| 1. |
- Asplund, Monika, et al.
(författare)
-
Prurigo nodularis - vid svårare symtom kan pregabalin övervägas.
- 2015
-
Ingår i: Läkartidningen. - 0023-7205. ; 112
-
Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Prurigo nodularis is a pruritic condition characterized by skin noduli. Different treatment options have been used with limited success. Pregabalin is a drug licensed for treatment of neuropathic pain in adults. As prurigo nodularis involves suffering for the patients and is difficult to treat, the aim of this case report is to report the effect of pregabalin treatment in seven patients with prurigo nodularis, treated in the dermatology clinic in Malmö, Sweden. Four patients experienced good effect of pregabalin, though two patients had a transient effect. Side effects of pregabalin have been reported. This case report indicates that pregabalin is a treatment option for therapy-resistant prurigo nodularis; even though one must be aware of that the effect may not be permanent and that there are side effects. The aim must be to use the drug for a limited time, taking the patient to a remission state, where the vicious itch-scratch cycle can be inhibited.
|
|
| 2. |
- Björk Javanshiri, Amanda, et al.
(författare)
-
Follow-up and screening for type-2 diabetes mellitus in women with previous gestational diabetes in primary care
- 2023
-
Ingår i: Scandinavian Journal of Primary Health Care. - : Informa UK Limited. - 0281-3432 .- 1502-7724. ; 41:1, s. 98-103
-
Tidskriftsartikel (refereegranskat)abstract
- ObjectiveGestational diabetes mellitus (GDM) is an established risk factor for developing type 2 diabetes mellitus (T2DM) that is possible to prevent by systematic follow-up and preventive measures. The aim of this study was to examine whether women with previous GDM were offered follow-up in primary care, according to Swedish national guidelines.DesignRetrospective review of electronic medical records.SettingPrimary care in southern Sweden, Skåne county.SubjectsWomen who received a GDM diagnosis in 2018 at the Endocrinology department, Skåne University Hospital in Lund. The study population consisted of a total number of 161 patients, whereof 83 patients were included.Main outcome measuresWhether primary care offered follow-up for T2DM after GDM and if any communication took place between secondary and primary care. Furthermore, it was examined whether the quality of the follow-up was in accordance with the national guidelines.ResultsOf the study population, a total of 29% (n = 24) had been followed-up by primary care. In 55% (n = 46) of the cases, there was no communication between secondary and primary care. Plasma glucose was checked in all (n = 20) cases where follow-up could be evaluated. Conversations about lifestyle habits took place in 70% (n = 14) of the cases. Weight and risk factors for cardiovascular disease were controlled in less than half (n = 9) of the patients. Lifestyle advice was offered in two cases and in 24% (n = 20) of the cases an annual check-up was planned.ConclusionsThe follow-up of women with previous GDM in primary care in southern Sweden was lacking in seven out of 10 cases and showed great potential for improvement.Key PointsGestational diabetes is an established risk factor for developing type 2 diabetes.Earlier research has recognized that risk reduction is possible by systematic follow-up and preventive measures, but the extent of follow-up in primary care in southern Sweden remains unknown.This study demonstrates a lack of follow-up according to national guidelines for women with previous gestational diabetes in primary care in southern Sweden.There is great potential to improve the care of these patients with relatively simple means.
|
|
| 3. |
- Bogers, Rik P., et al.
(författare)
-
Association of overweight with increased risk of coronary heart disease partly independent of blood pressure and cholesterol levels - A meta-analysis of 21 cohort studies including more than 300,000 persons
- 2007
-
Ingår i: Archives of Internal Medicine. - 0003-9926. ; 167:16, s. 1720-1728
-
Forskningsöversikt (refereegranskat)abstract
- Background: The extent to which moderate overweight (body mass index [BMI], 25.0-29.9 [calculated as weight in kilograms divided by height in meters squared]) and obesity ( BMI, >= 30.0) are associated with increased risk of coronary heart disease (CHD) through adverse effects on blood pressure and cholesterol levels is unclear, as is the risk of CHD that remains after these mediating effects are considered. Methods: Relative risks (RRs) of CHD associated with moderate overweight and obesity with and without adjustment for blood pressure and cholesterol concentrations were calculated by the members of a collaboration of prospective cohort studies of healthy, mainly white persons and pooled by means of random-effects models (RRs for categories of BMI in 14 cohorts and for continuous BMI in 21 cohorts; total N=302296). Results: A total of 18 000 CHD events occurred during follow-up. The age-, sex-, physical activity-, and smoking-adjusted RRs (95% confidence intervals) for moderate overweight and obesity compared with normal weight were 1.32 (1.24-1.40) and 1.81 (1.56-2.10), respectively. Additional adjustment for blood pressure and cholesterol levels reduced the RR to 1.17 (1.11-1.23) for moderate overweight and to 1.49 (1.32-1.67) for obesity. The RR associated with a 5-unit BMI increment was 1.29 (1.22-.35) before and 1.16 (1.11-1.21) after adjustment for blood pressure and cholesterol levels. Conclusions: Adverse effects of overweight on blood pressure and cholesterol levels could account for about 45% of the increased risk of CHD. Even for moderate overweight, there is a significant increased risk of CHD independent of these traditional risk factors, although confounding (eg, by dietary factors) cannot be completely ruled out.
