| 1. |
- Agvall, Björn, 1963-, et al.
(författare)
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Cost of heart failure in Swedish primary healthcare
- 2005
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Ingår i: Scandinavian Journal of Primary Health Care. - : Informa UK Limited. - 0281-3432 .- 1502-7724. ; 23, s. 227-232
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Tidskriftsartikel (refereegranskat)abstract
- Objectives. To calculate the cost for patients with heart failure (HF) in a primary healthcare setting. Design. Retrospective study of all available patient data during a period of one year. Setting. Two healthcare centers in Linköping in the southeastern region of Sweden, covering a population of 19 400 inhabitants. Subjects. A total of 115 patients with a diagnosis of HF. Main outcome measures. The healthcare costs for patients with HF and the healthcare utilization concerning hospital days and visits to doctors and nurses in hospital care and primary healthcare. Results. The mean annual cost for a patient with HF was SEK 37 100. There were no significant differences in cost between gender, age, New York Heart Association functional class, and cardiac function. The distribution of cost was 47% for hospital care, 22% for primary healthcare, 18% for medication, 5% for nursing home, and 6% for examinations. Conclusion. Hospital care accounts for the largest cost but the cost in primary healthcare is larger than previously shown. The total annual cost for patients with HF in Sweden is in the range of SEK 5.0–6.7 billion according to this calculation, which is higher than previously known.Read More: http://informahealthcare.com/doi/abs/10.1080/02813430500197647
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| 2. |
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| 3. |
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| 4. |
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| 5. |
- Arne, Mats, 1954-, et al.
(författare)
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Physical activity and quality of life in subjects with chronic disease : chronic obstructive pulmonary disease compared with rheumatoid arthritis and diabetes mellitus
- 2009
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Ingår i: Scandinavian Journal of Primary Health Care. - : Informa UK Limited. - 0281-3432 .- 1502-7724. ; 27:3, s. 141-147
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: Chronic diseases interfere with the life situation of the affected person in different ways. The aim was to compare the burden of disease in three chronic diseases - chronic obstructive pulmonary disease (COPD), rheumatoid arthritis (RA), diabetes mellitus (DM) - and in healthy subjects, with a particular interest in physical activity, quality of life, and psychological health. DESIGN: Cross-sectional, observational study. SETTING AND SUBJECTS: Postal survey questionnaire to a stratified, random population of 68 460 subjects aged 18-84 years in Sweden. The subjects included were 40-84 years old (n = 43 589) and data were analysed for COPD (n = 526), RA (n = 1120), DM (n = 2149) and healthy subjects (n = 6960). RESULT: Some 84% of subjects with COPD, 74% (RA), 72% (DM), and 60% in healthy subjects (p < 0.001, COPD versus RA, DM, and healthy subjects) had a physical activity level considered too low to maintain good health according to guidelines. Quality of life (EuroQol five-dimension questionnaire, EQ-5D) was lower in COPD and RA than in DM. Anxiety/depression was more common in subjects with COPD (53%) than in those with RA (48%) and DM (35%) (p < 0.001, COPD versus RA and DM), whereas mobility problems were more common in RA (55%) than COPD (48%) and DM (36%) (p < 0.001, RA versus COPD and DM). All differences between groups remained significant after adjusting for age, sex, and socioeconomic background factors. CONCLUSION: Subjects with chronic diseases had a low level of physical activity, most evident in subjects with COPD. COPD and RA had a higher negative impact on quality of life than DM. Our results indicate that increased attention regarding physical inactivity in subjects with chronic diseases is needed to minimize the burden of disease.
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| 6. |
- Arvidsson, Eva, et al.
