| 1. |
- Chermá Yeste, Maria Dolores, et al.
(författare)
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Assessment of the prescription of antidepressant drugs in elderly nursing home patients
- 2008
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Ingår i: Journal of Clinical Psychopharmacology. - 0271-0749 .- 1533-712X. ; 28:4, s. 424-431
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Tidskriftsartikel (refereegranskat)abstract
- The aim of the study was to investigate the use of antidepressant drugs among elderly people in nursing homes. Elderly residents who where found to have been prescribed at least one antidepressant drug according to the specific medication dispensing system were identified in 8 nursing homes in the county of Östergötland, Sweden. Data were collected from the medical record forms at the nursing home. Blood samples were drawn for the assessment of drug concentration, blood chemistry parameters and cytochrome P450 expression. At least one antidepressant drug was prescribed to 38% of elderly people in the nursing home studied. A total of 71 patients were evaluated, 80% women and 20% men. The median age was 84 years (range, 71-100 years). Indications for antidepressant drug treatment were found on 96% of medical record forms (depression, 60%); however, information relating to when treatment was initiated could not be found on 34% of medical record forms and a clear time schedule for how long this drug treatment was planned to continue could not be found either. A possible adverse effect of antidepressant drug treatment was retrieved in at least 77% of patients. Polypharmacotherapy was common; median number of drugs per patient was 11. Concentrations of drugs were higher than expected in 73%. Most patients were medicated with citalopram (n = 44). A clear interindividual variability of concentrations at each dose level was found for citalopram and for the metabolites desmethylcitalopram and didesmethylcitalopram. A significant correlation was found between the estimation of creatinine clearance and concentration-dose ratio of citalopram. Poor metabolizers, who had been prescribed an antidepressant drug that are substrate for the cytochrome P450 isoenzyme examined, have higher concentrations of prescribed antidepressant drug than do non-poor metabolizers in relation to dose. An increase in quality contribution to follow-up at antidepressant medications is needed. A more frequent clinical use of therapeutic drug monitoring and pharmacogenetic tests in addition to therapeutic drug monitoring may be one important tool in this process.
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| 2. |
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| 3. |
- Danielsson, Olof, et al.
(författare)
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Increased prevalence of celiac disease in idiopathic inflammatory myopathies
- 2017
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Ingår i: Brain and Behavior. - : WILEY. - 2162-3279 .- 2162-3279. ; 7:10
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Tidskriftsartikel (refereegranskat)abstract
- ObjectivesIdiopathic inflammatory myopathies (IIM) are often associated with other immune-mediated diseases or malignancy. Some studies have reported a high frequency of celiac disease in IIM. The aim of this study was to investigate the prevalence of celiac disease, systemic inflammatory diseases, and malignancy in a cohort of IIM patients, and estimate the incidence of IIM in the county of ostergotland, Sweden. Material and MethodsWe reviewed medical records and analyzed sera from 106 patients, fulfilling pathological criteria of inflammatory myopathy, for the presence of IgA antibodies against endomysium and gliadin. Antibody-positive patients were offered further investigation with small bowel biopsy or investigation for the presence of antibodies against antitissue transglutaminase (t-TG). The patients were classified according to Bohan and Peter or Griggs criteria. The presence of celiac disease, systemic inflammatory, and malignant diseases was documented. ResultsFour of 88 patients classified as IIM (4.5%) had biopsy-confirmed celiac disease, which is higher than the prevalence in the general population, detected with a similar screening procedure (0.53%). Thirty-three patients (38%) had a systemic inflammatory disease and five (5.7%) a malignancy. The incidence of confirmed IIM in the county of ostergotland was 7.3 per million/year. ConclusionsThe results highlight the high frequency of associated inflammatory and malignant diseases and confirm an increased prevalence of celiac disease in IIM.
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| 4. |
- Davidson, Thomas, et al.
(författare)
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Point-of-care monitoring of warfarin treatment in community dwelling elderly - A randomised controlled study
- 2015
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Ingår i: Journal of Telemedicine and Telecare. - : SAGE Publications (UK and US). - 1357-633X .- 1758-1109. ; 21:5, s. 298-301
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Tidskriftsartikel (refereegranskat)abstract
- The objective of this study was to assess clinical effectiveness and costs of launching point-of-care monitoring of warfarin treatment in community dwelling frail elderly patients. A prospective multicentre controlled randomised study over 12 months comparing a point-of-care strategy with usual monitoring routines was carried out in primary healthcare centres and anticoagulation clinics in southeast Sweden. The subjects were community dwelling elderly across rural southeast Sweden on chronic warfarin treatment. Main outcome measures were time in therapeutic range (TTR), rate of treatment-related adverse events and costs. The study comprised 103 elderly people (61% women) mean age 86 yrs (range 75-98) treated with warfarin for median 9 yrs (range 1-18). Patients randomised to start point-of-care monitoring (n = 55) showed 75.9% in TTR before trial vs. 72.6% during trial (ns). The patients randomised to continue on usual monitoring routines (n = 48) showed 75.2% in TTR prior to trial vs. 72.9% during trial (ns). The point-of-care monitoring showed potential savings of SEK 624 per patient annually (based partly on effects that were not statistically significant). The study shows that point-of-care monitoring of warfarin treatment in community dwelling elderly in rural areas is as effective as usual monitoring routines and that it may offer savings to society.
