| 1. |
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| 2. |
- Agvall, Björn, 1963-, et al.
(författare)
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Patients in primary health care diagnosed and treated as heart failure, with special reference to gender differences
- 2001
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Ingår i: Scandinavian Journal of Primary Health Care. - : Informa UK Limited. - 0281-3432 .- 1502-7724. ; 19:1, s. 14-19
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Tidskriftsartikel (refereegranskat)abstract
- Objective - The aim of the present study was to describe patients considered to have had heart failure (HF), or were being treated for HF, in a defined area in primary health care, e.g. diagnostic procedures, aetiologic diseases and management, and to evaluate whether there is a difference between the genders. Design - Descriptive retrospective investigation. Setting - ┼tvidaberg community situated in southeast Sweden, 12 400 inhabitants. Patients - 256 patients treated for symptomatic HF. Main outcome measures - Prevalence, aetiology, diagnostic procedures and management of HF and differences between the genders. Results - The diagnosis of HF was based on an objective evaluation of cardiac function in only 31% of the patients. Ischaemic heart disease (IHD) was the predominant associated disease, followed by hypertension. Therapy included diuretics (84%), angiotensin converting enzyme (ACE) inhibitors (56%) and digoxin (40%). Only 52% had optimal doses of ACE inhibitors. Women had a significantly higher mean age and their diagnoses were based on an objective diagnostic test (echocardiography) in only 20%. Women were prescribed ACE inhibitors to a lesser extent (43%) than men (64%) and with a lower optimal dose (44% versus 56% in men). Conclusion - There is still room for improvement in the management of HF in primary health care, especially in women, where the diagnosis is not generally based on an objective evaluation of cardiac function and where the treatment to a lesser extent than in men includes ACE inhibitors.
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| 3. |
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| 4. |
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| 5. |
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| 6. |
- Blivik, J, et al.
(författare)
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Screening for low bone mineral density with quantitative ultrasound within the primary health care system
- 2004
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Ingår i: Scandinavian Journal of Primary Health Care. - : Informa UK Limited. - 0281-3432 .- 1502-7724. ; 22:2, s. 78-82
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Tidskriftsartikel (refereegranskat)abstract
- Objective - To screen risk groups for low bone mineral density by quantitative ultrasound in primary health care. Design - Cross-sectional. Intervention - None. Subjects - Risk categories for osteoporosis (a fragility fracture, malabsorption, immobilisation, inflammatory joint disease, glucocorticoid, fenantoin or thyroxin treatment, renal insufficiency or "miscellaneous"), 775 women and 179 men aged between 40 and 93 were measured. Main outcome measures - Calcaneus quantitative ultrasound stiffness index T-score below -2.5 standard deviation (SD). Results - 41% of women and 24% of men and more than 80% of women and 50% of men over the age of 80, within the risk groups, had a stiffness index T-score below -2.5 SD. All over 80 years with a fragility fracture had a stiffness index T-score below -2.5 SD. Men aged 50-59 within the risk groups had lower stiffness index T-scores than controls (-1.4 versus -0.6, p=0.05). Individuals with a fragility fracture had lower stiffness index T-scores than controls, women aged 70-79 years (-3.1 versus -2.4, p<0.05) and men aged 60-69 years (-2.3 versus -1.2, p<0.05). Conclusion - Quantitative ultrasound calcaneus used in gender-specific, diagnosis-specific and age-specific cohorts can capture individuals with low bone mass.
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| 7. |
- Bäckman, Karin, et al.
(författare)
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Deep venous thrombosis : A new task for primary health care - A randomised economic study of outpatient and inpatient treatment
- 2004
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Ingår i: Scandinavian Journal of Primary Health Care. - : Informa UK Limited. - 0281-3432 .- 1502-7724. ; 22:1, s. 44-49
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Tidskriftsartikel (refereegranskat)abstract
- Objective - A health economic evaluation of two alternative treatment settings, inpatient care and outpatient care, for acute deep venous thrombosis. Design - A randomised multicentre trial in a defined population in regular clinical practice. Setting - Hospitals and related health care centres in the Jönköping county council in Sweden. Interventions - Patients were randomised to either an inpatient strategy (n = 66) or an outpatient strategy (n = 65) using low-molecular-weight heparin, dalteparin, administered subcutaneously once daily and adjusted for body weight. Subjects - Of 224 eligible patients, 131 entered the trial and 124 completed the economic part of the study. Main outcome measures - Direct medical and direct non-medical costs during a 3-month period. Results - Total direct costs were higher for those in the inpatient strategy group, i.e. Swedish Crowns (SEK) 16 400 per patient (Euro 1899) compared to SEK 12 100 per patient (Euro 1405) in the outpatient strategy group (p < 0.001). More patients in the outpatient group received assistance when they returned home. Few patients in either group reported sick leave. There was no difference in total number of days between the two groups. Conclusions - Total direct costs were significantly lower for the outpatient treatment strategy for deep venous thrombosis compared to the inpatient treatment strategy. No significant difference in health impact could be detected. Deep venous thrombosis can to a greater extent than previously be treated in primary care, safely, at a lower cost, and in accordance with patient preferences.
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| 8. |
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| 9. |
- Carlsson, L, et al.
(författare)
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Common cancer-related symptoms among GP patients - Opportunistic screening in primary health care
- 2001
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Ingår i: Scandinavian Journal of Primary Health Care. - 0281-3432 .- 1502-7724. ; 19:3, s. 199-203
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Tidskriftsartikel (refereegranskat)abstract
- Objective-To study the occurrence of symptoms related to the five most common forms of cancer among patients regularly visiting primary care. To estimate the proportion of symptoms needing GP examination, and the number of tumours thus diagnosed. Design-Patients with some form of non-malignant chronic disease received a letter with information about cancer-related symptoms along with an invitation to regular check-up. The letter described the most common symptoms of breast, colorectal, lung, prostate and skin cancers. Setting-12 health centres in Kalmar County, Sweden. Subjects-5200 patients aged over 40 years. Results-One patient in 13 reported cancer-related symptoms to the GP. Women reported more symptoms than men, and almost half of them had had symptoms at previous check-ups. The GP was able to explain 7 out of 10 patients' symptoms directly. When other symptoms were examined, 8 cancers were diagnosed as well as 6 pre-malignant tumours, corresponding to 3 tumour diagnoses per 1000 check-ups. Conclusion-While attending regular check-ups, patients may not report symptoms which cause anxiety and sometimes indicate serious diseases. It is possible to widen the perspective and link both primary and secondary prevention of certain cancers to the check-up.
