| 1. |
- Bergh, Håkan, 1958, et al.
(författare)
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Predictive factors for long-term sick leave and disability pension among frequent and normal attenders in primary health care over 5 years.
- 2007
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Ingår i: Public health. - : Elsevier BV. - 0033-3506. ; 121:1, s. 25-33
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: To find predictive factors for long-term sick leave (SL) and disability pension (DP) among frequent attenders (FAs) and normal attenders (NAs) in primary health care. STUDY DESIGN: A cohort study with follow-up over 5 years. METHODS: Groups of FAs and NAs were followed over 5 years. Information about background, situation, sociodemography, life events, social support and sense of coherence were gathered at baseline. Multiple logistic regression analysis was used to determine the influence of each variable on long-term SL and receipt of a DP. RESULTS: During the study period, 18.9% of FAs received long-term SL/DP compared with 6% of NAs. Chronic disease was a predictive factor for long-term SL/DP among FAs [odds ratio (OR) 7.0] and NAs (OR 3.4). Among FAs, a life event was also a predictive factor (OR 2.1). Each additional life event increased the ratio of FAs with long-term SL/DP by 110%. Conflicts and losses had the greatest negative effects on FAs. CONCLUSIONS: FAs are a high-risk group for long-term SL/DP. Besides chronic disease, a life event was the only predictive factor for long-term SL/DP among FAs. These findings indicate that FAs are a vulnerable group for stressful events. Consequently, healthcare personnel should take more notice of life events among FAs.
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| 2. |
- Bräutigam-Ewe, Marie, et al.
(författare)
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Characteristics of patients seeking a health promotion and weight reduction program in primary care
- 2019
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Ingår i: Journal of Multidisciplinary Healthcare. - 1178-2390. ; 12, s. 235-242
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: An important task in primary health care (PHC) is to address lifestyle-related diseases. Overweight (OW) individuals make up a large proportion of PHC patients, and they increasingly have lifestyle-related illnesses that influence their quality of life. Structured health promotion and weight reduction programs could help these patients. The objective of this study was to explore the characteristics, lifestyle habits, and health conditions of individuals seeking a health promotion and weight reduction program in PHC. Patients and methods: The study involved a comparative cross-sectional design performed in PHC in southwestern Sweden. The study population comprised 286 participants (231 women, aged 40-65 years, body mass index [BMI] 28-35 kg/m(2)) who were recruited between March 2011 and April 2014 to the 2-year program by adverts in local newspapers and recruitment from three PHC centers. Two reference populations were used: a general population group and an OW group. The study population data were collected using a questionnaire, with validated questions regarding health, lifestyle, illnesses, and health care utilization. Results: People seeking a health promotion and weight reduction program were mostly women. They had a higher education level and experienced worse general health than the OW population, and they visited PHC more frequently than both reference groups. They also felt more stressed, humiliated, had more body pain, and smoked less compared to the general population. However, they did not exercise less or had a lower intake of fruits and vegetables than either reference population. Conclusion: Individuals seeking a weight reduction program were mostly women with a higher education level and a worse general health than the OW population. They used more health care services compared to the reference groups.
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| 3. |
- Andersson, Helen, 1968, et al.
(författare)
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Individuals' Experiences of Being Screened for Hypertension in Dental Health Care – “No Big Deal”
- 2022
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Ingår i: Patient Preference and Adherence. - 1177-889X. ; 16, s. 1449-1456
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Tidskriftsartikel (refereegranskat)abstract
- Background: Hypertension is a common disease globally that accounts for the highest number of lost healthy life years and strongly associated with sequelae such as stroke and myocardial infarction. Early detection of individuals with high blood pressure can be ensured by screening also those who consider themselves “healthy”. Screening has both positive and negative effects where a diagnosis of hypertension can lead to worry about the future. These effects need to be elucidated in order to balance between benefit and harm before screening is introduced. The aim of the study was to describe individuals’ experiences of being screened for hypertension in dental health care. Methods: Data from individual semi-structured interviews, with twenty participants screened for cardiovascular risk factors in connection with dental examination and aged 55–80 years, were analysed by means of qualitative content analysis. Results: The results describe individuals’ experiences of blood pressure screening in dental health care by means of the following theme: “No big deal” based on two categories: “Convenient way of measuring blood pressure” and “Increased awareness of health”. Conclusion: The overall message from the interviews was that having one’s blood pressure measured when visiting the dentist was convenient, easy and “No big deal”. Blood pressure screening did not create any major concerns and contributed to an increased awareness of health.
