| 1. |
- Hultberg, Josabeth, et al.
(författare)
-
Clinical Gaze in Risk-Factor Haze : Swedish GPs' Perceptions of Prescribing Cardiovascular Preventive Drugs
- 2012
-
Ingår i: International Journal of Family Medicine. - : Hindawi Limited. - 2090-2042 .- 2090-2050. ; 2012
-
Tidskriftsartikel (refereegranskat)abstract
- Aims. To explore general practitioners' (GPs') descriptions of their thoughts and action when prescribing cardiovascular preventive drugs. Methods. Qualitative content analysis of transcribed group interviews with 14 participants from two primary health care centres in the southeast of Sweden. Results. GPs' prescribing of cardiovascular preventive drugs, from their own descriptions, involved "the patient as calculated" and "the inclination to prescribe," which were negotiated in the interaction with "the patient in front of me." In situations with high cardiovascular risk, the GPs reported a tendency to adopt a directive consultation style. In situations with low cardiovascular risk and great uncertainty about the net benefit of preventive drugs, the GPs described a preference for an informed patient choice. Conclusions. Our findings suggest that GPs mainly involve patients at low and uncertain risk of cardiovascular disease in treatment decisions, whereas patient involvement tends to decrease when GPs judge the cardiovascular risk as high. Our findings may serve as a memento for clinicians, and we suggest them to be considered in training in communication skills.
|
|
| 2. |
- Johansson, Maria, et al.
(författare)
-
Clinical Utility of Cognistat in Multiprofessional Team Evalutations of Patients with Cognitive Impairment in Swedish Primary Care
- 2014
-
Ingår i: International Journal of Family Medicine. - : Hindawi Publishing Corporation. - 2090-2042 .- 2090-2050. ; 2014, s. 649253-
-
Tidskriftsartikel (refereegranskat)abstract
- Background. Diagnostic evaluations of dementia are often performed in primary health care (PHC). Cognitive evaluation requires validated instruments.Objective. To investigate the diagnostic accuracy and clinical utility of Cognistat in a primary care population.Methods. Participants were recruited from 4 PHC centres; 52 had cognitive symptoms and 29 were presumed cognitively healthy. Participants were tested using the Mini-Mental State Examination (MMSE), the Clock Drawing Test (CDT), and Cognistat. Clinical diagnoses, based on independent neuropsychological examination and a medical consensus discussion in secondary care, were used as criteria for diagnostic accuracy analyses.Results. The sensitivity, specificity, positive predictive value, and negative predictive value were 0.85, 0.79, 0.85, and 0.79, respectively, for Cognistat; 0.59, 0.91, 0.90, and 0.61 for MMSE; 0.26, 0.88, 0.75, and 0.46 for CDT; 0.70, 0.79, 0.82, and 0.65 for MMSE and CDT combined. The area under the receiver operating characteristic curve was 0.82 for Cognistat, 0.75 for MMSE, 0.57 for CDT, and 0.74 for MMSE and CDT combined.Conclusions. The diagnostic accuracy and clinical utility of Cognistat was better than the other tests alone or combined. Cognistat is well adapted for cognitive evaluations in PHC and can help the general practitioner to decide which patients should be referred to secondary care.
|
|
| 3. |
- Wallerblad, A, et al.
(författare)
-
Care-Seeking Pattern among Persons with Depression and Anxiety: A Population-Based Study in Sweden
- 2012
-
Ingår i: International journal of family medicine. - : Hindawi Limited. - 2090-2050 .- 2090-2042. ; 2012, s. 895425-
-
Tidskriftsartikel (refereegranskat)abstract
- Background. In primary care, a vast majority of patients affected with depression and anxiety present with somatic symptoms. Detection rate of psychiatric symptoms is low, and knowledge of factors influencing care seeking in persons affected by depressive and anxiety disorders on a population level is limited. Objective. This study aims to describe if persons, affected by depression and anxiety disorders, seek care and which type of care they seek as well as factors associated with care seeking. Method. Data derives from a longitudinal population-based study of mental health conducted in the Stockholm County in 1998–2010 and the present study includes 8387 subjects. Definitions of anxiety and depressive disorders were made according to DSM-IV criteria, including research criteria, using validated diagnostic scales. 2026 persons (24%) fulfilled the criteria for any depressive or anxiety disorder. Results. Forty-seven percent of those affected by depression and/or anxiety had been seeking care for psychological symptoms within the last year. A major finding was that seeking care for psychological symptoms was associated with having treatment for somatic problems. Conclusions. As a general practitioner, it is of great importance to increase awareness of mild mental illness, especially among groups that might be less expected to be affected.
|
|
| 4. |
- Wiking, E, et al.