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| 10. |
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| 11. |
- Cederholm, Jan, et al.
(författare)
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Blood pressure and other cardiovascular risk factors among treated hypertensives in Swedish primary health care
- 2002
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Ingår i: Scandinavian Journal of Primary Health Care. - : Informa UK Limited. - 0281-3432 .- 1502-7724. ; 20:4, s. 224-229
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To evaluate antihypertensive treatment and other cardiovascular risk factors in primary health care.DESIGN: Cross-sectional survey of consecutive patients with treated hypertension in 1999.SETTING: 17 primary care centres in Sweden.SUBJECTS: 512 patients (mean age 67; SD 11 years).MAIN OUTCOME MEASURES: Antihypertensive treatment, cardiovascular risk factors.RESULTS: Patients with high diastolic BP (> or = 100 mmHg) and systolic BP (> 180 mmHg) values were few. The proportions with diastolic BP < 90, BP < 160/95 and < 140/90 mmHg were 64%, 54% and 15%. Mono-therapy was given in 51%, and > or = 3 drugs in 13%. Hypertensives with hyperlipidaemia were 42%, and only 26% of them were given lipid-lowering drugs, mainly statins, 21%. Smokers were 10%, 23% had diabetes, and many had overweight BMI = 25 kg/m2, 72%.CONCLUSION: Although two-thirds had diastolic BP < 90 mmHg, few had BP below the current treatment target < 140/90 mmHg. More than half of the hypertensives had at least one additional cardiovascular risk factor, and these hypertensives also had low proportions within several current treatment targets of hypertension and hyperlipidaemia, implying a need for intensified multiple risk factor intervention.
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| 12. |
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| 13. |
- Engström, Sven, et al.
(författare)
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Is general practice effective? : A systematic literature review
- 2001
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Ingår i: Scandinavian Journal of Primary Health Care. - : Informa UK Limited. - 0281-3432 .- 1502-7724. ; 19:2, s. 131-144
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Tidskriftsartikel (refereegranskat)abstract
- Objective - To find evidence of the effectiveness of physicians working in primary care. Design - Systematic literature search in the Medline and Cochrane databases. Material - Out of 7223 titles found in the search, 45 studies, comparing, from different aspects, primary care with specialist care, were extracted. Main outcome measures - Health indicators, health care costs, quality of health care. Results - Primary care contributed to improved public health, as expressed through different health parameters, and a lower utilisation of medical care leading to lower costs. Physicians working in primary care, in comparison with other specialists, took care of many diseases without loss of quality and often at lower cost. The organisation of primary care was important in respect of reimbursement by capita tion, more group practices, higher personal continuity, and having generalists as primary care physicians. Conclusions - To compare the effectiveness of primary care and specialist care is a complex task and there are limitations in all studies. However, we have found evidence that increased accessibility to physicians working in primary care contributes to better health and lower total costs in the health care system. It is also clear that studies with evaluation of how to most effectively organise primary care are far too few. There is an extensive need for future research in this area, a suitable task for collaborative research between the Nordic countries.
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| 14. |
- Forssén, Annika, et al.
(författare)
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Work, health and ill health : new research makes women's experiences visible
- 2001
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Ingår i: Scandinavian Journal of Primary Health Care. - : Informa UK Limited. - 0281-3432 .- 1502-7724. ; 19:3, s. 154-7
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Tidskriftsartikel (refereegranskat)abstract
- This study presents new knowledge about women’s work, health and ill health. The point of departure is a lack of knowledge and understanding in medical research and practice of women’s work and experiences of ill health. The study is qualitative and based on the life histories of 20 elderly women. What can be learned from them is often of use also in the encounter with younger female patients. The research constitutes a part of feminist science. The women taught us about invisible and heavy work, paid and unpaid, and often carried out for the benefit of others. The relationship between the married women and their husbands had a strong impact on both the women’s work and their health. Being responsible for other people’s well being, and with little sway over their working conditions, the women often had difficulty looking after their own health. The results point to the necessity of asking women thorough questions about their everyday life when they seek primary health care. Great parts of their work and working conditions, crucial to their health, might otherwise be overlooked over.
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| 15. |
- Fritz, Tomas, et al.
(författare)
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Walking for exercise - immediate effect on blood glucose levels in type 2 diabetes
- 2001
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Ingår i: Scandinavian Journal of Primary Health Care. - : Informa UK Limited. - 0281-3432 .- 1502-7724. ; 19:1, s. 31-33
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Tidskriftsartikel (refereegranskat)abstract
- Objective - To determine the immediate effect of walking on blood glucose levels in patients with type 2 diabetes. Design - Participating patients walked for half an hour on one occasion and on another day they remained physically inactive for half an hour. Blood glucose was measured before and after walking and resting. Setting - Krokom in the north of Sweden. Patients - Thirty-nine persons with type 2 diabetes, aged 63 (SD 8.5). Main outcome measures - Difference of blood glucose levels before and after walking and resting respectively. Results ? Post-walk glycaemic levels were reduced by 2.2 mmol/l (SD 1.5). No significant reduction could be observed after a period of physical rest. Conclusion ? Walking can be safely employed in groups or individually as an introduction to low-intensity exercise and as a demonstration of its blood glucose lowering effect in type 2 diabetes.
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| 16. |
- Fröjdh, Karin, et al.
(författare)
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Are there any clinical characteristics of depression in elderly people that could be useful for case finding in general practice?