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| 4. |
- Andersson, Helen, 1968, et al.
(författare)
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The cost-effectiveness of a two-step blood pressure screening programme in a dental health-care setting
- 2021
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Ingår i: PLoS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 16:5
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Tidskriftsartikel (refereegranskat)abstract
- Background Hypertension is one of the largest contributors to the disease burden and a major economic challenge for health-care systems. Early detection of persons with high blood pressure can be achieved through screening and has the potential to reduce morbidity and mortality. We evaluate the cost-effectiveness of an opportunistic hypertension screening programme in a dental-care facility for individuals aged 40-75 in comparison to care as usual (the no-screening baseline scenario). Methods A cost-effectiveness analysis (CEA) was carried out from the payer and societal perspectives, and the short-term (from screening until diagnosis has been established) cost per identified case of hypertension and long-term (20 years) cost per quality-adjusted life year (QALY) were reported. Data on the short-term cost were based on a real-world screening programme in which 2025 healthy individuals were screened for hypertension. Data on the long-term cost were based on the short-term outcomes combined with modelling in a Markov cohort model. Deterministic and probabilistic sensitivity analyses were carried out to assess uncertainty. Results The short-term analysis showed an additional cost of 4,800 SEK (470) per identified case of hypertension from the payer perspective and from the societal perspective 12,800 SEK (1,240). The long-term analysis showed a payer cost per QALY of 2.2 million SEK (210,000) and from the societal perspective 2.8 million SEK per QALY (270,000). Conclusion The long-term model results showed that the screening model is unlikely to be cost-effective in a country with a well-developed health-care system and a relatively low prevalence of hypertension.
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| 5. |
- Andersson, Helen, 1968, et al.
(författare)
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White-coat hypertension detected during opportunistic blood pressure screening in a dental healthcare setting
- 2021
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Ingår i: Scandinavian Journal of Primary Health Care. - : Informa UK Limited. - 0281-3432 .- 1502-7724. ; 39:3, s. 348-354
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Tidskriftsartikel (refereegranskat)abstract
- Objective To study white-coat hypertension (WCHT, blood pressure >= 140/90 mmHg in a clinic and normal blood pressure <135/85 mmHg at home), with blood pressure screening of a healthy population during their dental healthcare visit and the associated risk factors. Design A multicentre observational study. Setting A healthy general population at four dental clinics in a region in southern Sweden. Subjects 2025 individuals aged 40-75 years were screened for high blood pressure at their annual regular check-up dental visit. Main outcome measures Frequencies of normal and elevated blood pressure (BP) in dental clinics, with home BP as a reference. According to BP results, the population was divided into three groups: normotension (NT), WCHT and suspected hypertension (HT). Background and life style factors were measured: sex, age, family history of hypertension, body mass index (BMI kg/m(2)), education level, tobacco use, and physical activity level. Results The overall prevalence of WCHT in the study was 17.7%, and the prevalence was 57.2% among those with clinically high blood pressure. Compared with NT, WCHT was associated with male sex (OR 1.56, CI 1.18-2.06), older age group (OR 2.33, CI 1.66-3.26), family history of hypertension (OR 1.61, CI 1.24-2.10), high BMI kg/m(2) (OR 2.36, CI 1.80-3.10), daily snuff use (OR 1.74, CI 1.19-2.53). In comparison with WCHT, HT was associated with male sex (OR 2.16, CI 1.44-3.25), older age group (OR 2.85, CI 1.75-4.65), daily smoking (OR 2.10, CI 1.14-3.85), less daily snuff use (OR 0.59, CI 0.34-0.99). Conclusions The prevalence of WCHT in a healthy population was 17.7%. Regarding cardiovascular risk factors, WCHT seems to be in the middle of NT and HT. Individuals with WCHT can be identified and given lifestyle advice in connection with a dental check-up, but follow-up and assessment of their cardiovascular risk should take place in primary care.
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| 6. |
- Bergh, Håkan, 1958, et al.