(författare)
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Primary care patients' attitudes to priority setting in Sweden
- 2009
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Ingår i: Scandinavian Journal of Primary Health Care. - : Informa UK Limited. - 0281-3432 .- 1502-7724. ; 27:2, s. 123-128
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Tidskriftsartikel (refereegranskat)abstract
- Objective. To analyse attitudes to priority setting among patients in Swedish primary healthcare. Design. A questionnaire was given to patients comprising statements on attitudes towards prioritizing, on the role of politicians and healthcare staff in prioritizing, and on patient satisfaction with the outcome of their contact with primary healthcare (PHC). Settings. Four healthcare centres in Sweden, chosen through purposive sampling. Participants. All the patients in contact with the health centres during a two-week period in 2004 (2517 questionnaires, 72% returned). Main outcomes. Patient attitudes to priority setting and satisfaction with the outcome of their contact. Results. More than 75% of the patients agreed with statements like Public health services should always provide the best possible care, irrespective of cost. Almost three-quarters of the patients wanted healthcare staff rather than politicians to make decisions on priority setting. Younger patients and males were more positive towards priority setting and they also had a more positive view of the role of politicians. Less than 10% of the patients experienced some kind of economic rationing but the majority of these patients were satisfied with their contact with primary care. Conclusions. Primary care patient opinions concerning priority setting are a challenge for both politicians and GPs. The fact that males and younger patients are less negative to prioritizing may pave the way for a future dialogue between politicians and the general public.
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| 7. |
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| 8. |
- Barabas, G, et al.
(författare)
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No association between elevated post-void residual volume and bacteriuria in residents of nursing homes
- 2005
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Ingår i: Scandinavian Journal of Primary Health Care. - : Informa UK Limited. - 0281-3432 .- 1502-7724. ; 23:1, s. 52-56
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Tidskriftsartikel (refereegranskat)abstract
- Objective To evaluate the concept that increased post-void residual urine volume (PVR) is a risk factor for bacteriuria. Design Cross-sectional study. Setting Three nursing homes in Jönköping, southern Sweden. Subjects A total of 147 elderly residents in municipal nursing homes. Main outcome values PVR volumes measured with a portable ultrasonic bladder scan, urine specimen, and questionnaire data on incontinence, immobility, impaired cognition, neurological diseases, and medications. Results Mean age was 86 years and 78% were women. The prevalence of a PVR for the four chosen cut-off values (30, 50, 100, and 150 ml) was 51%, 39%, 20%, and 7%, respectively. The prevalence of bacteriuria was 42%, 46% for women and 28% for men. Elevated PVR was not associated with bacteriuria, incontinence, immobility, impaired cognition or neurological disease (stroke, Parkinson's disease). Conclusion Bacteriuria and elevated PVR are common among elderly residents in nursing homes. The study could not confirm that elevated PVR predisposes to bacteriuria in elderly residents in nursing homes.
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| 9. |
- Bari, Muhammad Rizuanul, et al.
(författare)
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Abdominal obesity and insulin resistance in patients with type 2 diabetes in a Swedish community - Skaraborg Hypertension and Diabetes Project
- 2006
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Ingår i: Scandinavian Journal of Primary Health Care. - : Informa UK Limited. - 0281-3432 .- 1502-7724. ; 24:4, s. 211-217
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Tidskriftsartikel (refereegranskat)abstract
- Objective. To explore the association between abdominal obesity and insulin resistance in patients with type 2 diabetes. Design. A cross-sectional observational study. Setting. Primary care in Skara, Sweden. Subjects. A total of 198 men and 186 women with type 2 diabetes who consecutively completed an annual check-up in 1992-1993. Main outcome measures. Abdominal obesity was defined according to criteria for the metabolic syndrome using the waist circumference (WC): > 102 cm for men and > 88 cm for women. Insulin resistance was estimated using the Homeostasis Model Assessment (HOMA), and was dichotomized by the 75th percentile (IR). Results. Abdominal obesity was found in 66 men (33%), and in 106 women (57%). Pearson's correlation coefficients between components of the metabolic syndrome and IR were statistically significant for WC, waist-hip ratio, serum triglycerides, and HDL cholesterol, and were higher for WC (0.40) than for waist-hip ratio (0.23) in both genders (p < 0.001). The association between WC and IR was challenged by successively entering other components of the metabolic syndrome into the model in a logistic regression. In the final model, adjusting for differences in age, systolic blood pressure, HbA1c, serum triglycerides, HDL cholesterol, and microalbuminuria, the association remained statistically significant both in men (OR 8.6, 95% CI 3.0-25.2, p < 0.001), and in women (OR 5.6, 95% CI 1.7-18.1, p = 0.004). Conclusions. WC provides a feasible measure for insulin resistance in the vast majority of subjects with type 2 diabetes. It is convenient and less expensive than direct means and could be used as a proxy for insulin resistance in population studies.
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| 11. |
- Björkelund, Cecilia, 1948, et al.