- 2003
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Ingår i: Scandinavian Journal of Primary Health Care. - : Informa UK Limited. - 0281-3432 .- 1502-7724. ; 21:4, s. 214-218
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: The aim of this study was to identify clinical characteristics of depression in elderly people that could be useful for case finding in general practice. DESIGN: A cross-sectional study of clinical characteristics through review of medical records. SETTING: Herrhagen health centre, Karlstad, Sweden. SUBJECTS: Seventy-one persons with a high depressive score in a screening of depressive symptoms and an age-matched and sex-matched control group of 138 persons with a low depressive score. RESULTS: The high depressive score group had an increased relative risk for "mental health problems" (RR 3.4; CI 95% 1.7-7.2), "many contacts with the health care centre" (> or = 14/3 years) (RR 2.9; CI 95% 1.4-6.1), and prescriptions of benzodiazepines (RR 1.7; CI 95% 1.0-2.9). Two-thirds of those in the high depressive score group had at least one of these characteristics. However, three-quarters of those with any of these characteristics had a low depressive score. In our population of elderly people with an estimated prevalence of 10.2% the positive predictive value would be 21% and the negative predictive value 95%. CONCLUSION: General practitioners should suspect a possible depressive disorder in elderly patients with mental health problems, with frequent contacts with the health centre or with prescriptions of benzodiazepines. Despite the high occurrences of these prominent clinical characteristics in the high-score group, they did not unfortunately have sufficient discriminatory power to be useful for case finding.
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| 17. |
- Getz, Linn, et al.
(författare)
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A matter of heart: the general practitioner consultation in an evidence-based world
- 2003
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Ingår i: Scandinavian Journal of Primary Health Care. - : Informa UK Limited. - 0281-3432 .- 1502-7724. ; 21:1, s. 3-9
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Tidskriftsartikel (refereegranskat)abstract
- This article is based on a keynote presentation at the 12th Nordic Congress in General Practice in Trondheim, Norway in September 2002. The aim was to demonstrate the strengths and limitations of evidence-based medicine (EBM) in a primary healthcare setting. The presentation comprised two separate lectures discussing an authentic case history from everyday practice that had been presented to the authors by the congress organisers. Initially, Peter Nilsson overviews the correct approach to the situation as described according to EBM. Subsequently, Linn Getz questions whether we can be sure that application of EBM is necessarily in this particular patient's best interests. The title of the presentation, 'A matter of heart', has a double meaning. On the one hand it indicates an update on preventive cardiology, on the other it addresses the importance of academic courage (coeur = heart) among members of the medical community. The general practitioner is in a unique position to observe the interaction between the scientific paradigm of biomedicine and individuals, whether suffering from ill health or considering themselves healthy. It is our privilege and professional duty to reflect upon clinical experience and be open to critical debate.
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| 18. |
- Halling, Anders, et al.
(författare)
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Diagnosis and treatment of heart failure in primary health care among elderly patients with non-insulin-dependent diabetes mellitus, with special reference to use of echocardiography
- 2003
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Ingår i: Scandinavian Journal of Primary Health Care. - OSLO : TAYLOR & FRANCIS AS. - 0281-3432 .- 1502-7724. ; 21:2, s. 96-98
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Tidskriftsartikel (refereegranskat)abstract
- Objective-The aim of the present study was to describe how the diagnosis of heart failure (HF) was assessed, aetiology and management in elderly patients with non-insulin-dependent diabetes mellitus (NIDDM) in primary health care, with special reference to use of echocardiography. Design-Descriptive retrospective investigation. Setting-Ronneby and Karlskrona communities, both situated on the Swedish south-east coast, 28,600 and 60,600 inhabitants, respectively. Patients-279 patients with NIDDM, mean age 77 years (range 70-85). Main outcome measures-Prevalence, aetiology, diagnostic procedures and management of HF. Results-The majority of patients were given the diagnosis of HF mainly as a result of clinical examination, ECG and chest X-ray, or of hospitalisation for HF. The diagnosis of HF by the primary care physicians was based on an objective evaluation of cardiac function in 8% of the patients. Hypertension was the predominant associated disease, followed by ischaemic heart disease (IHD). Therapy included diuretics (91%), angiotensin-converting enzyme (ACE) inhibitors (43%) and digoxin (53%). Conclusion-There is still a gap between current management of HF in primary care and guidelines, particularly in the case of diagnosis that is not generally based on an objective evaluation of cardiac function.
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| 19. |
- Hasselgren, Mikael, 1964-, et al.
(författare)
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Estimated prevalences of respiratory symptoms, asthma and chronic obstructive pulmonary disease related to detection rate in primary health care
- 2001
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Ingår i: Scandinavian Journal of Primary Health Care. - : Taylor & Francis. - 0281-3432 .- 1502-7724 .- 0000-0000. ; 19:1, s. 54-57
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To assess the prevalence of respiratory symptoms, asthma and chronic obstructive pulmonary disease (COPD), and to relate it to an estimated detection rate in primary health care.DESIGN: A two-staged study with a cross-sectional survey and a clinical validation.SETTING: The adult population of Värmland, a county in Sweden.SUBJECTS: 4814 persons completed the survey and 206 the confirmative validation study.MAIN OUTCOME MEASURES: Prevalence of respiratory symptoms, of asthma and COPD.RESULTS: More than 40% reported respiratory symptoms. Wheeze was reported by 8.0%, shortness of breath by 11.4% and sputum production by 14.1%. Smoking was more common among women than among men. The prevalence of asthma was 8.2% and COPD 2.1%. Of persons with asthma, 33% were estimated to be undiagnosed, 67% used medication and nearly 60% attended primary health care services.CONCLUSION: Respiratory symptoms as well as asthma were common in this study and equivalent to earlier findings. The difference between the epidemiologically estimated prevalence of asthma and the lower detection rate in primary health care can be explained by at least three factors: persons who did not seek any care, were underdiagnosed or attended other health care providers.
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| 20. |
- Hägglund, Doris, 1949-, et al.
(författare)
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Changes in urinary incontinence and quality of life after four years : a population-based study of women aged 22-50 years
- 2004
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Ingår i: Scandinavian Journal of Primary Health Care. - : Informa UK Limited. - 0281-3432 .- 1502-7724. ; 22, s. 112-117
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES:To investigate (a) the incidence and remission rates of female urinary incontinence (UI), (b) changes in type of UI and quality of life (QoL), and (c) whether professional help had been consulted regarding UI.DESIGN:A 4-year follow-up population-based cohort study.SETTING:Surahammar, Sweden, a community of 10,500 inhabitants.SUBJECTS:All 118 incontinent and 130 continent women aged between 22 and 50 years.MAIN OUTCOME MEASURES:Changes in type of UI were measured using the Detrusor Instability Score (DIS), which was used to distinguish between the stress incontinent and the urge incontinent women. Changes in QoL were measured using the SF-36 Health Survey.RESULTS:The mean annual incidence and remission rates of UI were the same (4%). The majority of women (83%) reported unchanged UI after 4 years and 77% of these women had stress incontinence. At follow-up, the changes in QoL scores were significantly greater in five out of eight dimensions in the persistently incontinent group compared with the persistently continent group. QoL scores did not change significantly from baseline to the 4-year follow-up within the incidence and remission groups. Three of four women with UI had not sought professional help.CONCLUSIONS:At 4-year follow-up the type of UI is fairly stable in women below 50 years of age. The QoL decreases in five dimensions, but the clinical relevance of this might be questioned. Most women with UI had not sought professional help.
