| 1. |
- Chin, Kuo Zhe, et al.
(författare)
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Extended prenatal and postnatal home visits in a vulnerable area in Sweden—a pilot study
- 2023
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Ingår i: Scandinavian Journal of Primary Health Care. - 1502-7724 .- 0281-3432. ; 41:4, s. 486-494
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Tidskriftsartikel (refereegranskat)abstract
- Objective: Despite close to all-embracing access to child healthcare, health divides exist among children in Sweden. Home visits to families with new-born babies are a cost-effective way to identify and strengthen vulnerable families. An extended postnatal home visiting programme has been implemented in a disadvantaged suburb in Stockholm with positive results. Design: Longitudinal, prospective study and register study from medical records. Setting: A vulnerable rural area in Sweden. Intervention: A parent advisor from the social services and a midwife performed an extended home visiting programme during the end of pregnancy to mothers of children born between 1 May 2018 and 31 May 2019. During these children’s first 15 months, three additional home visits were made by a parent advisor and a child healthcare nurse. The aim of the study is to evaluate the effect of the intervention on the health of the children and the mothers. Subjects: All firstborn children at the study site (N = 30 study, N = 55 control group). Main outcome measures: The proportion participating in visits to the child and maternal healthcare services, children being breastfed and receiving childhood vaccinations. Results: There were fewer absentees in the study group during routine check-up visits (93 vs. 84%). More mothers in the study group attended the check-up with the midwives (90 vs. 80%). More children in the study group were breastfed (90 vs. 67%) and received all vaccinations (100 vs. 96%). Conclusion: Supplementing the extended home visiting programme with a visit at the end of pregnancy seems to contribute to fewer absentees at routine visits for both mothers and children; furthermore, more children were breastfed and vaccinated compared with the control group.
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| 2. |
- Dalemo, Sofia, et al.
(författare)
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Bone mineral density in primary care patients related to serum calcium concentrations: a longitudinal cohort study from Sweden
- 2018
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Ingår i: Scandinavian Journal of Primary Health Care. - : Informa UK Limited. - 0281-3432 .- 1502-7724. ; 36:2, s. 198-206
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Tidskriftsartikel (refereegranskat)abstract
- Objective: Elevated calcium concentration is a commonly used measure in screening analyses for primary hyperparathyroidism (pHPT) and cancer. Low bone mineral density (BMD) and osteoporosis are common features of pHPT and strengthen the indication for parathyroidectomy. It is not known whether an elevated calcium concentration could be a marker of low BMD in suspected pHPT patients with a normal parathyroid hormone concentration. Purpose: To study if low BMD and osteoporosis are more common after ten years in patients with elevated compared with normal calcium concentrations at baseline. Subjects: One hundred twenty-seven patients (28 men) with baseline elevated, and 254 patients (56 men) with baseline normal calcium concentrations, mean age 61 years, were recruited. After ten years, 77% of those still alive (74 with elevated and 154 with normal calcium concentrations at baseline) participated in a dual energy x-ray absorptiometry measurement for BMD assessment and analysis of calcium and parathyroid hormone concentrations. Main outcome measures: Association between elevated and normal calcium concentration at base-line and BMD at follow-up. Correlation between calcium and parathyroid hormone concentrations and BMD at follow-up. Results: A larger proportion of the patients with elevated baseline calcium concentrations who participated in the follow-up had osteoporosis (p value - 0.036), compared with the patients with normal concentrations. In contrast, no correlation was found between calcium or parathyroid hormone concentrations and BMD at follow-up. Conclusions: In this study, patients with elevated calcium concentrations at baseline had osteoporosis ten years later more often than controls (45% vs. 29%), which highlights the importance of examining these patients further using absorptiometry, even when their parathyroid hormone level is normal.
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| 3. |
- Dalemo, Sofia, et al.
(författare)
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Diagnosis of patients with raised serum calcium level in primary care, Sweden.