|
|
| 4. |
- Bolmsjö, Beata Borgström, et al.
(författare)
-
Text message-based lifestyle intervention in primary care patients with hypertension : a randomized controlled pilot trial
- 2020
-
Ingår i: Scandinavian Journal of Primary Health Care. - : Informa UK Limited. - 0281-3432 .- 1502-7724. ; 38:3, s. 300-307
-
Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To evaluate the feasibility of a randomized controlled pilot study with lifestyle-promoting text messages as a treatment for hypertension in primary care.DESIGN: Randomized controlled pilot trial.SETTING: Three primary health care centers in southern Sweden.SUBJECTS: Sixty patients aged 40-80 years with hypertension were included.MAIN OUTCOME MEASURES: Feasibility of the pilot study, i.e. recruitment rate, dropout rate and eligibility criteria. Secondary outcomes were change in blood pressure and other cardiovascular risk factors.METHODS: Thirty participants were randomized to the intervention group with four lifestyle-promoting text messages sent every week for six months. The control group received usual care. The baseline and follow-up visits for all 60 patients included measurements of blood pressure, anthropometrics, blood tests and a self-reported questionnaire.RESULTS: All feasibility criteria (recruitment rate (≥55%), dropout rate (≤15%) and eligibility (60 eligible patients during the four-month inclusion period) for the pilot study were fulfilled. This means that a larger study with a similar design may be conducted. After six months, there were no significant improvements in cardiovascular risk factors. However, we found favorable trends for all secondary outcomes in the intervention group as compared to the control group.CONCLUSION: Lifestyle modification in patients with hypertension is important to reduce cardiovascular risk. However, primary healthcare has limited resources to work with modifying lifestyle habits. This is the first pilot study to test the feasibility of text message-based lifestyle intervention in patients with hypertension in Swedish primary healthcare. Whether significant improvement in cardiovascular risk factors may be achieved in a larger study population remains to be evaluated. Key points This pilot randomized controlled trial (RCT) is the first study to evaluate the feasibility of text message-based lifestyle advice to patients with hypertension in Swedish primary healthcare. •All feasibility criteria for the pilot study were fulfilled. This outcome means that a larger study with a similar design may be conducted. •The study was not powered to find significant changes in cardiovascular risk factors. Nevertheless, after six months we found favorable trends for all secondary outcomes in the intervention group compared to control. •If a future larger study can show significant results, this intervention could serve as a useful tool in everyday primary healthcare.
|
|
| 5. |
- Calling, Susanna, et al.
(författare)
-
Coronary heart disease in mothers and fathers of adult children with alcohol use disorders
- 2021
-
Ingår i: Addiction. - : Wiley. - 0965-2140 .- 1360-0443. ; 116:12, s. 3390-3397
-
Tidskriftsartikel (refereegranskat)abstract
- Background and aim: Having a family member with an alcohol use disorder (AUD) may negatively affect a person's health. Our aim was to study the long-term risk of coronary heart disease (CHD) in parents who have an offspring with AUD. Design: Cohort study with Cox regression models and co-sibling analyses. Setting: Sweden. Participants: From population registers, we selected all parent-offspring pairs in which the parent was born in Sweden between 1945 and 1965. Measurements: Baseline was set when the offspring was 15 years old and AUD was assessed from medical and criminal registers. The parents were followed for CHD during a mean follow-up of 18 years. Hazard ratios (HRs) in mothers and fathers were calculated and adjusted for potential confounders (year of birth, age at childbirth, sex of the child, parent' AUD, educational level, and marital status). Findings: In mothers, the adjusted HR for CHD was 1.24 (95% CI = 1.19–1.28) in relation to having a child with AUD. In fathers, the HR for CHD was lower than in mothers but still increased; the adjusted HR was 1.08 (95% CI = 1.05–1.12). In the co-sibling analyses, the HRs for mothers were similar to the HRs estimated from the population-based sample, but in fathers the association did not remain significant (HR = 0.98 [0.90–1.06]). Conclusions: In Sweden, there appears to be an association between having an offspring with alcohol use disorder and increased risk of developing coronary heart disease. For fathers, the association did not remain in co-sibling analyses.
|
|
| 6. |
- Calling, Susanna, et al.