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| 21. |
- Johansson, Birgitta, et al.
(författare)
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The role on the general practitioner in cancer care and the effect of an extended information routine
- 2000
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Ingår i: Scandinavian Journal of Primary Health Care. - : Informa UK Limited. - 0281-3432 .- 1502-7724. ; 18:3, s. 143-148
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To describe the role of the General Practitioner (GP) in the care of one specified cancer patient per GP, and to explore the GP's knowledge about that patient's disease and treatments, and what information she/he wanted versus received from the specialist clinic. A further aim was to evaluate the effects of an Extended Information Routine (EIR), including increased information from the specialist clinic to the GP.DESIGN:Semi-structured interviews with GPs about a patient randomised between an extended information routine and standard information from the specialist clinics.SETTINGS:Primary Health Care.SUBJECTS:20 GPs, 10 who received extended information about the specified patient and 10 who did not.MAIN OUTCOME MEASURES:The extent of GPs' contact with the patient, GPs' potential or actual possibilities to support the patient, desired and received information from the specialist clinic.RESULTS AND CONCLUSIONS: GPs are commonly involved in the care of cancer patients, particularly in the diagnostics of the disease but also during the periods of treatment and follow-up. The information from the specialist clinic to the GP is insufficient in standard care. The extended information routine increased the GPs' knowledge of the disease and treatments, and facilitated their possibilities to determine patients' need for support.
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| 22. |
- Johansson, Eva, et al.
(författare)
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Gender bias in female physician assessments : Women considered better suited for qualitative research
- 2002
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Ingår i: Scandinavian Journal of Primary Health Care. - : Informa UK Limited. - 0281-3432 .- 1502-7724. ; 20:2, s. 79-84
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To analyse whether physician assessment of scientific quality is biased by gender. DESIGN: Two fictive research abstracts on back pain treatment were constructed, one with a quantitative and one with a qualitative design. Authorship was assigned to either a woman or a man. SUBJECTS: 1637 randomly selected Swedish physicians were asked to judge the scientific quality of the two designs in a structured assessment form. MAIN OUTCOME MEASURES: The assessments of 1364 abstracts (286 female and 394 male assessors) were analysed by chi-square test and logistic regression. RESULTS: The quantitative design was judged the same, regardless of the gender of the author or assessor. The qualitative design, however, was ranked as more accurate, trustworthy, relevant and interesting with a female author. Women assessors upgraded female authors more than male authors, while male assessors reflected no gender differences. Assessor speciality interacted with judgement; physicians in primary care appreciated the qualitative abstract more than hospital physicians did (OR 2.78; 95% CI 1.97-3.92). CONCLUSION: Gender seems to affect scientific evaluations. The results are worth considering in situations where research is judged and interpreted, in medical tutoring, research guidance, peer reviewing and certainly in forming evaluation committees for research funding.
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| 23. |
- Krakau, I
(författare)
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The importance of practice-based evidence
- 2000
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Ingår i: Scandinavian journal of primary health care. - : Informa UK Limited. - 0281-3432 .- 1502-7724. ; 18:3, s. 130-131
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
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| 24. |
- Lagerström, Folke, et al.
(författare)
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Sputum specimens can be obtained from patients with community-acquired pneumonia in primary care
- 2004
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Ingår i: Scandinavian Journal of Primary Health Care. - : Informa UK Limited. - 0281-3432 .- 1502-7724. ; 22:2, s. 83-86
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Tidskriftsartikel (refereegranskat)abstract
- Objective - To improve the aetiological diagnosis in community-acquired pneumonia (CAP) increased efforts were made to obtain expectorated sputum specimens from patients with CAP. Design - A prospective, clinical study. Patients were encouraged to cough spontaneously and to expectorate a sputum specimen. If unsuccessful, they were asked to inhale nebulized hypertonic saline to induce secretion and cough. Setting - One primary health care centre in Örebro, Sweden. Subjects - Patients attending the Health Centre with acute symptoms of CAP. Main outcome measures - Availability and quality of sputum specimen from patients with CAP in primary care. Results - 177 patients were included, 63% were women and the mean age was 51years. 28% were smokers and 46% showed infiltrates on chest X-ray. Sputum specimens were obtained from 125 patients. Fifty-nine were expectorated spontaneously and 66 were induced. Ninety-one of the specimens were found to be acceptable, whereas 34 were discarded. Potential pathogens were found in 57% of the 91 specimens. Conclusion - Acceptable sputum specimens can be obtained with some effort from approximately half of the patients in primary care. Sputum culture might improve the knowledge of the bacterial aetiology of CAP in selected patients and in epidemiological studies.
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| 25. |
- Lindell, Lisa, et al.
(författare)
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Prevalence of fibromyalgia and chronic widespread pain
- 2000
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Ingår i: Scandinavian Journal of Primary Health Care. - Abingdon : Taylor & Francis. - 0281-3432 .- 1502-7724. ; 18:3, s. 149-153
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To explore the prevalence of fibromyalgia and chronic widespread musculoskeletal pain in a general population using the criteria of the American College of Rheumatology from 1990.DESIGN: Structured interview and clinical examination, including tender-point count and pain threshold measured with a dolorimeter, of subjects with suspected chronic widespread musculoskeletal pain.SETTING: The general population in south-west Sweden 1995-1996.SUBJECTS: 303 individuals with suspected chronic widespread pain were identified in a previously defined cohort containing 2425 men and women aged 20-74 years. 202 individuals were invited and 147 agreed to participate.MAIN OUTCOME MEASURES: Tenderpoint count, pain threshold and prevalence of chronic widespread pain and fibromyalgia.RESULTS: The prevalence of fibromyalgia was estimated to 1.3% (95% CI 0.8-1.7; n = 2425) and that of all chronic widespread pain to 4.2% (95% CI 3.4-5.0; n = 2425). The mean pain threshold measured with a dolorimeter was lower in subjects with chronic widespread pain (p < 0.01) and correlated with the number of tender points (r = -0.59, p < 0.01) but could not be used to distinguish the subjects with fibromyalgia.CONCLUSION: Compared to other studies, fibromyalgia and chronic widespread musculoskeletal pain seemed to be relatively rare conditions in the south-west of Sweden.