(författare)
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Association of Sublingual Varices With Heart- and Cerebrovascular Disease
- 2024
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Ingår i: International Dental Journal. - 0020-6539 .- 1875-595X. ; 74:2, s. 216-222
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Tidskriftsartikel (refereegranskat)abstract
- Objective: The aim of this research was to investigate whether sublingual varices (SV) are associated with new events of ischaemic heart disease (IHD) and new events of cerebrovascular disease. Methods: A prospective observational study was conducted amongst 1139 dental patients aged between 48 and 84 years across 2 cohorts (201 enrolled from 2010–2013 and 938 from 2018–2020). Participants provided baseline data on demographics, risk factors, and medical diagnoses, followed by an assessment of their tongue's ventral surface to classify veins as either having no sublingual varices (nSV) or having sublingual varices (SV). Information regarding medical diagnoses was gathered during the follow-up period from both participants and their medical records. The primary outcome variables were the onset of new IHD and new cerebrovascular disease events. Comparisons were made between participants with SV and nSV. Results: The study population comprised 54% women with an average age of 66 years. SV were present in 33% of participants. Those with SV predominantly were male, older, and smokers; had a higher body mass index, and exhibited more instances of hypertension, diabetes, and dyslipidaemia than those with nSV. New occurrences of IHD (4.5% vs 1.8%, P =.009) and cerebrovascular disease (4.2% vs 2.0%, P =.026) were more prevalent in the SV group compared with the nSV group. The link between SV and new IHD events persisted even after adjustments for sex, age, and smoking habits (OR, 2.26; 95% CI, 1.07–4.76), but not for new cerebrovascular disease events (OR, 1.77; 95% CI, 0.84–3.71). Conclusions: Our study identifies a correlation between SV and new events of IHD, but not new events of cerebrovascular disease. The detection of SV occurred prior to the IHD events, suggesting a temporal relationship. This novel finding proposes a potential shared pathophysiology between IHD and SV.
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| 7. |
- Bergh, Håkan, 1958, et al.
(författare)
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Consultations for injuries by frequent attenders are found to be medically appropriate from general practitioners' perspective.
- 2005
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Ingår i: Scandinavian journal of public health. - : SAGE Publications. - 1403-4948 .- 1651-1905. ; 33:3, s. 228-32
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Tidskriftsartikel (refereegranskat)abstract
- AIMS: A study was carried out to determine whether frequent attenders' (FAs') consultations for injuries are medically appropriate or not. METHODS: A retrospective review was undertaken of medical records in a primary healthcare centre. All injury consultations by frequent attenders and controls during a period of one year were evaluated by two general practitioners (GPs). Outcome variables were: number of injuries, chronic diseases, type of injuries, and their treatments. The GPs made a comprehensive picture of each case and evaluated whether it was medically appropriate to consult a doctor or not. RESULTS: Injuries were 7.2 times more common among frequent attenders compared with the controls. Frequent attenders had significantly more chronic diseases. Mean number of injury consultations was the same for frequent attenders with or without chronic disease. There was no difference concerning medically appropriate consultations between frequent attenders and controls. CONCLUSIONS: Consultations for injuries with frequent attenders were considered medically appropriate. Chronic diseases did not explain the higher injury incidence among frequent attenders. These findings are interesting and contradict the opinion that increased healthcare consumption by FAs is a waste of resources. Our findings may suggest that FAs are more vulnerable individuals.
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| 8. |
- Bergh, Håkan, 1958
(författare)
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Frequent attenders in primary health care. A vulnerable patient group seen from a biopsychosocial perspective
- 2005
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Introduction - The small number of the population who make disproportionally greater use of health care are called frequent attenders (FAs). This group, or 3-5% of the population, account for 15- 25% of all visits to general practitioners (GPs). They have, besides more chronic diseases, often a combination of medical, social and psychological problems. Is the high consulting frequency explained by FAs’ comprehension of and way of coping with illness or do they, due to an increased vulnerability, contract diseases more often? No consistent explanation for FAs’ high consulting frequency has yet been found. Aim - The overall aim of this thesis was to describe and explore the phenomenon of frequent attenders in primary health care from a biopsychosocial perspective with special focus on vulnerability. Material and methods – Among 341 frequent attenders and 1 025 controls divided by age and sex, data about consultation rate, diagnoses, prescribed medicine, referrals and certificates of illness, were gathered from the medical records during one year. All consultations concerning injuries were evaluated regarding the medical appropriateness of consulting a doctor or not. A questionnaire battery comprising scales of socio-demographic variables, stressful life events, social support and sense of coherence (SOC) was sent to the participants. The influence of each variable on frequent attendance was then determined. Based on data covering a five-year period from the National Health Insurance register concerning sick leave and disability pension, the influence of each variable on long-term sick leave and disability pension was estimated. Results – FAs’ morbidity in different age and sex groups was similar to that of the controls, but they had a higher consulting frequency for most medical problems. There was no difference concerning medically appropriate consultations for injuries between FAs and controls, although injuries were 7.2 times more common among FAs. SOC had a significant influence on frequent attendance, while stressful life events and social support did not. FAs were found to be a high-risk group for long-term sick leave and disability pension and, here, stressful life events was the only predictive factor. Conclusions – The age- and sex-specific morbidity of FAs is similar to the rest of the population but significantly increased. Although their consulting frequency was very high, FAs’ consultations were medically appropriate A weak SOC, which is supposed to indicate a reduced ability to handle stresses of life, distinguished FAs from controls and supported the finding that stressful life events predicted a bad prognosis regarding long-term sick leave and disability pension. The findings from this thesis all point in the same direction – that FAs are a vulnerable group of patients.