(författare)
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Secular trends in cardiovascular risk factors with a 36-year perspective: observations from 38- and 50-year-olds in the Population Study of women in Gothenburg
- 2008
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Ingår i: Scandinavian Journal of Primary Health Care. - : Informa UK Limited. - 1502-7724 .- 0281-3432. ; 26:3, s. 140-6
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Tidskriftsartikel (refereegranskat)abstract
- Department of Public Health and Community Medicine/Primary Health Care, The Sahlgrenska Academy, University of Gothenburg, Sweden. cecilia.bjorkelund@allmed.gu.se OBJECTIVES: To study secular trends in cardiovascular risk factors in four different cohorts of women examined in 1968-1969, 1980-1981, 1992-1993 and 2004-2005. DESIGN: Comparison of four representative cohorts of 38- and 50-year-old women over a period of 36 years. SETTING: Gothenburg, Sweden with approximately 450,000 inhabitants. SUBJECTS: Four representative samples of 38- and 50-year-old women were invited to free health examinations (participation rate 59-90%, n =1901). MAIN OUTCOME MEASURES: Body mass index (BMI), systolic and diastolic blood pressure (SBP, DBP), leisure time exercise, use of antihypertensive medication, smoking, levels of haemoglobin, b-glucose, s-cholesterol, s-triglycerides and HDL-cholesterol. RESULTS: There was no significant difference in mean BMI from 1968-1969 versus 2004-2005. Mean leisure time exercise was significantly higher in later born cohorts; in 1968, around 15% were physically active compared with 40% in 2004. SBP and DBP, mean s-cholesterol and s-triglyceride levels were significantly lower in both 38- and 50-year-old cohorts in 2004-2005 versus 1968-1969. HDL-cholesterol (not measured until 1992-1993), showed a significantly higher mean level in 2004-2005. Reduction of risk factors was apparent in women with a high as well as low level of physical activity. Smoking declined most in women with high levels of physical activity. CONCLUSIONS: Several cardiovascular risk factors related to lifestyle have improved in middle-aged women from the 1960s until today. Most of the positive trends are observed in women with both low and high physical activity.
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| 12. |
- Blomstrand, Ann, et al.
(författare)
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Low-budget method for lifestyle improvement in primary care. Experiences from the Göteborg Health Profile Project.
- 2005
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Ingår i: Scandinavian journal of primary health care. - : Informa UK Limited. - 0281-3432 .- 1502-7724. ; 23:2, s. 82-7
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To describe a self-administered preventive tool dealing with risk factors for cardiovascular disease and its effect with special reference to the question: did the project involve persons most in need of lifestyle changes? DESIGN: Screening questions offered to consecutive patients and followed by a self-administered health profile, intervention, and follow-up. Setting. Primary healthcare area of Askim, Sweden. SUBJECTS: Men and women between 18 and 65 years of age visiting GPs for acute disorders or planned visits during a three-month period were offered screening questions and, if wanted, a health profile. MAIN OUTCOME MEASURES: Participation rates, effects on lifestyle factors. RESULTS: There was an overrepresentation of subjects with a less favourable lifestyle among those who asked for the health profile. There was good agreement for all variables between self-estimation in screening questions and grading in the basal health profile. Lifestyle improvement was observed for dietary habits, physical activity, and mental stress at the one year follow-up. CONCLUSIONS: The results indicate that a relevant selection of persons with a "risk profile" can be made by means of simple screening questions. The pedagogic model using self-administered health profile in combination with own responsibility seems to be a tool for low-budget preventive work in primary healthcare.
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| 13. |
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| 14. |
- Bremberg, S, et al.
(författare)
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Justifications of physicians' choice of action
- 2005
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Ingår i: Scandinavian journal of primary health care. - : Informa UK Limited. - 0281-3432 .- 1502-7724. ; 23:2, s. 102-108
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Tidskriftsartikel (refereegranskat)
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| 15. |
- Bremberg, S, et al.