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| 5. |
- Faresjö, Åshild, et al.
(författare)
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Sex differences in dietary coping with gastrointestinal symptoms
- 2010
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Ingår i: EUROPEAN JOURNAL OF GASTROENTEROLOGY and HEPATOLOGY. - : Wolter kluwer Health. - 0954-691X. ; 22:3, s. 327-333
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Tidskriftsartikel (refereegranskat)abstract
- Aim Nutritional changes are often considered first-line treatment in public health diseases that apply to many gastrointestinal (GI) disorders, as different food and beverages may modulate GI motor and sensory functions, and may provoke GI symptoms. The aim of this study was to examine dietary coping and possible changes in food and beverage intake in relation to GI symptoms reported by identified irritable bowel syndrome (IBS) patients compared with healthy controls, and whether any sex differences were observed in these respects. Methods A population-based case-control design was used. Three primary healthcare centres were selected in the city of Linko ping in Sweden. The IBS patients were recruited from the studied primary healthcare centers on the basis of diagnoses from computerized medical records. The controls were randomly selected from the general population in the same region. A questionnaire was used with specific questions about self-reported food and beverage increase or decrease of GI symptoms and self-reported changes in dietary habits. Results Female IBS patients seem to be more willing to change dietary habits because of their GI problems than men. Effects of these nutritional behaviour changes were reported for almost all participants that had made dietary adjustments. Fatty food, certain vegetables, dairy products and eggs were significantly more reported to cause GI complaints among IBS patients compared with their controls. Conclusion Female IBS patients reported more changes in their dietary habits because of GI problems than men with the disease. The majority of both women and men who changed their dietary habits because of GI problems experienced improvement in their symptoms.
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| 6. |
- Grehn, Susanne, et al.
(författare)
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Dietary habits of Swedish adult coeliac patients treated by a gluten-free diet for 10 years
- 2001
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Ingår i: Scandinavian Journal of Nutrition/Næringsforskning. - 1102-6480 .- 1651-2359. ; 45:4, s. 178-182
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Tidskriftsartikel (refereegranskat)abstract
- Background: Uncertainty still exists whether coeliac patients living on a gluten-free diet for several years are ensured a nutritionally balanced diet. Objective: To evaluate the dietary habits of adults with longstanding coeliac disease Design: The intake of nutrients and foods was assessed in 49 Swedish coeliac patients (32 women) aged 45-64 years treated for 8-12 years using 4-day dietary record. Compliance with the diet was ascertained by showing a villous intestinal structure at repeat biopsy or normal serological tests. The control group (n:498) consisted of a general population sample of same age. Results: The coeliac patients showing the same energy intake as controls had a lower intake of fibre, niacin equivalents, folate, vitamin B12, calcium, phosphorus and zinc. In relation to recommended intakes, low levels of fibres, folate, vitamin E and selenium were seen in both coeliacs and controls. Significant differences between coeliac patients and controls were seen for half of the food groups under study and this was particularly true for women. Conclusions: The results suggest that Swedish coeliac patients living on a gluten-free diet for several years need to improve their dietary habits. To this end, regularly visiting a dietitian could be helpful to introduce oat-based options and increase the intake of fresh fruits and greens.
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| 7. |
- Grodzinsky, Ewa, et al.
(författare)
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Could gastrointestinal disorders differ in two close but divergent social environments?
- 2012
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Ingår i: International Journal of Health Geographics. - : BioMed Central. - 1476-072X. ; 11:5
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Tidskriftsartikel (refereegranskat)abstract
- Background: Many public health problems in modern society affect the gastrointestinal area. Knowledge of the disease occurrence in populations is better understood if viewed in a psychosocial context including indicators of the social environment where people spend their lives. The general aim of this study was to estimate the occurrence in the population and between sexes of common gastrointestinal conditions in two neighborhood cities representing two different social environments defined as a "white-collar" and a "blue-collar" city. less thanbrgreater than less thanbrgreater thanMethods: We conducted a retrospective register study using data of diagnosed gastrointestinal disorders (cumulative incidence rates) derived from an administrative health care register based on medical records assigned by the physicians at hospitals and primary care. less thanbrgreater than less thanbrgreater thanResults: Functional gastrointestinal diseases and peptic ulcers were more frequent in the white-collar city, while diagnoses in the gallbladder area were significantly more frequent in the blue-collar city. Functional dyspepsia, irritable bowel syndrome, and unspecified functional bowel diseases, and celiac disease, were more frequent among women while esophageal reflux, peptic ulcers, gastric and rectal cancers were more frequent among men regardless of social environment. less thanbrgreater than less thanbrgreater thanConclusions: Knowledge of the occurrence of gastrointestinal problems in populations is better understood if viewed in a context were the social environment is included. Indicators of the social environment should therefore also be considered in future studies of the occurrence of gastrointestinal problems.