(författare)
-
Effects of body fatness and physical activity on cardiovascular risk: risk prediction using the bioelectrical impedance method.
- 2006
-
Ingår i: Scandinavian Journal of Public Health. - : SAGE Publications. - 1651-1905 .- 1403-4948. ; 34:6, s. 568-575
-
Tidskriftsartikel (refereegranskat)abstract
- Aims: To explore the effects of body fat percentage (BF%) on incidence of and mortality from cardiovascular disease (CVD) and to study the cardio-protective effect of physical activity in relation to BF%. Methods: A total of 26,942 men and women, aged 45-73 years, without history of CVD were followed up for incidence of coronary events (CE), ischaemic stroke, and CVD mortality over seven years in relation to sex-specific quartiles (Q1-Q4) of BF%. The cardio-protective effect of leisure-time physical activity was studied in relation to BF%. Results: In men, the relative risk (RR) for CE and CVD mortality increased progressively with BF%. RR for CE in Q4 was 1.37 (95% confidence interval: 1.07-1.74), adjusted for age, height, smoking, high alcohol intake, and physical activity, compared with Q1. In women, BF% was significantly associated with incidence of CE and stroke. BF% was more strongly correlated to body mass index (BMI) (r=50.83) and waist circumference (r=0.76) in women than in men (r=0.59 and r=50.66, respectively). BF% was a stronger risk factor than BMI in women, and equally strong as waist circumference. A significant interaction (p=0.013 for incidence of CE, p=0.026 for ischaemic stroke) was found between BF% and sex. The raised cardiovascular risk was reduced by physical activity in subjects with high BF%. Conclusions: BF% is a risk factor for CE, ischaemic stroke, and CVD mortality. An interaction between BF% and sex suggests that BF% is a stronger CVD risk factor in women. The raised cardiovascular risk associated with high BF% is reduced by physical activity.
|
|
| 7. |
- Calling, Susanna
(författare)
-
Från evidensbaserad medicin till kliniskt kunskapsstöd
- 2017
-
Ingår i: Nationellt kliniskt kunskapsstöd primärvård i Region Skåne och Södra sjukvårdsregionen 2017.
-
Bokkapitel (populärvet., debatt m.m.)abstract
- Allmänmedicin är ett brett område som spänner över många sjukdomstillstånd, med fokus på patientcentrering. Inom många områden sker en snabb kunskapsutveckling och rekommendationer för utrednings- och behandlingsstrategier uppdateras hela tiden. För en allmänläkare kan det vara svårt att hålla sig uppdaterad och tidsbrist begränsar möjligheterna att leta kunskap i det dagliga kliniska arbetet. Digitalisering och ökande tillgång till information via internet gör att patienter är alltmer pålästa och förberedda. Detta ger dock inte bara adekvat kunskap utan även information som ligger långt från vetenskap och beprövad erfarenhet. Även medarbetaren inom sjukvården riskerar att ta till sig information som inte är faktagranskad. För att kunna förklara för patienten vilken information som är pålitlig, är det av stort värde att kunna hänvisa till information som är kvalitetssäkrad utifrån evidens.
|
|
| 8. |
- Calling, Susanna, et al.
(författare)
-
Impact of neighborhood resources on cardiovascular disease : A nationwide six-year follow-up
- 2016
-
Ingår i: BMC Public Health. - : Springer Science and Business Media LLC. - 1471-2458. ; 16:1
-
Tidskriftsartikel (refereegranskat)abstract
- Background: Living in a socially deprived neighborhood is associated with lifestyle risk factors, e.g., smoking, physical inactivity and unhealthy diet, as well as an increased risk of cardiovascular disease, i.e., coronary heart disease and stroke. The aim was to study whether the odds of cardiovascular disease vary with the neighbourhood availability of potentially health-damaging and health-promoting resources. Methods: A nationwide sample of 2 040 826 men and 2 153 426 women aged 35-80 years were followed for six years for first hospitalization of coronary heart disease or stroke. Neighborhood availability of health-damaging resources (i.e., fast-food restaurants and bars/pubs) and health-promoting resources (i.e., health care facilities and physical activity facilities) were determined by use of geographic information systems (GIS). Results: We found small or modestly increased odds ratios (ORs) for both coronary heart disease and stroke, related to the availability of both health-damaging and health-promoting resources. For example, in women, the unadjusted OR (95 % confidence interval) for stroke in relation to availability of fast-food restaurants was 1.18 (1.15-1.21). Similar patterns were observed in men, with an OR = 1.08 (1.05-1.10). However, the associations became weaker or disappeared after adjustment for neighborhood-level deprivation and individual-level age and income. Conclusions: This six year follow-up study shows that neighborhood availability of potentially health-damaging as well as health-promoting resources may make a small contribution to the risk of coronary heart disease and stroke. However, most of these associations were attenuated or disappeared after adjustment for neighborhood-level deprivation and individual-level age and income. Future studies are needed to further examine factors in the causal pathway between neighborhood deprivation and cardiovascular disease.