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| 26. |
- Lindström, Kjell, et al.
(författare)
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Determinants of hospitalisation rates : does primary health care play a role?
- 2003
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Ingår i: Scandinavian Journal of Primary Health Care. - : Informa UK Limited. - 0281-3432 .- 1502-7724. ; 21:1, s. 15-20
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Tidskriftsartikel (refereegranskat)abstract
- Objective - To analyse the influence of rates of general practitioner visits on rates of hospitalisations.Design - Ecological cross-sectional study of factors influencing hospitalisation rates. Aggregated data on primary care centre area level.Setting - The county of Östergötland, Sweden, with 3 hospital districts and 41 primary health care centres, and the hospital district of Jönköping in the county of Jönköping, Sweden, with 11 primary health care centres.Outcome measure - Hospitalisation rates.Results - Age and rates of outpatient hospital visits were the most important factors explaining the variation in rates of hospitalisations between the primary health care centre areas. Hospital districts, socioeconomic factors and rates of GP visits also influenced the rates of hospitalisations.Conclusion - When evaluating the influence of primary health care on the rates of hospitalisations, both socioeconomic factors and health care structure must be taken into consideration. Doing this, the rates of GP visits correlated negatively with the rates of hospitalisations.
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| 27. |
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| 28. |
- Lundh, Christel, 1948, et al.
(författare)
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Generation shift in family vs. working conditions as most important influence on women's mood? The Prospective Population Study of Women in Gothenburg, Sweden.
- 2004
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Ingår i: Scandinavian journal of primary health care. - : Informa UK Limited. - 0281-3432 .- 1502-7724. ; 22:2, s. 101-5
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To find out whether family or working conditions is most important for mood in different ages in women. DESIGN: Prospective study. SETTING: Göteborg, Sweden, population about 430,000. SUBJECTS: Representative samples of a general population of women, born in 1930 (n = 276), 1942 (n = 93) and 1954 (n = 61), examined both in 1980-81 and 1992-93. MAIN OUTCOME MEASURES: Associations between "mood" and different social factors indicated by correlation coefficients and studied cross-sectionally and longitudinally. RESULTS: In younger women, the variable "mood" was associated with variable work situation but not family situation (correlation coefficient 0.47, p <0.001, and correlation coefficient 0.26, not statistically significant, respectively), while in older women "mood" was associated with variable family situation as well as work situation (correlation coefficients 0.45 and 0.41, p <0.01 both). Changes in the mood variable between 1980-81 and 1992-93 were associated with changes in working conditions in the younger cohort, but with changes in variable family conditions in the older cohort. CONCLUSIONS: In the latest born cohort, the importance of women's paid work outside the home was increased as an influential factor on mood in comparison with the importance of the family situation, while the situation was the opposite in the earlier born cohorts.
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| 29. |
- Lundh, Christel, 1948, et al.
(författare)
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To be a helpless helpoholic--GPs' experiences of women patients with non-specific muscular pain.
- 2004
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Ingår i: Scandinavian journal of primary health care. - : Informa UK Limited. - 0281-3432 .- 1502-7724. ; 22:4, s. 244-7
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: To explore and describe what it means to be a GP meeting patients with non-specific symptoms. DESIGN: Focus group interviews analysed in a phenomenological approach. SETTING: GPs at two urban healthcare centres from a big city, a low socioeconomic area with mostly immigrants and a high socioeconomic area, and from a smaller town. SUBJECTS: 14 GPs in 3 focus groups. RESULTS: The essence of the study was the GPs' feeling of being a "helpless helpoholic". All GPs specified the patient with non-specific symptoms as a female patient with muscular pain. The key constituents were: inconsistent patient, insufficient tools, frustration, helplessness, and devotion to help. The tools were described as communication skills, biomedical education, and holistic perspective. Even if most informants were trained in communication skills, this did not help to avoid the feeling of helplessness. CONCLUSIONS: To be a "helpless helpoholic" may make the GPs less patient-centred and may create even more feelings of frustration and helplessness. This can be an important reason why consultations with female patients with non-specific muscular pain often fail.
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| 30. |
- Lundqvist, Gunnar, 1945-, et al.
(författare)
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Smokers in Västerbotten County, Sweden. What contributes to increased cardiovascular risk among heavy smokers?
- 2003
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Ingår i: Scandinavian Journal of Primary Health Care. - 0281-3432 .- 1502-7724. ; 21:4, s. 237-241
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To analyse risk factor levels and risk factor patterns among heavy smokers compared to never smokers. DESIGN: An incident case-referent study. SETTING: The study was nested within the Västerbotten Intervention Programme (VIP). SUBJECTS: 286 people (62 women and 224 men) claimed to be heavy smokers, i.e. smoked 25 cigarettes or more per day. For each of them, two referents (who reported never to have been smokers) were matched on age and gender (572 referents). MAIN OUTCOME MEASURES: Differences in biomedical variables and social and lifestyle factors were confirmed. RESULTS: S-cholesterol, s-triglycerides, fasting blood glucose, body weight and body mass index were all significantly elevated among the heavy smokers. Some gender differences were also found. Social and lifestyle factors differed significantly between heavy smokers and never smokers, but without gender differences. CONCLUSIONS: Heavy smokers carry a risk factor pattern corresponding to an increased risk of developing cardiovascular disease. Unfavourable changes in serum lipids and in glucose metabolism can exacerbate other deleterious effects of tobacco smoke on the cardiovascular system. Obviously, heavy smokers and never smokers differ not only in regard to biomedical variables but also to lifestyle and social health determinants. These are important factors to consider in public health efforts aimed at reducing the increased risk for cardiovascular diseases among smokers.