(författare)
-
Consultations between Immigrant Patients, Their Interpreters, and Their General Practitioners: Are They Real Meetings or Just Encounters? A Qualitative Study in Primary Health Care
- 2013
-
Ingår i: International journal of family medicine. - : Hindawi Limited. - 2090-2042 .- 2090-2050. ; 2013, s. 794937-
-
Tidskriftsartikel (refereegranskat)abstract
- Objective. In Sweden, about 19% of residents have a foreign background. Previous studies reported immigrant patients experience communication difficulties despite the presence of interpreters during consultations. The objective of this study was to gain insights into the participants’ perceptions and reflections of the triangular meeting by means of in-depth interviews with immigrant patients, interpreters, and general practitioners (GPs). Method. A total of 29 participants—10 patients, 9 interpreters, and 10 GPs—participated in face-to-face interviews. Content analysis was used to process the interview material. Results. Six themes were generated and arranged under two subject areas: the interpretation process (the means of interpreting and means of informing) and the meeting itself (individual tailored approaches, consultation time, the patient’s feelings, and the role of family members). Conclusion. This paper highlights feelings including frustration and insecurity when interpretation and relationships are suboptimal. Strategies for immigrant patients, interpreters, and GPs for getting a successful consultation may be needed. To transform the triangular meeting from an encounter to a real meeting, our results indicate a need for professional interpreters, for GPs to use a patient-tailored approach, and sufficient consultation time. Practice Implications. Use of professional interpreters is recommended, as is developing cultural competence.
|
|
| 5. |
- Ahacic, Kozma, et al.
(författare)
-
Income and education as predictors of stroke mortality after the survival of a first stroke
- 2012
-
Ingår i: Stroke Research and Treatment. - : Hindawi Publishing Corporation. - 2090-8105 .- 2042-0056.
-
Tidskriftsartikel (refereegranskat)abstract
- Background. It is well known that socioeconomic indicators, such as income and education, predict both stroke incidence and stroke mortality. This means that persons in lower socioeconomic positions are less likely to survive their stroke, and there will be a selective survival in the group discharged from hospital after their first stroke. Question. Does socioeconomic position continue to predict mortality, stroke specific, or from other causes, among patients surviving their first stroke in spite of this selective survival? Methods. All persons in Sweden aged 40–59 years who were discharged after a first hospitalization for stroke in 1996–2000 were included (n = 10,487), then followed up until the end of the fourth calendar year after discharge. Data were analysed with Cox regressions controlling for age, sex, and stroke type. Results. Persons with high socioeconomic position, measured by education and income, have lower mortality than those of low position. Education was not significant when adjusted for income, however. The risk of dying was similar for stroke-specific mortality and all-cause mortality, for those with cerebral infarction as well as for all patients. Conclusions. Socioeconomic position predicted stroke-specific mortality also in the selective group of persons who survived their first stroke.
|
|
| 6. |
- Ahlberg, Emilia, 1983, et al.
(författare)
-
Perceived changes in communication as an effect of STN surgery in Parkinson's disease: a qualitative interview study.
- 2011
-
Ingår i: Parkinson's disease. - : Hindawi Limited. - 2090-8083 .- 2042-0080.
-
Tidskriftsartikel (refereegranskat)abstract
- The aim of the present study was to explore four individuals' perspective of the way their speech and communication changed as a result of subthalamic nucleus deep brain stimulation treatment for Parkinson's disease. Interviews of two men and two women were analyzed using qualitative content analysis. Three themes emerged as a result of the analysis. The first theme included sub-themes describing both increased and unexpected communication difficulties such as a more vulnerable speech function, re-emerging stuttering and cognitive difficulties affecting communication. The second theme comprised strategies to improve communication, using different speech techniques and communicative support, as well as trying to achieve changes in medical and stimulation parameters. The third theme included descriptions of mixed feelings surrounding the surgery. Participants described the surgery as an unavoidable dramatic change, associated both with improved quality of life but also uncertainty and lack of information, particularly regarding speech and communication changes. Despite negative effects on speech, the individuals were generally very pleased with the surgical outcome. More information before surgery regarding possible side effects on speech, meeting with a previously treated patient and possibly voice and speech therapy before or after surgery are suggested to facilitate the adjustment to the new speech conditions.
|
|
| 7. |
- Andersson, Åsa, 1963-, et al.