(författare)
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Justifications of physicians' choice of action - Attitudes among the general public, GPs, and oncologists in Sweden
- 2005
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Ingår i: Scandinavian Journal of Primary Health Care. - : Informa UK Limited. - 0281-3432 .- 1502-7724. ; 23:2, s. 102-108
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Tidskriftsartikel (refereegranskat)abstract
- Objective. To compare choice of actions and justifying reasons among the general public, GPs and oncologists. Design. A postal questionnaire using four vignettes: a healthy patient reluctant to quit smoking and one demanding an X-ray, a pulmonary cancer patient reluctant to quit smoking and one demanding immunotherapy. Subjects. A random sample of the general public (n=1000), GPs (n=200), and oncologists (n=200). Main outcome measures. The respondents' choice of how the physician should act (general public)/would act (physicians), and, with reference to their choice of action, their justifying reasons. Results. A majority answered that the physician should/would bring up the question about smoking cessation with the reluctant patient, justified by promotion of medical benefit and protection from harm. With reference to the reluctant cancer patient every second oncologist and every third GP would not mention smoking cessation, justified by respect for self-determination and enhancement of the relationship. Facing the patient demanding a new X-ray the general public was more in favour while the physicians rejected it. One-third of the general public answered that the seriously ill patient's demand for immunotherapy should be granted and referred to respect for self-determination and enhanced relationship. A majority of the physicians rejected such a demand, justified by promotion of a fair distribution of resources. Conclusion. The fear of infringing the patient's right to self-determination and harming the relationship is exaggerated by physicians. They are mostly expected to bring up smoking cessation with a reluctant patient. How to manage demanding patients is more controversial.
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| 16. |
- Bøg-Hansen, Erik, et al.
(författare)
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Predictors of acute myocardial infarction mortality in hypertensive patients treated in primary care.
- 2007
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Ingår i: Scandinavian Journal of Primary Health Care. - : Informa UK Limited. - 0281-3432 .- 1502-7724. ; 25:4, s. 237-243
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Tidskriftsartikel (refereegranskat)abstract
- Objective. To explore risk factors for acute myocardial infarction (AMI) mortality in hypertensive patients treated in primary care. Design. Community-based cohort study. Setting. Hypertension outpatient clinic in primary health care. Subjects. Patients who consecutively underwent an annual follow-up during 1992-1993 (n =894; 377 men and 517 women). Methods. All events of fatal AMI were ascertained by record linkage to the National Mortality Register to December 31, 2002. Gender-specific predictors for AMI mortality were analysed by Cox regression. Main outcome measure. AMI mortality. Results. During a mean follow-up of 8.7 years 32 cases (8.5%) of fatal AMI were observed in men and 31 cases (6.0%) were observed in women. Most important predictors for AMI mortality in men were microalbuminuria (HR 3.8, CI 1.8-8.0) and left ventricular hypertrophy (HR 4.0, CI 1.7-9.4), whilst in women type 2 diabetes (HR 4.8, CI 2.4-9.8) was an important predictor. In hypertensive patients without diabetes male gender was associated with high AMI mortality (HR 2.7, CI 1.4-5.3), but in patients with both hypertension and type 2 diabetes the higher risk in men disappeared (HR 0.8, CI 0.4-1.7). Conclusion. Cardiovascular disease risk factors remain strong predictors of AMI mortality in hypertensive patients but with a different pattern in the two genders. Markers of organ damage are more important predictors in men, whereas markers of impaired glucose metabolism are more important predictors in women.
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| 17. |
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| 18. |
- 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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| 19. |
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| 20. |
- Danielsson, Ulla E, et al.
(författare)
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Beyond weeping and crying : a gender analysis of women´s and men´s expressions of depression
- 2005
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Ingår i: Scandinavian Journal of Primary Health Care. - : Informa UK Limited. - 0281-3432 .- 1502-7724. ; 23, s. 171-177
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Tidskriftsartikel (refereegranskat)abstract
- Objective. To explore depression from a gender perspective, by capturing depressed women's and men's formulations of their experiences and understanding of their situation. Design. Qualitative interview study. Setting. A healthcare centre in northern Sweden. Subjects. Eighteen patients who had been diagnosed with depression and treated for at least 6 months were interviewed in depth, both women and men of different ages and social status. Open questions were posed around the themes of Malterud's key questions, focusing especially on how the informants conveyed their experiences. Interviewing and qualitative data analysis went on simultaneously. Results. The experience of depression held similarities for men and women, but the outward manifestations differed by gender as well as socioeconomic status. Though experiences of high demands underlay the narratives of all informants, home or work had different priority. Men talked more easily about physical distress – often the heart – than about emotions. Women verbalized more readily emotional distress – shame and guilt – while physical symptoms often revolved around the stomach. Men dealt with insecurity by aggrandizing their previous competence, women by self-effacement. Conclusion. As clinicians we must listen attentively not only to the manifest but to the avoided or unarticulated. By doing so we might counteract normative gender patterns that highlight the depression of women and conceal that of men.