|
|
| 9. |
- Calling, Susanna, et al.
(författare)
-
Longitudinal trends in self-reported anxiety. Effects of age and birth cohort during 25 years
- 2017
-
Ingår i: BMC Psychiatry. - : Springer Science and Business Media LLC. - 1471-244X. ; 17:1
-
Tidskriftsartikel (refereegranskat)abstract
- Background: Anxiety has been suggested to increase among young individuals, but previous studies on longitudinal trends are inconclusive. The aim of this study was to analyze longitudinally, the changes over time of prevalence of self-reported anxiety in the Swedish population between 1980/1981 and 2004/2005, in different birth cohorts and age groups. Methods: A random sample of non-institutionalized persons aged 16-71years was interviewed every eighth year. Self-reported anxiety was assessed using the question" Do you suffer from nervousness, uneasiness, or anxiety?" (no; yes, mild; yes, severe). Mixed models with random intercepts were used to estimate changes in rates of anxiety (mild or severe) within different age groups and birth cohorts and in males and females separately. In addition to three time-related variables - year of interview, age at the time of the interview, and year of birth -the following explanatory variables were included: education, urbanization, marital status, smoking, leisure time physical activity and body mass index. Results: Overall prevalence of self-reported anxiety increased from 8.0 to 12.4% in males and from 17.8% to 23.6% in females, during the 25-year follow-up period. The increasing trend was found in all age groups except in the oldest age groups, and the highest increase was found in young adults 16-23years, with more than a three-fold increase in females, and a 2.5-fold increase in males, after adjustments for covariates. Conclusions: Between 1980/81 and 2004/05, there was an increasing prevalence of self-reported anxiety in all age groups except in the oldest, which indicates increased suffering for a large part of the population, and probably an increased burden on the health care system. Clinical efforts should focus particularly on young females (16-23years), where the increase was particularly large; almost one third experienced anxiety at the end of the 25-year follow-up.
|
|
| 10. |
- Calling, Susanna, et al.
(författare)
-
Lung function, respiratory symptoms and incident venous thromboembolism during a 44-year follow-up
- 2023
-
Ingår i: Thrombosis Update. - Oxford : Elsevier. - 2666-5727. ; 12
-
Tidskriftsartikel (refereegranskat)abstract
- Background: Chronic obstructive pulmonary disease (COPD) and infections are risk factors for venous thromboembolism (VTE), but the reasons behind the associations are not fully known. Few studies have investigated whether lung function and respiratory symptoms in individuals without COPD are associated with VTE. Objectives: To study the incidence of VTE in individuals without COPD and other major VTE risk factors, in relation to baseline lung function and respiratory symptoms, through a 44-year follow-up prospective cohort study. Methods: As part of a health screening program, a total of 20,253 men and 7361 women underwent a baseline examination from 1974 to 1992, including a spirometry test and a self-administered questionnaire about respiratory symptoms, e.g., chronic bronchitis, cough, phlegm, and dyspnoea. Lung function was assessed through quartiles of forced expiratory volume in 1 s/forced vital capacity (FEV1/FVC). Through linkage with national registers, all individuals were followed for incidence of VTE. Results: Respiratory symptoms (cough and dyspnoea) at baseline were associated with an increased risk of incident VTE in women after adjustments for age, height, BMI, smoking status, varicose veins, and FEV1/FVC. The adjusted hazard ratio in relation to chronic bronchitis was 1.57 (95% confidence interval 1.17–2.11). Poor lung function was not associated with an increased risk of VTE after adjustments for potential confounders. Conclusion: Women with respiratory symptoms of cough and dyspnoea without COPD have an increased risk of VTE, independent of lung function and major VTE risk factors. Further studies are needed to confirm the association and to study the clinical applicability of the results. © 2023 The Authors
|
|