- 2006
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Ingår i: Scandinavian journal of primary health care. - : Informa UK Limited. - 0281-3432 .- 1502-7724. ; 24:3, s. 160-5
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To study the diagnosis of hypercalcaemic patients and to evaluate whether frequent analyses of serum calcium can detect more patients with hypercalcaemia. DESIGN: Retrospective study of serum calcium analyses performed during the time period 1992-2000 and of the medical records of patients with elevated serum calcium levels between 1995 and 2000. SETTING: Primary care in Tibro, Sweden. SUBJECTS: Patients from the local community attending the primary healthcare centre. MAIN OUTCOME MEASURES: Frequency of serum calcium analyses, hypercalcaemic patients, and their diagnosis. RESULTS: Doubling the number of serum calcium analyses did not increase the detected number of raised calcium levels. On the other hand, more frequent parathyroid hormone (PTH) analyses resulted in a corresponding increase in detected high PTH levels. In Tibro, 15% (n = 22) of the patients with hypercalcaemia were diagnosed with primary hyperparathyroidism, giving a rate of 0.22%. This is comparable to the prevalence in other population studies. Over 40% (n = 9) of patients with primary hyperparathyroidism in the study had only slightly raised serum calcium levels (2.55-2.60 mmol/l). In 70% (n = 99) of the cases, the cause of hypercalcaemia was unknown. The second most common diagnosis was skeletal disorders followed by kidney disease. CONCLUSION: An increase in the number of serum calcium analyses did not result in increased detection of raised calcium levels. In contrast, an increase in the number of PTH analyses resulted in increased detection of primary hyperparathyroidism. Therefore, PTH analyses should be used more frequently.
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| 4. |
- Dalemo, Sofia, et al.
(författare)
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Long-term follow-up of patients with elevated serum calcium concentration in Swedish primary care
- 2013
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Ingår i: Scandinavian Journal of Primary Health Care. - : Informa UK Limited. - 0281-3432 .- 1502-7724. ; 31:4, s. 248-254
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Tidskriftsartikel (refereegranskat)abstract
- Objective. To follow up patients with elevated calcium concentrations after 10 years. Design. Longitudinal, using medical records, questionnaires, and clinical investigation. Setting. Primary care in Tibro, Sweden, 2008–2010. Subjects. 127 patents with elevated calcium concentrations and 254 patients with normal calcium concentrations from the local community, attending the health care centre. Main outcome measures. Diagnoses and mortality in patients with elevated calcium concentrations in 1995–2000, compared with patients with normal calcium concentrations and the background population. Results. The proportion of patients for whom no underlying cause was detected decreased from 55% at baseline to 12% at follow-up. Primary hyperparathyroidism was most common in women, 23% at baseline and 36% at follow-up, and the cancer prevalence increased from 5% to 12% in patients with elevated calcium concentration. Mortality tended to be higher in men with elevated calcium concentrations compared with men with normal calcium concentrations, and was significantly higher than in the background population (SMR 2.3, 95% CI 1.3–3.8). Cancer mortality was significantly increased in men (p = 0.039). Low calcium concentrations were also associated with higher mortality (p = 0.004), compared with patients with normal calcium concentrations. Conclusion. This study underscores the importance of investigating patients with increased calcium concentrations suggesting that most of these patients – 88% in our study – will turn out to have an underlying disease associated with hypercalcaemia during a 10-year follow-up period. Elevated calcium concentrations had a different disease pattern in men and women, with men showing increased cancer mortality in this study. Read More: http://informahealthcare.com/doi/abs/10.3109/02813432.2013.861152
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| 5. |
- Dalemo, Sofia, et al.
(författare)
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Plasma albumin and calcium concentrations, and long-term mortality in primary health care patients in Sweden.