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| 21. |
- Dannetun, E., et al.
(författare)
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Parents' reported reasons for avoiding MMR vaccination : A telephone survey
- 2005
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Ingår i: Scandinavian Journal of Primary Health Care. - : Informa UK Limited. - 0281-3432 .- 1502-7724. ; 23:3, s. 149-153
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Tidskriftsartikel (refereegranskat)abstract
- Objective. During the second half of the 1990s and the first years of the 2000s a declining coverage for MMR vaccination in two-year-olds was observed in Sweden. The aim was to assess reasons for postponement or non-vaccination. Design. A telephone survey using a structured questionnaire on parents' attitudes regarding their choice to postpone or abstain from vaccinating their child. Setting. The County of Östergötland in Sweden. Subjects. A total of 203 parents of children who had no registered date for MMR vaccination at a Child Health Centre. Main outcome measures. Parental reasons for non-vaccination. Results. In all, 26 of the 203 children had received MMR vaccination but this had not been registered. Of those not vaccinated, 40% of the parents had decided to abstain and 60% to postpone vaccination. Fear of side effects was the most common reason for non-vaccination in both groups. The main source of information was the media followed by the Child Health Centre. Parents with a single child more often postponed vaccination and those who abstained were more likely to have had a discussion with a doctor or nurse about MMR vaccine. Conclusion. Postponers and abstainers may have different reasons for their decision. The role of well-trained healthcare staff in giving advice and an opportunity to discuss MMR vaccination with concerned parents is very important. © 2005 Taylor & Francis.
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| 22. |
- Edvardsson, Ingrid, et al.
(författare)
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When do adolescents become smokers?
- 2009
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Ingår i: Scandinavian Journal of Primary Health Care. - : Informa UK Limited. - 0281-3432 .- 1502-7724. ; 27, s. 41-46
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Tidskriftsartikel (refereegranskat)abstract
- Objective. To follow the development of a class of pupils' tobacco habits for seven years, and to study differences in tobacco use between girls and boys. Setting. Kronoberg County in southern Sweden. Subjects. All the approximately 2000 pupils were followed from approximately age 12 to approximately age 18. Design. Yearly cross-sectional surveys from 1994 to 2000. Each year, the pupils filled in an established tobacco questionnaire. They did it anonymously in the classroom. Main outcome measures. Percentage of smokers, number of cigarettes smoked per day, and percentage of pupils using "snus", the Swedish variety of oral moist snuff. Results. From grade 6 of compulsory school to grade 12 of upper secondary school, the proportion of daily smokers rose, from 0.2% to 22% for girls and from 0.5% to 14% for boys. Among both genders, the increase occurred mainly between grades 7 and 10, and from grade 10 onwards the daily smokers were the largest group of smokers. Starting from grade 9, boys had higher total tobacco consumption than girls, as a result of their increased use of "snus", and at the end of the study 39% of the boys used tobacco compared with 34% of the girls. Conclusion. Studying young people's tobacco habits over time gives an understanding of when preventive measures should be implemented. In order for these to influence attitudes, they should be put in place well before tobacco is introduced.
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| 23. |
- Eggertsen, Robert, 1948, et al.
(författare)
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Effects of treatment with a commercially available St John's Wort product (Movina) on cholesterol levels in patients with hypercholesterolemia treated with simvastatin.