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| 31. |
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| 32. |
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| 33. |
- Månsson, Jörgen, 1958, et al.
(författare)
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Collection and retrieval of structured clinical data from electronic patient records in general practice. A first-phase study to create a health care database for research and quality assessment.
- 2004
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Ingår i: Scandinavian journal of primary health care. - : Informa UK Limited. - 0281-3432 .- 1502-7724. ; 22:1, s. 6-10
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To evaluate prerequisites, practicalities, attitudes and limitations related to the collection of structured clinical data in everyday general practice for use in the future establishment of a national registration network. DESIGN: Prospective study. SETTING: Primary health care centres in south-western Sweden. SUBJECTS: Fourteen participating general practitioners in five primary health care centres. MAIN OUTCOME MEASURES: Feasibility and workload involved in structured data entry and in the retrieval of data from different record systems. The accuracy of clinical data in terms of clinical variables, correctness and representativeness. RESULTS: All four record systems could deliver basic data on the patient population. One centre had to be excluded from further data retrieval because of limitations in the data retrieval export format. Collecting data in everyday practice was feasible with acceptable data accuracy and moderate workload. CONCLUSION: It was feasible to collect, retrieve and store structured clinical data with respect to accuracy and extra workload. Interest in a national registration network and an increasing demand for information about primary health care in order to optimise clinical practices and support research, creates prerequisites for establishing a valid and reliable database. However, developmental work focusing on classification limitations, coding tools and routines for data retrieval is necessary.
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| 34. |
- Nilsson, Berit, 1940-, et al.
(författare)
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Sense of coherence in different stages of health and disease in northern Sweden : Gender and psychosocial differences
- 2000
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Ingår i: Scandinavian Journal of Primary Health Care. - : Informa Healthcare. - 0281-3432 .- 1502-7724. ; 18:1, s. 14-20
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Tidskriftsartikel (refereegranskat)abstract
- Objective - To investigate ?Sense of Coherence? (SOC) and its relation to perceived health, different stages of disease, and different psychosocial factors in a population-based study. Design - Postal survey of a population-based sample, the MONICA study (1994). Setting - Norrbotten and Västerbotten, the two northernmost counties in Sweden, with a total population of 510,000 inhabitants. Subjects - 837 men and 882 women in three mutually-exclusive groups: stomach trouble of many years' standing, identified disease (stroke, cardiac infarction, diabetes, anti-hypertension treatment) and no reported disease. Main outcome measures - SOC scores in relation to sociodemographic variables and perceived health. Results - We found a relationship between low SOC scores and poor perceived health, low social support and low emotional support on a population level. When comparing persons with stomach trouble with those without disease, or with established diseases, we found similar relationships between low mean SOC scores in all strata for both women and men. ?Perceived health?, however, was only significantly correlated for women, and women had an overall stronger relationship. Conclusions - In a study in northern Sweden, female patients with stomach trouble comprise a vulnerable group. The concept of SOC introduces a new dimension for perceiving health and disease. In clinical practice, care providers can identify and elaborate on the relationship between SOC scores and sociodemographic data.
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| 35. |
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| 36. |
- Nilsson, Gunnar, et al.
(författare)
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Textual content, health problems and diagnostic codes in electronic patient records in general practice
- 2003
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Ingår i: Scandinavian Journal of Primary Health Care. - : Informa UK Limited. - 0281-3432 .- 1502-7724. ; 21:1, s. 33-36
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Tidskriftsartikel (refereegranskat)abstract
- Objective - To investigate textual content, health problems and diagnostic codes in everyday electronic patient records. Design - Retrospective and observational database study. Setting - Primary health care in Stockholm. Subjects - Twenty randomly selected general practitioners with 20 records each. Main outcome measures - The frequency of use of problem-oriented medical records. The number of words, problems and diagnostic codes. The completeness and correctness of the diagnostic codes. Results - About 14.5% of 400 studied records were problem-oriented. The mean number of words per record was 99.4, and the mean number of problems managed per record was 1.2. On average, there were 1.1 diagnostic codes per record and this differed widely among GPs and also among the electronic patient record systems. The mean number of codes per problem was 0.9, and the proportion of correct codes was 97.4%. Conclusions - The electronic patient records in general practice in Stockholm have an extensive textual content. A vast majority of the problems are coded and the completeness and correctness of diagnostic codes are high. It seems that problem-oriented electronic patient record systems enforce coding activities. It is feasible to establish a database of diagnostic data for research and health care planning based on electronic patient records.
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| 37. |
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| 38. |
- Nilsson, P, et al.
(författare)
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Gender differences in secondary prevention of coronary heart disease: reasons to worry or not?
- 2003
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Ingår i: Scandinavian Journal of Primary Health Care. - : Informa UK Limited. - 0281-3432 .- 1502-7724. ; 21:1, s. 37-42
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Tidskriftsartikel (refereegranskat)abstract
- Objective - To analyse potential gender differences in cardiovascular risk factors and treatment patterns, reflecting clinical practice in secondary prevention. Design - Observational national study during 3 years of patients eligible for secondary prevention of coronary heart disease (CHD). Setting - Fifty-two healthcare districts in Sweden, involving primary health care and hospitals in collaboration, participating in a national quality assurance programme for the prevention of CHD. Subjects - A national sample of male and female patients surviving acute myocardial infarction, or following CABG/PTCA interventions for CHD, controlled at 3-6 months (n=9135) and 12 months (n=4802) of follow-up. The proportion of female patients (25%) did not differ between visits. Main outcome measures - Self-reported data on lifestyle, drug treatment and cardiovascular risk factor levels after consultation in general practice or at hospital policlinics. Results - No major gender differences were recorded in risk factor levels or in cardiovascular drug treatment patterns at 12 months of follow-up. Female patients participated in educational programmes to improve lifestyle to a higher degree than males (52.0 vs 45.1%), but after 1 year were more often (p < 0.001) self-reported smokers (11.7 vs 8.4%). Female patients showed higher levels of blood pressure, total cholesterol and HDL cholesterol, but not LDL cholesterol compared to male patients. Conclusions - In general, a gender-equal level of lipid control and access to medical drug treatment has been established for patients in secondary prevention from a national sample in Sweden, followed for 1 year after CHD manifestations and related interventions.