- 2020
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Ingår i: Scandinavian journal of primary health care. - : Informa UK Limited. - 1502-7724 .- 0281-3432. ; 38:4, s. 430-438
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Tidskriftsartikel (refereegranskat)abstract
- Low plasma (p)-albumin and p-calcium concentrations are associated with increased mortality in hospitalised patients. There are few studies addressing this in primary care. Low p-calcium has been associated with mortality, but it is not known whether this applies to p-albumin. Could p-albumin and p-calcium be used as markers of an increased risk of mortality?To study p-albumin and p-calcium at baseline and their association with mortality after 10-14 years.Prospective cohort study using data from a large primary health care area and the National Swedish Cause of Death Register.Primary health care in Skaraborg, Sweden.43,052 patients (39.1% men), ≥18 years, 60.7±18.4 years with p-albumin and p-calcium concentrations registered in 2001-2005.P-albumin and p-calcium concentrations at baseline and their association with mortality after a mean follow-up period of 10.3±4.0 years.Low p-albumin was associated with total mortality compared with normal p-albumin, greatest at lower ages (18-47 years). The hazard ratios for women and men were 3.12 (95% CI 1.27-7.70) and 4.09 (95% CI 1.50-11.14), respectively. The increased mortality was seen in both cardiovascular and malignant diseases in both women and men. In contrast, low p-calcium was not associated with increased mortality, 1.00 (95% CI 0.96-1.05). Elevated p-calcium was associated with increased mortality, 1.17 (95% CI 1.13-1.22).Low p-albumin could be a marker of an increased risk of mortality, especially in patients of younger ages. This finding should prompt diagnostic measures in order to identify underlying causes. KEY POINTS Low p-albumin and calcium concentrations have been associated with increased mortality in hospitalised patients, but this is unexplored in primary care patients. A low p-albumin concentration at baseline was a risk marker for mortality; highest in the younger age groups. Increased mortality in both cardiovascular and malignant diseases was seen in both men and women with low compared with normal p-albumin concentrations. Elevated but not low p-calcium concentrations were associated with increased mortality after 10-14 years of follow-up.
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| 6. |
- Dalemo, Sofia, et al.
(författare)
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Quality of life and health care consumption in primary care patients with elevated serum calcium concentrations in - a prospective, case control, study
- 2014
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Ingår i: BMC Family Practice. - : Springer Science and Business Media LLC. - 1471-2296. ; 15:84
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Tidskriftsartikel (refereegranskat)abstract
- Abstract Background Patients with elevated calcium concentrations have an increased morbidity due to various underlying illnesses. However, there is a lack of studies of quality of life and health care consumption in patients with hypercalcaemia per se. The study aims to investigate quality of life and health care consumption, as measured by, sick leave, drug prescriptions and the number of visits and admissions to health care centres and hospitals, in primary care patients with elevated calcium concentrations. Methods A prospective, case control, study in primary care centre, in Sweden. Patients with elevated, (n = 127, 28 men), and normal calcium concentrations, (n = 254, 56 men), mean age 61.4 year, were recruited in the study and followed during 10 years. Eighty-six percent of those alive at the time of follow up participated in a follow up visit. The study participants completed a quality of life survey, SF-36, which also were compared with the Swedish SF-36 national normative database. Results Patients with elevated calcium concentrations had significantly lower quality of life both compared with the control group (patients with normal calcium concentrations) and compared with age and gender-matched reference material from the Swedish SF-36 national normative database. The group with elevated calcium concentrations had significantly more hospitalisations (p = 0.017), subsequently cancer diagnoses (p < 0.003), sick leave (p = 0.007) and medication (p = 0.002) compared with patients with normal calcium concentrations. Men with elevated calcium concentrations had more contacts with the psychosocial team (p = 0.02) at the health care centre. Conclusions Elevated calcium concentrations are associated with significantly reduced quality of life and increased health care consumption and should therefore be an important warning flag that should alert the physician to further investigate and care for the patient. This is the first study in this field and the results need to be confirmed in further studies.
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| 7. |
- Dalemo, Sofia, et al.
(författare)
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Variation in plasma calcium analysis in primary care in Sweden--a multilevel analysis.