- 2007
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Ingår i: Scandinavian journal of primary health care. - : Informa UK Limited. - 0281-3432 .- 1502-7724. ; 25:3, s. 154-9
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To assess the effect of treatment with a St John's Wort product (Movina) on cholesterol levels (total cholesterol, LDL-cholesterol, and HDL-cholesterol) in patients with hypercholesterolemia on treatment with a stable dose of simvastatin. DESIGN: Controlled, randomized, open, crossover pharmacodynamic study. SETTING: Two primary healthcare centres. Intervention. Patients were treated with Movina one tablet (containing 300 mg of Hypericum perforatum) twice daily and control (a commercially available multivitamin tablet, Vitamineral). The trial started with a run-in period of 4 weeks. Then the treatment order between control and active treatment was decided (randomization using sealed envelopes). The duration of each treatment period was 4 weeks and simvastatin treatment was kept unchanged during the whole study period (12 weeks). SUBJECTS: Twenty-four patients with hypercholesterolemia treated with a stable dose of simvastatin (10-40 mg daily) for at least three months. MAIN OUTCOME MEASURES: Assessments of total cholesterol, HDL- cholesterol, LDL-cholesterol, and triglycerides were performed in the morning with the patients in a fasting condition. RESULTS: All patients completed the study. LDL-cholesterol was significantly increased during active treatment compared with control. Thus, the mean LDL-cholesterol after 4 weeks' active treatment was 2.72 mmol/L compared with 2.30 mmol/L after treatment with control (p <0.0001). An increase in total-cholesterol was also observed (5.08 mmol/L compared with 4.56 mmol/L, p <0.0001). CONCLUSION: Products containing St John's Wort should not be given to patients with hypercholesterolemia who are on treatment with simvastatin.
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| 24. |
- Ekesbo, Rickard, et al.
(författare)
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Effects of anti-secretory factor (ASF) on irritable bowel syndrome (IBS)
- 2008
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Ingår i: Scandinavian Journal of Primary Health Care. - : Informa UK Limited. - 0281-3432 .- 1502-7724. ; 26:2, s. 106-110
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Tidskriftsartikel (refereegranskat)abstract
- Objective. To evaluate the role of the endogenous protein anti-secretory factor (ASF) on the symptoms, especially loose stools, in irritable bowel ayndrome (IBS). Design. A diet with specially processed cereals (SPC) known to induce ASF production was used in patients with IBS, in an eight-week randomized, placebo-controlled study. Subjects. Eighty-two patients with IBS were randomized to a diet with either SPC or placebo. Main outcome measures. The overall clinical condition and the quality of life were measured by VAS and SF-36 questionnaire, respectively. The plasma levels of ASF were determined in 14 patients with dominating loose stools before and after diet. Results. All patients significantly (p < 0.001) improved in IBS-related symptoms irrespective of active or placebo diet. In an active-diet sub-group with diarrhoea (n = 11) there was a significant (p < 0.05) correlation between the increase of plasma ASF level and the improvement on the VAS. Conclusion. Both study groups improved significantly on the VAS but no additive effect was seen for the active treatment. In the sub-group with loose stools, the SPC diet induced ASF plasma levels in IBS patients and was correlated to significant symptom improvement in the individual patient.
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| 25. |
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| 26. |
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| 27. |
- Fatahi, Nabi, 1961, et al.
(författare)
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General practitioners' views on consultations with interpreters: a triad situation with complex issues.
- 2008
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Ingår i: Scandinavian journal of primary health care. - : Informa UK Limited. - 1502-7724 .- 0281-3432. ; 26:1, s. 40-5
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To study a group of general practitioners' (GPs) views on cross-cultural consultations through interpreters in primary healthcare in Sweden. DESIGN: Two group interviews and three personal interviews with experienced GPs regarding clinical consultation through interpreters were carried out. The interviews were transcribed and analysed and the text was categorized according to content analysis. SETTING: Primary healthcare. SUBJECTS: Eight GPs were interviewed. MAIN OUTCOME MEASURES: The response and opinions of the GPs. RESULTS: In the analysis it appeared that an optimal clinical encounter demands an active role by all participants involved in the consultation. The interpreter has to strive after being a stable neutral information bridge, and has a balancing role between the GP and the patient. The GP has to be open to cultural inequalities and recognize consultation through an interpreter as a part of her/his job. The patient needs to be an active and visible participant, not hiding behind the interpreter. Common obstacles and imperfections to reach the best possible triad were discussed. Additionally, practical assets in the encounter were delineated. Accurate physical placing of the persons in the room, adequate length of consultation time, and using the same interpreter from one visit to another were mentioned as factors influencing the outcome of the consultation. CONCLUSION: Barriers in cross-cultural communications could originate from all persons involved, the interpreter, the GP, and the patient, as well as from tangible factors. Ways to reduce misunderstandings in GP-patient encounters through interpreters are suggested.
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| 28. |
- Fatahi, Nabi, 1961, et al.
(författare)
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Interpreters' experiences of general practitioner-patient encounters.