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| 39. |
- Nilsson, Sverker, et al.
(författare)
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Trends in the misuse of androgenic anabolic steroids among boys 16-17 years old in a primary health care area in Sweden
- 2001
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Ingår i: Scandinavian Journal of Primary Health Care. - Stockholm : Almqvist & Wiksell Periodical Company. - 0281-3432 .- 1502-7724. ; 19:3, s. 181-182
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Tidskriftsartikel (refereegranskat)abstract
- Objective To evaluate the effects of an appearance programme in preventing the misuse of androgenic anabolic steroids among male adolescents in a primary health care area in Sweden. Methods Attitudes to steroid hormones among 16-17 years old male and female adolescents are discussed. A well-established anonymous multiple-choice questionnaire was answered by 921 adolescents and statistically analysed. Results The misuse of androgenic anabolic steroids tended to decrease after the intervention. Conclusions The misuse of androgenic anabolic steroids did not increase, and even tended to decrease, after the intervention, indicating that drug-abuse among male adolescents can be decreased through discussions about appearance and attitudes. Repeat and prospective studies have to be done before this intervention programme can be generalised.
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| 40. |
- Norbergh, Karl-Gustaf, et al.
(författare)
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A retrospective study of functional ability among people with dementia when admitted to group-dwelling
- 2001
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Ingår i: Scandinavian Journal of Primary Health Care. - : Informa UK Limited. - 0281-3432 .- 1502-7724. ; 19:1, s. 39-42
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Tidskriftsartikel (refereegranskat)abstract
- Objective - To describe functional ability among people with dementia when admitted to group-dwelling (GD) during different time periods, and the probability of their remaining in these units for the rest of their lives. Design - Retrospective study of functional ability and likelihood of staying in GD. Setting - Thirteen GD units in the Sundsvall region, Sweden. Subjects - One-hundered-and-forty-two demented people admitted to GD in the period 1986-1996. Main outcome measures - Ability to manage personal care and somatic and psychiatric status were measured with the use of a rating scale. Result - On comparing people over the years, a significant increase was found in the need of assistance to manage everyday life on admission to GD. The likelihood of living the rest of life in GD has increased over time. Conclusions - Increasing dependency and increasing probability óf remaining in GD may influence the intention of GD as a unique way of caring for people with dementia. It is crucial to consider these changes in order to to encourage the development of GD.
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| 41. |
- Ólafsdóttir, María, et al.
(författare)
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Dementia in Primary Care : Why the Low Detection Rate?
- 2001
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Ingår i: Scandinavian Journal of Primary Health Care. - : Informa UK Limited. - 0281-3432 .- 1502-7724. ; 19:3, s. 194-198
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Tidskriftsartikel (refereegranskat)abstract
- Objective - The aim of the present study was to find reasons for the low detection rate of dementia in primary care. Another aim was to investigate the attitudes and knowledge on dementia among Swedish general practitioners (GPs).Design - Two-hundred-and-twenty-eight postal questionnaires were distributed to GPs in the county of Östergötland. Setting - Primary care in Sweden.Main outcome measures - The opinions of GPs on dementia management in primary care.Results - The response rate was 67%. GPs showed a good knowledge of dementia diseases but underestimated the occurrence of dementia. They presented a positive attitude towards managing patients with dementia and considered that existing drug therapy justified an active search for patients with dementia in primary care, but they believed the efficacy of the drugs to be limited. Assessing the social environment of patients and organising social support were regarded as the most difficult tasks in the management of demented patients.Conclusion - The study indicates that the main obstacles are a lack of resources and a sceptical attitude to the benefits of drug treatment. Co-operation between the community services, specialist clinics and the primary care team should be improved.
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| 42. |
- Petersson, C, et al.
(författare)
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General parental education in Sweden: participants and non-participants
- 2003
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Ingår i: Scandinavian Journal of Primary Health Care. - : Informa UK Limited. - 0281-3432 .- 1502-7724. ; 21:1, s. 43-46
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Tidskriftsartikel (refereegranskat)abstract
- Objective - To study factors of importance for participation in parental education within routine child health care. Design - All parents of children born during 1 year were invited by the district nurse to participate in parental education; their participation during the infant year was registered. Setting - Catchment area of two health centres in Vaxjo, Sweden. Subjects - 221 infants and their parents. Main outcome measures - Number of educational sessions for mothers and fathers. Results - 63% of mothers and 20% of fathers attended at least one session. These mothers attended a mean of 5.7 (SD 2.2) sessions and these fathers a mean of 2.8 (SD 2.3) sessions. Logistic regression analyses showed that the only variable of significance for participation was being a first-time parent (odds ratio 3.9 for the mothers and 3.7 for the fathers). Odds ratios above 2.0 (non-significant) were found for married mothers and Swedish mothers, as well as for Swedish fathers. Conclusion - It is still a considerable problem to get certain groups involved in routine parental education in Swedish child healthcare programmes.
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| 43. |
- Petersson, Ulla, et al.
(författare)
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Thyroid function tests, serum lipids and gender interrelations in a middle-aged population
- 2001
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Ingår i: Scandinavian Journal of Primary Health Care. - : Informa UK Limited. - 0281-3432 .- 1502-7724. ; 19:3, s. 183-185
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To study the value of screening for thyroid function in a screening program for hyperlipidaemia. DESIGN: A screening study in primary health care. SETTING: All individuals in a defined rural area, Söderåkra, Sweden, aged 40-59 years were invited to a screening programme at the local primary health care centre. PARTICIPANTS: 782 individuals were invited for screening. Blood samples were obtained from 88% of the invited males and from 92% of the females. MAIN OUTCOME MEASURES: Thyroid function tests (thyroid stimulating hormone (TSH) and free T4), serum lipids (total-cholesterol, HDL-cholesterol, LDL-cholesterol and s-triglycerides), b-glucose and body anthropometry (body mass index and waist to hip circumference) were measured. RESULTS: 0.57% of males and 1.13% of females showed evidence of hypothyroidism as defined by a TSH value greater than 3.75 mU/l of those with s-cholesterol concentration above 7 mmol/l. In addition, higher TSH values in females were associated with higher s-cholesterol, s-LDL-cholesterol and s-triglycerides. CONCLUSION: It seems appropriate to screen for hypothyroidism in females with s-cholesterol above 7.0 mmol/l.