(författare)
-
Hip fractures in persons with stroke
- 2013
-
Ingår i: Stroke Research and Treatment. - : Hindawi Publishing Corporation. - 2090-8105 .- 2042-0056. ; 2013
-
Tidskriftsartikel (refereegranskat)abstract
- Background. Our aim was to determine the incidence of hip fractures within two years after stroke, to identify associated factors, to evaluate which test instruments that best could identify people at risk, and to describe the circumstances that prevailed when they sustained their hip fractures. Method. A total of 377 persons with first-ever stroke were followed up for a 24-month period. Stroke severity, cognition, and associated medical conditions were registered. The following test instruments were used: National Institutes of Health Stroke Scale, Mini-Mental State Examination, Berg Balance Scale, Timed Up & Go, and Stops Walking When Talking. Result. Sixteen of the persons fractured their hip within the study period, which corresponds to an incidence of 32 hip fractures per 1000 person-years. Persons with fractures more often had impaired vision and cognitive impairment and more had had previous fractures. Of the investigated test instruments, Timed Up & Go was the best test to predict fractures. Conclusion. The incidence of hip fractures in persons with stroke was high in this study. Persons with previous fractures, and visual and cognitive defects are at the greatest risk. Certain test instruments could be used in order to find people at risk, which should be targeted for fall preventive measures.
|
|
| 8. |
- Carta, AR, et al.
(författare)
-
Dyskinesia in Parkinson's disease therapy
- 2012
-
Ingår i: Parkinson's disease. - : Hindawi Limited. - 2042-0080 .- 2090-8083. ; 2012, s. 639080-
-
Tidskriftsartikel (refereegranskat)
|
|
| 9. |
- Chermenina, Maria, et al.
(författare)
-
Single injection of small-molecule amyloid accelerator results in cell death of nigral dopamine neurons in mice
- 2015
-
Ingår i: Parkinson's Disease. - : Springer Science and Business Media LLC. - 2090-8083 .- 2042-0080 .- 2373-8057. ; 1
-
Tidskriftsartikel (refereegranskat)abstract
- The assembly process of a-synuclein toward amyloid fibers is linked to neurodegeneration in Parkinson´s disease. In the present study, we capitalized on the in vitro discovery of a small-molecule accelerator of a-synuclein amyloid formation and assessed its effects when injected in brains of normal mice. An accelerator and an inhibitor of a-synuclein amyloid formation, as well as vehicle only, were injected into the striatum of normal mice and follwed by behavioral evaluation, immunohistochemistry, and metabolomics up to six months later. The effects of molecules injected into the substansia nigra of normal and a-synuclein knockout mice were also analyzed. When accelerator or inhibitor was injected into the brain of normal mice no acute compound toxicity was found. However, 6 months after single striatal injection of accelerator, mice sensorimotor functions were impaired, whereas mice injected with inhibitor had no dysfunctions. Injection of accelerator (but not inhibitor or vehicle) into the substantia nigra revealed singificant loss of tyrosine hydroxylase (TH)-positive neurons after 3 months. No loss of TH-positive neurons was found in a-synuclein knock-out mice injected with accelerator intor the substantia nigra. Metabolic serum profiles from accelerator-injected normal mice matched those of newly diagnosed Parkinson´s disease patients, whereas the profiles from inhibitor-injected normal mice matched controls. Single inoculation of a small-molecule amyloid accelerator may be a new approach for studies of early events during dopamine neurodegeneration in mice.
|
|
| 10. |
- Danielsson, Anna, 1957, et al.
(författare)
-
Physical activity, ambulation, and motor impairment late after stroke.
- 2012
-
Ingår i: Stroke research and treatment. - : Hindawi Limited. - 2042-0056 .- 2090-8105. ; 2012
-
Tidskriftsartikel (refereegranskat)abstract
- Objective. To assess walking capacity and physical activity using clinical measures and to explore their relationships with motor impairment late after stroke. Subjects. A nonrandomised sample of 22 men and 9 women with a mean age of 60 years, 7-10 years after stroke. Methods. Fugl-Meyer Assessment, maximum walking speed, 6min walk test, perceived exertion, and heart rate were measured, and the Physiological Cost Index was calculated. Physical activity was reported using The Physical Activity Scale for the Elderly. Results. Mean (SD) 6min walking distance was 352 (±136)m, and Physiological Cost Index was 0.60 (±0.41). Self-reported physical activity was 70% of the reference. Motor impairment correlated with walking capacity but not with the physical activity level. Conclusion. It may be essential to enhance physical activity even late after stroke since in fairly young subjects both walking capacity and the physical activity level were lower than the reference.
|
|