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| 8. |
- Grodzinsky, Ewa, 1958-
(författare)
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Serological markers in subclinical and clinical gluten enteropathy
- 1994
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- An enzyme-linked immunosorbent assay (ELISA) has been developed for the measurement of anti-gliadin antibodies (AGA), thereby providing a practical and cheap assay for use in the diagnosis of coeliac disease (CD). Since gliadin is a common food antigen for most people, a large group of apparently healthy blood donors (n=l866) was analysed, as well as children and adults with symptoms more or less suggesting CD. The effects of various cut-offvalues on the sensitivity, specificity and predictive value (PV) of the test were calculated, both alone and together with anti-endomysium antibodies (EMA). A high prevalence value, of at least 1/256 (7!1866), for gluten enteropathy (GE) was found in the blood donor population. Moreover, a high frequency of CD among fanners with diffuse symptoms, conceivably due to a high exposure to gluten by inhalation, was also observed. It was impossible to combine high sensitivity with high specificity for both IgA- and IgG AGA, and vice versa, in adults. A significant increase in the mean lgA AGA level with age was seen when the blood donors were divided into age groups. A positive PV of 18-25% was found for IgA-AGA, depending on how-the cut-off value was defined. For IgG-AGA the positive PV was 0% (0/35) among asymptomatic subjects. IgA-EMA yielded both high specificity and a high positive PV, but a lower sensitivity than IgA-AGA, especially in children younger than 2 years, with signs of CD. When screening for GE in a population with expected low prevalence, measurement of IgA-AGA is suggested as a primary test because of fairly good sensitivity, technical simplicity, and low cost. Sera found to be positive are then re tested with IgA-EMA, which gives a positive PV close to 100%. For populations with a moderate or high expected prevalence for CD, our results indicate that different tests should be used depending on the age of the population studied. In younger children ( < 2 years old) lgA-AGA yielded a high sensitivity (lOO%) and a high specificity (86%). fu older children (> 2 years old) and adults the use of IgA-EMA seems more suitable, because of the high specificity (99-100%) and positive PV (95-100% ). Since, however, the negative PV was not 100%, a negative test result does not exclude CD.
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| 9. |
- Hallert, Claes, 1945-, et al.
(författare)
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B vitamins improve health in patients with coeliac disease living on a gluten-free diet
- 2009
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Ingår i: Alimentary Pharmacology and Therapeutics. - : Wiley. - 0269-2813 .- 1365-2036. ; 29:8, s. 811-816
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Tidskriftsartikel (refereegranskat)abstract
- Background Patients with coeliac disease living on a gluten-free diet show vitamin deficiency and reduced subjective health status. Aim To study the biochemical and clinical effects of B vitamin supplementation in adults with longstanding coeliac disease. Methods In a double blind placebo controlled multicentre trial, 65 coeliac patients (61% women) aged 45–64 years on a strict gluten-free diet for several years were randomized to a daily dose of 0.8 mg folic acid,0.5 mg cyanocobalamin and 3 mg pyridoxine or placebo for 6 months. The outcome measures were psychological general well-being (PGWB) and the plasma total homocysteine (tHcy) level, marker of B vitamin status. Results Fifty-seven patients (88%) completed the trial. The tHcy level was baseline median 11.7 μmol/L (7.4–23.0), significantly higher than in matched population controls [10.2 μmol/L (6.7–22.6) (P < 0.01)]. Following vitamin supplementation, tHcy dropped a median of 34% (P < 0.001), accompanied by significant improvement in well-being (P < 0.01), notably Anxiety (P < 0.05) and Depressed Mood (P < 0.05) for patients with poor well-being. Conclusions Adults with longstanding coeliac disease taking extra B vitamins for 6 months showed normalized tHcy and significant improvement in general well-being, suggesting that B vitamins should be considered in people advised to follow a gluten-free diet.
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| 10. |
- Hallert, Claes, 1945-, et al.
(författare)
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Celiakiboken om glutenintolerans
- 2005. - 1
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Ingår i: Celiakiboken om glutenintoerans. - Stockholm : Förlagshuset Gothia. - 9172054638 - 9789172054639 ; , s. 11-125
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Bokkapitel (övrigt vetenskapligt/konstnärligt)abstract
- Celiakiboken vänder sig i första hand till personer med celiaki (glutenintolerans) och deras närstående men också till andra som kommer i kontakt med celiaki. Innehållet är vetenskapligt granskat och kan användas vid utbildning och fortbildning av vårdpersonal på alla nivåer. Boken förmedlar tio unika nycklar till ett gott, glutenfritt liv med hög livskvalitet. Den tar upp olika typer av celiaki, hur gluten påverkar tarmen, olika symtom hos både vuxna och barn samt de senaste resultaten inom aktuell forskning. Ett stort utrymme ägnas åt själva behandlingen med mat utan gluten.
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