| 1. |
- af Sillén, Ulrika, et al.
(författare)
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Self-rated health in relation to age and gender: influence on mortality risk in the Malmö Preventive Project.
- 2005
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Ingår i: Scandinavian Journal of Public Health. - : SAGE Publications. - 1651-1905 .- 1403-4948. ; 33:3, s. 9-183
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Tidskriftsartikel (refereegranskat)abstract
- Aims: A study was undertaken to examine whether poor self-rated health (SRH) can independently predict all-cause mortality during 22-year follow-up in middle-aged men and women. Subjects and methods: Data are derived from a population-based study in Malmo¨ , Sweden. This included baseline laboratory testing and a self-administered questionnaire. The question on global SRH was answered by 15,590 men (mean age 46.4 years) and 10,089 women (49.4 years). Social background characteristics (occupation, marital status) were based on data from national censuses. Mortality was retrieved from national registers. Results: At screening 4,261 (27.3%) men and 3,085 (30.6%) women reported poor SRH. Among subjects rating their SRH as low, 1,022 (24.0%) men and 228 (7.4%) women died during follow-up. Corresponding figures for subjects rating their SRH as high were 1801 (15.9%) men and 376 (5.4%) women. An analysis of survival in subjects reporting poor SRH revealed an age-adjusted hazard risk ratio (HR, 95%CI) for men HR 1.5 (1.4–1.7), and for women HR 1.4 (1.2–1.6). The corresponding HR after adjusting for possible social confounders was for men HR 1.3 (1.1–1.4), and women HR 1.1 (0.9–1.4). When additional adjustment was made for biological risk factors the association for men was still significant, HR 1.2 (1.1–1.3). Conclusion: Poor SRH predicts increased long-term mortality in healthy, middle-aged subjects. For men the association is independent of both social background and selected biological variables. The adjustment for biological variables can be questioned as they might represent mediating mechanisms in a possible causal chain of events.
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| 2. |
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| 3. |
- Ekvall-Hansson, Eva, et al.
(författare)
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Benign Paroxysmal Positional Vertigo among Elderly Patients in Primary Health Care.
- 2005
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Ingår i: Gerontology. - : S. Karger AG. - 1423-0003 .- 0304-324X. ; 51:6, s. 386-389
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Tidskriftsartikel (refereegranskat)abstract
- <i>Background:</i>Dizziness influences well-being in old age, and benign paroxysmal positional vertigo (BPPV) is a common cause. The condition is diagnosed using the Hallpike maneuver and treated by the particle-repositioning maneuver or habituation exercises. <i>Objective:</i>To identify patients with BPPV among a variety of diagnoses represented by the ICD-10 diagnosis R42 in people 65 aged years and older who visited primary health care because of vertigo and dizziness. <i>Methods:</i>Searches were performed in the computerized medical records of 6 different health care centers over the period of 1 year for the ICD-10 diagnosis R42 and the age group 65 years and older. Letters were sent to the patients identified with an invitation for assessment and physical examination by a physiotherapist. Thirty-eight patients responded to the letter and were included in the study. All patients were assessed by physical examination including the Hallpike maneuver. <i>Results:</i> The study group included 13 men and 25 women, 65–94 (median 83) years of age. After physical examination, 15 patients were found to have BPPV (confidence interval 24–55%). <i>Conclusion:</i>In this study, 2 of 5 of the patients with ICD-10 diagnosis R42 (dizziness and giddiness) had BPPV. BPPV is probably an underestimated cause of dizziness/vertigo among elderly patients in primary health care.
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| 5. |
- Ekvall-Hansson, Eva, et al.
(författare)
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Treatment for benign paroxysmal positional vertigo - a case study
- 2005
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Ingår i: Advances in Physiotherapy. - : Informa UK Limited. - 1651-1948 .- 1403-8196. ; 7:4, s. 183-186
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Tidskriftsartikel (refereegranskat)abstract
- Benign paroxysmal positional vertigo (BPPV) is a common cause of vertigo and can be successfully treated with particle-repositioning procedures or habituation exercises. However, some patients do not tolerate this treatment. The aim of the study was to investigate the possibility of treating patients with BPPV, where treatment at first seemed too demanding for the patients, using a descriptive study in a primary health care centre setting. Three patients, aged 79, 81 and 89, with BPPV, who could not tolerate common treatment, were studied. The main outcome measure was the Dix-Hallpike manoeuvre. The patients were successfully treated with versions of manoeuvre treatment and habituation exercises, including rolling from supine to side-lying, performing habituation exercises more slowly than recommended and use of sedation. The results show that, with a few adjustments, it is possible to successfully treat patients for whom the treatment at first seems too demanding. Since BPPV is possible to treat, every opportunity to minimize vertigo among the elderly is valuable, irrespective of factors such as fear, reduced mobility, concomitant or multiple diseases.
