and 68% did not recover completely interictally. The mean MARS score was 22.52.8. One third (35%) was not highly adherent. Neither demographic characteristics, nor any of the studied disease specific variables were significantly associated with adherence. Discussion The full benefit of prophylactic migraine medication cannot be realised at currently achieved levels of adherence. Characteristics of the headaches per se are the starting point of patients’ decision-making. However, the present study indicates that other factors play a more important role in this complicated process.
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| 10. |
- Jonsson, Pernilla, 1978
(författare)
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Problematic medication use in headache - Epidemiology and qualitative aspects of medication overuse headache and non-adherence to prophylactic migraine treatment
- 2012
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Aim: The aim was to analyze problematic medication use among persons with headache, focusing on overuse of acute medications, with subsequent medication overuse headache (MOH), and on underuse of prophylactic medication. Methods: Data in Studies I and II came from a population survey in which 44 300 Swedes were interviewed by telephone about headache and medication use. In Study III, a questionnaire concerning adherence and beliefs about medicines was distributed to 174 consecutive migraine patients at a headache clinic. Study IV was a qualitative study, using grounded theory, in which 14 individual interviews were conducted with persons who fulfilled the diagnostic criteria for MOH. Results: The prevalence of MOH in Sweden was 1.8% (95% C.I. 1.7–1.9). It was 2.8 times more common among women than among men and inversely associated with socioeconomic status. Fewer than half of those with MOH had made a headache-related visit to a physician during the previous year, and almost half used only over-the-counter (OTC) medications to treat their headaches. The proportion only using OTC medications was particularly high among the young. There were several differences indicating that the use of medications and the rate of health care contacts were unequal in relation to educational level. As for use of prophylactic medications, approximately one third of the migraineurs were considered non-adherent. The participants in the qualitative study perceived headaches as something that threatened to ruin their lives, and despite extensive efforts, they were unable to find any effective aid other than the acute medication. Because of this, the acute medication became indispensable to them. Conclusion: Both overuse of acute medication and underuse of prophylactic medication are significant problems among persons with headache. Since both problems may lead to increased headaches, it is likely that many persons with headache carry an unnecessarily high disease burden.
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