- 2005
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Ingår i: Scandinavian journal of primary health care. - : Informa UK Limited. - 0281-3432 .- 1502-7724. ; 23:3, s. 159-63
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To study interpreters' experiences of problems in cross-cultural communication with special regard to the general practitioner (GP)-patient encounter. DESIGN: A focus-group interview with authorized interpreters was carried out. A phenomenographic method was used in the analysis. SETTING: Primary health care. RESULTS: The interpreters displayed a number of problems mainly related to the difficulty in balancing the triad relation (GP-patient-interpreter), the role of the interpreter in relation to other healthcare staff, the time aspects of the translation procedure, and the problems of diverse health beliefs and cultural inequalities. CONCLUSION: The interpreters notice a set of difficulties that need to be highlighted in order to improve consultations with cross-cultural GP-patient encounters.
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| 29. |
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| 30. |
- Färnkvist, Lisbeth, et al.
(författare)
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Did a health dialogue matter? Self-reported cardiovascular disease and diabetes 11 years after health screening.
- 2008
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Ingår i: Scandinavian journal of primary health care. - : Informa UK Limited. - 1502-7724 .- 0281-3432. ; 26:3, s. 135-139
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To study the potential impact of health screening, with or without a motivational health dialogue, on the risk and morbidity of cardiovascular diseases (CVD) and diabetes (DM). DESIGN: Two cross-sectional studies with an interval of 11 years. SETTING: The community of Härnösand, Sweden. SUBJECTS: In the first study, 402 men born in 1934, 1944, or 1954 underwent health screening for CVD prevention in 1989. In the second study, 415 men (of the same ages) completed a questionnaire in 2000 (11 years later). MAIN OUTCOME MEASURES: Odds ratio (OR) for self-reported CVD and DM. RESULTS: The odds ratio of self-reported CVD and DM was more than doubled among participants in the health screening without a health dialogue (OR 2.5; 95% CI 0.8-7.4) and threefold for those not participating (OR 3.0; 95% CI 1.0-8.8) compared with those who reported participation in health screening that included a structured health dialogue. CONCLUSIONS: Health screening for the prevention of CVD and DM benefits from inclusion of a structured, motivational health dialogue.
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| 31. |
- Halling, Anders, et al.
(författare)
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Concordance between elderly patients' understanding of and their primary healthcare physician's diagnosis of heart failure
- 2006
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Ingår i: Scandinavian Journal of Primary Health Care. - : Informa UK Limited. - 0281-3432 .- 1502-7724. ; 24:2, s. 110-114
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Tidskriftsartikel (refereegranskat)abstract
- Objective. The objective was to study primary healthcare patients' understanding of their diagnosis of heart failure (HF), using patients treated for diabetes mellitus (DM) as a comparative group. Design. A cross-sectional community based study. Setting. Karlskrona community situated on the Swedish south-east coast with 60 600 inhabitants. Subjects. A total of 1402 subjects, aged 60 - 96 years in 10 age cohorts, selected randomly from the national population registry participating in the Swedish National study on Ageing and Care - Blekinge. Main outcome measures. Understanding of diagnosis of HF or DM in primary healthcare. Prevalence of cognitive impairment. Results. In all, 39.8% of patients with a diagnosis of HF treated in primary healthcare and 97.1% of patients with DM had an understanding of their respective diagnosis. Cognitive impairment was significantly more prevalent in the groups of patients treated for HF ( OR 1.9, 95% CI 1.2 to 3.0) and DM ( OR 1.8, 95% CI 1.1 to 3.1), when compared with those not treated for either HF or DM. The odds ratio for understanding of diagnosis was 0.013 ( 95% CI 0.003 to 0.052, p< 0.001) in patients treated for HF, compared with patients treated for DM, when adjusted for the subject's age, sex, and cognitive function. Conclusion. In this study it was shown that patients' understanding of their diagnosis was highly dependent on diagnosis, independently of age, sex, or cognitive function. The results suggest that there is room for improvement of care in primary healthcare, to increase HF patients' understanding of their diagnosis.
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| 32. |
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| 33. |
- Hansson, Anders, 1953-, et al.