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| 6. |
- Hansson, Eva Ekvall, et al.
(författare)
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Falls among dizzy patients in primary healthcare: an intervention study with control group.
- 2008
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Ingår i: International Journal of Rehabilitation Research. - 1473-5660. ; 31:1, s. 51-57
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Tidskriftsartikel (refereegranskat)abstract
- The objective of this study is to investigate whether vestibular rehabilitation can improve balance, reduce self-perceived handicap because of dizziness and, if possible, reduce falls among dizzy patients in primary healthcare. The study also finds out which of the balance measures and measure of self-perceived handicap, if any, predicted the risk of falls. The design of this study is an intervention study with control group. Fifty-eight patients, 65 years and older, with multisensory dizziness were taken as participants. The intervention group trained vestibular rehabilitation twice a week for 9 weeks. All patients were assessed at baseline and after 3 months, with four different balance measures and the Dizziness Handicap Inventory. After 6, 9 and 12 months, a follow-up by telephone was performed and, at 12 months, the patients also filled out a Dizziness Handicap Inventory questionnaire. Statistically significant differences were found between the groups between baseline and 3 months in one static balance measure and in one dynamic measure (P=0.038 and 0.044). In total, 40 falls were reported, 31 were classified as intrinsic falls, 26 of them caused by vertigo and nine falls were classified as extrinsic. No difference was found between the two groups in proportions of patients who fell. Poor ability to stand in tandem stance doubled the risk for falls. Vestibular rehabilitation can improve balance in elderly patients with multisensory dizziness. Vertigo is a common cause of falls in this group of patients and vestibular rehabilitation is a feasible treatment.
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| 7. |
- Håkansson, Anders, et al.
(författare)
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Research methods courses as a mean of developing academic general practice
- 2005
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Ingår i: Scandinavian Journal of Primary Health Care. - 0281-3432. ; , s. 132-136
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Tidskriftsartikel (refereegranskat)abstract
- Since 1989, the authors have given courses in research methodology, and these courses are now given at six venues in southern Sweden, as well as in Denmark. The course corresponds to half a year's full-time study, with half the time devoted to lectures and studies of literature, while the rest is spent on an individual project under supervision. To enable part-time study, the course extends over 1(1/2) years. In 15 years roughly 1000 people, mainly physicians, have been given training in basic research methods. The course model has been appreciated by clinically active colleagues, who have been able to attend a course and simultaneously work with patients. Among the GPs in the region, one in five has taken this course, and one in five has then gone on to start formal PhD studies. The authors have thus succeeded in their goal of giving basic scientific schooling to many physicians and recruiting some for further research.
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| 8. |
- Johnell, K, et al.
(författare)
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Neighborhood social participation, use of anxiolytic-hypnotic drugs, and women's propensity for disability pension: a multilevel analysis
- 2006
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Ingår i: Scandinavian Journal of Public Health. - : SAGE Publications. - 1651-1905 .- 1403-4948. ; 34:1, s. 41-48
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Tidskriftsartikel (refereegranskat)abstract
- Aims: The increasing number of people on disability pension in Sweden is of concern for Swedish policy-makers, and there is a need for a better understanding of the mechanisms behind disability pension. We investigated ( i) whether women living in the same neighborhood have a similar propensity for disability pension that relates to neighborhood social participation, and ( ii) whether there is an association between anxiolytic-hypnotic drug ( AHD) use and disability pension in women that is modified by the neighborhood context. Methods: We used multilevel logistic regression with 12,156 women aged 45 to 64 ( first level) residing in 95 neighborhoods ( second level) in the city of Malmo ( 250,000 inhabitants), Sweden, who participated in the Malmo Diet and Cancer Study ( 1991 - 96). Results: Both AHD use ( OR=2.09, 95% CI 1.65, 2.65) and neighborhood rate of low social participation ( OR=11.85, 95% CI 5.09, 27.58) were associated with higher propensity for disability pension. The interval odds ratio indicated that the influence of neighborhood social participation was large compared with the unexplained variance between the neighborhoods. The association between AHD use and disability pension was not modified by the neighborhood context. The median odds ratio was 1.44 after adjusting for individual characteristics and 1.27 after the additional adjusting for neighborhood social participation. Conclusions: Women living in the same neighborhood appear to have a similar propensity for disability pension, beyond individual characteristics, and this contextual effect seems largely explained by neighborhood social participation. In addition, AHD use might increase the propensity for disability pension in women.