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| 44. |
- Reigo, Tomas, et al.
(författare)
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Clinical findings in a population with back pain : Relation to one-year outcome and long-term sick leave
- 2000
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Ingår i: Scandinavian Journal of Primary Health Care. - : Informa UK Limited. - 0281-3432 .- 1502-7724. ; 18:4, s. 208-214
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Tidskriftsartikel (refereegranskat)abstract
- Objective - To investigate whether physical examination findings can be used in predicting recovery from back pain and new episodes of sick leave.Design - One-year prospective study of a single cohort.Settings - Semi-rural Swedish county.Population - A cross-section of a general population with back pain (207 women, 176 men) between 20 and 59 years of age.Main outcome measures - Cumulative incidence of sick leave due to back pain, cumulative incidence of sick leave due to back pain > 30 days, incidence of recovery from back pain.Results - For recovery from pain, the absence of tenderness in the trapezius muscle (OR 0.33, CI 0.1-0.5) was predictive. New sick leave was predicted by tenderness in the trapezius muscle (OR 2.67, CI 1.5-4.9), and had a tendency to be associated with a flattened lumbar lordosis and a restricted cervical range of motion. For long-term sick leave, the same findings and also observation of scoliosis (OR 3.44, CI 1.1-10.5) were predictive.Conclusion - There are subgroups with back pain predisposed to development of more persistent symptoms and a higher risk for sick-listing.
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| 45. |
- Rudebeck, CE
(författare)
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The doctor, the patient and the body
- 2000
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Ingår i: Scandinavian journal of primary health care. - : Informa UK Limited. - 0281-3432 .- 1502-7724. ; 18:1, s. 4-8
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Tidskriftsartikel (refereegranskat)
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| 46. |
- Schaufelberger, Maria, 1954, et al.
(författare)
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Can brain natriuretic peptide (BNP) be used as a screening tool in general practice?
- 2004
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Ingår i: Scandinavian journal of primary health care. - : Informa UK Limited. - 0281-3432 .- 1502-7724. ; 22:3, s. 187-90
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE:To investigate plasma brain natriuretic peptide (p-BNP) in consecutive primary care patients for heart failure screening. DESIGN: Open, descriptive. SETTING: Three primary care clinics, university hospital. SUBJECTS: 291 consecutive patients, > or =40 years. MAIN OUTCOME MEASURES: p-BNP and general practitioners estimated probability of CHF. RESULTS: Median p-BNP was 29 ng/L. In 42% p-BNP was >40 ng/L in the first sample. In 41 patients further investigated, median p-BNP was 98 ng/L, with a correlation between p-BNP and physicians' estimation of probability of heart failure (r=0.469, p<0.0001). New York Heart Association class was correlated to p-BNP (r=0.343, p=0.034). No correlation between ejection fraction and p-BNP was seen. CONCLUSION:P-BNP concentrations in unselected primary care patients of 40 years of age or above were elevated in a larger proportion of patients than previously reported. Owing to the low specificity, p-BNP concentration limits have to be defined before the test can be used for screening in primary care.
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| 47. |
- Silwer, Louise, et al.
(författare)
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Drug prescribing in public primary care centres : Results from prescription studies 1988-1997 in the county of Halland, Sweden
- 2002
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Ingår i: Scandinavian Journal of Primary Health Care. - London : Informa Healthcare. - 0281-3432 .- 1502-7724. ; 20:4, s. 236-241
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To present the prescribing patterns of general practitioners (GPs) at public primary care centres (PPCCs) in Halland, a county in the south-west of Sweden. GP share of the total prescribing of different drug groups 1988-1997 is presented, as well as changes in patterns. DESIGN: A descriptive prescription study performed 3 months each year in 10 consecutive years. SETTING: Medical service and pharmacies in Halland. SUBJECTS: Prescriptions from about 100 GPs of PPCCs and 550 physicians of various other specialties. MAIN OUTCOME MEASURES: Percentages and absolute numbers of GPs prescribing. RESULTS: GPs prescribed 45% and 51% of the prescriptions from physicians in 1988 and 1997, respectively, while the cost shares were 40% and 42%. An increase in prescriptions was seen both in relative and in absolute numbers (from 117414 in 3 months in 1988 to 161012 in 1995). The increase in cost per DDD (defined daily dose) during the study period was 47% for GPs and 72% for other doctors. CONCLUSIONS: GP prescribing increased in both absolute and relative numbers, while the cost increase per DDD was moderate compared to other physicians.
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| 48. |
- Svartvik, Lena, et al.
(författare)
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Dyslipidaemia and impaired well-being in middle-aged women reporting low Sense of Coherence. The Women's Health in the Lund Area (WHLA) Study
- 2000
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Ingår i: Scandinavian Journal of Primary Health Care. - : Informa UK Limited. - 0281-3432 .- 1502-7724. ; 18:3, s. 177-182
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: A low Sense of Coherence (SOC) is a concept related to a feeling of ill health. Not much is known about possible relationships between SOC and biological factors. SETTING: Population-based study of middle-aged women. SUBJECTS AND METHODS: Four-hundred-and-fifty women participated as a subgroup of a larger study of cardiovascular risk factor screening. A self-administered questionnaire with 29 questions related to SOC was completed in addition to questions on social background factors and medical history. RESULTS: The mean score of SOC was 150.9 (SD 23.4). HDL cholesterol was lower (p < 0.05) and triglyceride levels higher (p < 0.05) in women with low SOC (1.5 and 2.1 mmol/L) compared to women with medium (1.8 and 1.4 mmol/L) or high SOC (1.7 and 1.5 mmol/L). In multiple regression analysis, a low HDL cholesterol level was still significantly associated with low SOC (p < 0.05) after adjustment for possible confounders. Women reporting low SOC were further characterised by a higher proportion of subjects with regular clinical visits for health care (49% vs 35% and 29%). CONCLUSIONS: Middle-aged women reporting low SOC showed lower HDL cholesterol and higher triglyceride levels, and reported more clinical visits and medical symptoms than women with higher SOC.
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| 49. |
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| 50. |
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