- 2010
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Ingår i: BMC family practice. - : Springer Science and Business Media LLC. - 1471-2296. ; 11
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Tidskriftsartikel (refereegranskat)abstract
- Primary hyperparathyroidism (pHPT) is a common disease that often remains undetected and causes severe disturbance especially in postmenopausal women. Therefore, national recommendations promoting early pHPT detection by plasma calcium (P-Ca) have been issued in Sweden. In this study we aimed to investigate variation of P-Ca analysis between physicians and health care centres (HCCs) in primary care in county of Skaraborg, Sweden.
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| 8. |
- Starzmann, Karin, 1965, et al.
(författare)
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Diagnoses have the greatest impact on variation in sick-leave certification rate among primary-care patients in Sweden: A multilevel analysis including patient, physician and primary health-care centre levels
- 2015
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Ingår i: Scandinavian Journal of Public Health. - : SAGE Publications. - 1403-4948 .- 1651-1905. ; 43:7, s. 704-712
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Tidskriftsartikel (refereegranskat)abstract
- Aims: The aims of this study were to determine and evaluate simultaneously the importance of factors known to influence sick-leave certification such as the sick leave-related diagnoses, the patients' socio-economic status, and characteristics of the physicians. Methods: Computerised medical records from 24 public primary health-care centres (PHCC) were used in a multilevel logistic regression analysis at three levels: patients (n=64,354; sex, age, socio-economic status, workplace factors and diagnoses), physicians (n=574; sex and level of experience) and PHCC (n=24). The variation of sick-leave certification at each level was the outcome. Results: Most of the variation was attributed to the patient level and only 3.5% to the physician and 1.2% to the PHCC levels. Among the patient characteristics, psychiatric diagnoses (mostly acute stress) had the highest odds ratio (OR) for sick leave (OR=16.0; 95% confidence interval [CI] 15-17.2), followed by musculoskeletal diagnoses (OR=6.1; 95% CI 5.8-6.5). Other factors with increased OR were low education (OR=1.7; 95% CI 1.6-1.8), use of social allowance (OR=1.4; 95% CI 1.2-1.7) and certain workplaces (manufacture and health and social care). Being older was not associated with increased certified sick leave. Conclusions: The greatest variation in sick-leave certification rate was seen at the patient level, specifically psychiatric diagnoses. Socio-economic factors increasing the risk for sick-leave certification were education, social allowance and occupations in manufacture and caregiving. Understanding the impact of the different factors that influence certified sick leave is important both for targeted interventions in order to facilitate patients' return to work.
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| 9. |
- Starzmann, Karin, 1965, et al.
(författare)
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No physician gender difference in prescription of sick-leave certification: a retrospective study of the Skaraborg Primary Care Database
- 2012
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Ingår i: Scandinavian Journal of Primary Health Care. - : Informa UK Limited. - 0281-3432 .- 1502-7724. ; 30:30, s. 48-54
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Tidskriftsartikel (refereegranskat)abstract
- Abstract Objective . The primary objective was to investigate how physicians ’ gender and level of experience affects the rate and length of sick-leave certifi cate prescription. The secondary objective was to study the physicians ’ gender and professional experience in relation to the diagnoses on the certifi cates. Design . Retrospective, cross-sectional study of computerized medical records from 24 health care centres in 2005. Setting . Primary care in Sweden. Subjects . Primary care physicians (n 589) and patients (n 88 780) aged 18 – 64 years. Main outcome measures . Rate and duration of sick leave certifi ed by different categories of physicians and for different diagnoses and gender of patients. Results . Sick leave was certifi ed in 9.0% (muscuoskeletal (3%) and psychiatric (2.3%) diagnoses were most common) of all contacts and the mean duration was 32.2 days. Overall there was no difference between male and female physicians in the sick-leave certifi cation prescription rate (9.1% vs. 9.0%) or duration of sick leave (32.1 vs. 32.6 days). The duration of sick leave was associated with the physician ’ s level of professional experience in general practice (GPs (Distriktläkare) 37, GP trainees (ST-läkare) 26, interns (AT-läkare) 20 and locum (vikarier) 19 days, p 0.001). Conclusion . Contrary to earlier studies we found no difference in sick-leave certification prescription rate and length between male and female physicians.
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