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| 9. |
- Melander, Arne, et al.
(författare)
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Utilisation of antihyperglycaemic drugs in ten European countries: different developments and different levels.
- 2006
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Ingår i: Diabetologia. - : Springer Science and Business Media LLC. - 1432-0428 .- 0012-186X. ; 49:9, s. 2024-2029
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Tidskriftsartikel (refereegranskat)abstract
- Aims/hypothesis The aim of this study was to compare developments in the utilisation of antihyperglycaemic drugs (AHGDs) in ten European countries. Subhect and methods Data on the yearly utilisation of insulin and oral AHGDs were collected from public registers in Denmark, Finland, Norway, Sweden, Belgium, England, Germany, Italy, Portugal and Spain, and were expressed as defined daily doses per 1,000 inhabitants per day. Results Total AGHD utilisation increased everywhere, but at different rates and levels. Insulin utilisation doubled in England and Germany, but hardly changed in Belgium, Portugal or Italy. Sulfonylurea utilisation doubled in Spain, England and Denmark but was reduced in Germany and Sweden. Metformin utilisation increased greatly everywhere. There were two- to three-fold differences in AHGD utilisation even between neighbouring countries. In Finland, there were more users of both insulin (+120%) and oral AHGDs (+80%) than in Denmark, and the daily oral AHGD doses were higher. In Denmark and Sweden, AHGD utilisation was equal in subjects aged < 45 years, but in those >= 45 years of age, both insulin and oral AHGD utilisation were twice as high in Sweden. Conclusions/interpretation The ubiquitous increase in AHGD utilisation, particularly metformin, seems logical, considering the increasing prevalence of type 2 diabetes and the results of the UK Prospective Diabetes Study. However, the large differences even between neighbouring countries are more difficult to explain, and suggest different habits and attitudes in terms of screening and management of type 2 diabetes.
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| 10. |
- Sundbeck, Mats, et al.
(författare)
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Snuff use associated with abdominal obesity in former smokers.
- 2009
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Ingår i: Scandinavian journal of public health. - : SAGE Publications. - 1403-4948 .- 1651-1905. ; 37:5, s. 487-93
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Tidskriftsartikel (refereegranskat)abstract
- AIM: To describe the consumption of snuff in a rural male population and to explore associations between snuff use and obesity. Participants and METHODS: Tobacco use was explored in 834 men aged 30-75 years old who participated in a cross-sectional population survey in the municipality of Vara (participation rate was 81%). Self-reported questionnaires assessed the habits of smoking and snuff use. Anthropometric measures were obtained during a health examination. RESULTS: Of these men 21% (n = 179) were snuff users, 13% (n = 109) current smokers, and 65% (n = 546) were non-users. Of all snuff users 65% (n = 116) were former smokers, and 35% (n = 63) were exclusive snuff users (current users who never smoked). Among non-users 65% (n = 357) were never users and 35% (n = 189) had quit smoking without nicotine substitution. These men were characterized by abdominal obesity; OR 1.84 (1.08-3.12) (p = 0.002) (WHR 41.0) and OR 1.71 (1.08-2.72) (p = 0.022) (waist circumference 4102 cm). One can/week use of snuff among ex-smokers was associated with a 1.21 cm wider (0.05-2.36) (p = 0.041) waist circumference and 0.01 (0.00-0.02) units higher (p = 0.021) WHR. There were statistically significant associations between former smoking without current nicotine substitute and both general and abdominal obesity. No similar association with abdominal obesity was seen among exclusive snuff users. CONCLUSIONS: Abdominal obesity in current snuff users is limited to former smokers. The remaining effect of previous smoking has to be considered in future studies on obesity and related disorders in snuff users. Counselling among people who substitute snuff for smoking should include measures to prevent weight gain.
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