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| 9. |
- Bergh, Håkan, 1958, et al.
(författare)
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Life events, social support and sense of coherence among frequent attenders in primary health care.
- 2006
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Ingår i: Public health. - : Elsevier BV. - 0033-3506 .- 1476-5616. ; 120, s. 229-236
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: The aim of this survey was to compare stressful life events, social support and sense of coherence (SOC) between frequent attenders (FAs) and normal attenders (controls) in primary health care. STUDY DESIGN: A cross-sectional study was conducted in a primary healthcare centre in the south-west of Sweden. METHODS: A postal questionnaire was sent to 263 frequent attenders and 703 normal attenders. The questionnaire comprised sociodemographic variables and scales of stressful life events, social support and SOC. The results from the questionnaire were compared between the groups, and the significance of the variables in terms of attendance was tested in a multiple regression analysis. RESULTS: More of the FAs were secondarily single, they had more chronic diseases and were more often living on a sickness/disablement pension than the controls. FAs did not report more stressful life events than the controls nor was their experience of events more negative. Social support was as strong among FAs as among controls, and it had no significant effect on their frequent attendance. FAs had a significantly weaker SOC compared with controls. The variables that significantly influenced frequent attendance were high age [odds ratio (OR) = 1.02], chronic disease (OR = 3.08), sickness/disablement pension (OR = 2.46) and SOC (OR = 0.97). CONCLUSIONS: SOC had a significant influence on frequent attendance in primary health care, but stressful life events and social support did not. FAs did not report more stressful life events. However, due to an inadequate coping strategy, indicated by a weak SOC, the life events probably caused them more symptoms and diseases, and thereby a higher consulting frequency.
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| 10. |
- Bergh, Håkan, 1958, et al.
(författare)
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Persistence and stability of sublingual varices over time and their connection to underlying factors: an 8 year follow up study
- 2022
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Ingår i: Bmc Oral Health. - : Springer Science and Business Media LLC. - 1472-6831. ; 22:1
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Tidskriftsartikel (refereegranskat)abstract
- Objective To investigate whether sublingual varices are constant or inconstant over time and whether this is connected to background variables, cardiovascular risk factors or disease. Design This longitudinal observational study was performed between 2010 and 2020 at the Public Dental Services Vastra Vall, Varberg, Sweden. The study was based on 431 patients included in a previous study in which the relationship between sublingual varices and hypertension was examined. In connection to the annual dental examination, 281 patients were included in the follow-up study. They completed a questionnaire about background and health factors and diseases. Length and weight were measured. Two intraoral photos were taken with a digital camera. Two dentists independent of each other graded all photographs as none/few visible sublingual varices (nSV) or medium/severe sublingual varices (SV). Results The prevalence of SV was 25.6% at baseline and 30.6% at follow-up. At the follow up, a total of 76.5% had maintained their sublingual vascular status. Of those with nSV at baseline (n209), 80.9% still had nSV, and 19.1% had developed SV during the 8-year follow-up period. Of those 72 participants who had SV at baseline, 46 (63.9%) were unchanged at follow-up, and 26 (36.1%) were classified as nSV. Those who had developed SV at follow-up had a higher mean age (p = 0.003) and a higher prevalence of cardiovascular disease (CVD), 13.2% versus 3.0% (p = 0.021). This association with CVD did not persist after an adjustment for sex and age (OR 3.2, 95% CI 0.81-12.46). They exhibited more hypertension (35.0% vs. 22.5%) and diabetes type 2 (7.5% vs. 3.0%), but with no significant difference. Conclusions This study revealed that 76.5% of the participants had an unchanged status regarding sublingual varices during an 8-year period and that the development from nSV to SV was associated with advanced age.
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