(författare)
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Balancing - an equilibrium act between different positions : an exploratory study on general practitioners' comprehension of their professional role
- 2007
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Ingår i: Scandinavian Journal of Primary Health Care. - : Taylor & Francis. - 0281-3432 .- 1502-7724. ; 25:2, s. 80-85
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Tidskriftsartikel (refereegranskat)abstract
- Objective. There is a call to make the duties and working conditions of the GP more transparent. The aim of this study was to explore practising GPs’ personal experiences of their professional role and what they regard to be its salient characteristics. Design. An exploratory and descriptive study was undertaken by interviewing GPs and by performing a focus-group study of experienced GPs. The interviews were transcribed and analysed, and the text was categorized according to content analysis. Setting. The practice of the interviewed GPs. Subjects. Seven GPs in individual interviews and a focus group of experienced GPs. Results. A major theme, Balancing, was identified. It was derived from a number of opposing concepts to which different features were related. “The good shepherd” versus “The medical expert”; “Curing” versus “Caring”; “Short visits” versus “Long consultations”; “The personal doctor” versus “The society's doctor”. In many consultations the GP has to contemplate how to stay in focus between these diverse roles. Conclusion.General practice requires a balance to be achieved between a number of opposing conditions. In their clinical work GPs have to adjust to and integrate alternative perspectives. Problems of recruiting new GPs might be associated with dilemmas in this balancing act.
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| 34. |
- Hedblad, Bo, et al.
(författare)
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High blood pressure despite treatment: Results from a cross-sectional primary healthcare-based study in southern Sweden.
- 2006
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Ingår i: Scandinavian Journal of Primary Health Care. - : Informa UK Limited. - 0281-3432 .- 1502-7724. ; 24:4, s. 224-230
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Tidskriftsartikel (refereegranskat)abstract
- Objective. To study degree of blood pressure (BP) control in primary healthcare (PHC) treated hypertensive patients in relation to sex, age, drug treatment, and concomitant diseases. Design. Random sample of patients with hypertension. Setting. Ten PHC centres in the Region of Skane, Sweden. Subjects. All the 30- to 95-year-old patients with hypertension who during the period 12 September to 24 September 2004 attended their PHC (146 men and 229 women). Main outcome measures. Achievement of BP control (< 140/90 mmHg) according to European guidelines. Results. Some 90% had been treated > 12 months, 40% had mono-therapy, 15% >= 3 drugs. Use of diuretics was more common in women while use of ACE inhibitors and calcium channel blockers was common in men. Inadequate BP control was related to age; only 22% had BPB < 140/90 mmHg, 38% had a BP >= 160/100 mmHg. BP decline was inversely related to BP measured 12 months or more prior to the present follow-up (r = -0.64, p < 0.001, for systolic and r = -0.67, p < 0.001, for diastolic BP). The systolic or diastolic BP had in every fifth patient during treatment increased by >= 10 mmHg. No association was found between average BP decline and prescribed number of drugs. Conclusion. A minority of the patients had BP below the level (< 140/90 mmHg) recommended by European guidelines. This study illustrates the need for continued follow-up of defined groups of patients in order to improve quality of care.
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| 35. |
- Hedin, Katarina, et al.
(författare)
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Infection prevention at day-care centres: Feasibility and possible effects of intervention
- 2006
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Ingår i: Scandinavian Journal of Primary Health Care. - : Informa UK Limited. - 0281-3432 .- 1502-7724. ; 24:1, s. 44-49
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Tidskriftsartikel (refereegranskat)abstract
- Objective. To study the effect of an educationally oriented intervention programme, with the recommendations from the National Board of Health and Welfare as a base. Design. A prospective intervention study. Setting. Six day-care centres in Vaxjo, Sweden. Three centres comprised the intervention group and three constituted the control group. Subjects and main outcome measures. The parents and personnel completed a questionnaire on their views concerning information about infectious diseases. During a nine-month period, parents of all children reported every episode of absence, the number of days absent, the cause of absence, and any contact with doctors or prescription of antibiotics. Results. The guidelines were implementable in routine child day-care. Parents found regular information valuable and felt better informed about infectious diseases. Multilevel analyses showed no statistically significant results of the intervention. "Infection-prone'' children had more sickness absence, doctor's consultations, and antibiotic prescriptions than those not "infection-prone''. Conclusion. It is possible to implement an educationally oriented intervention programme directed against infectious diseases in child day-care. No significant effect of the intervention was found, which is why a larger intervention study is needed.
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| 36. |
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| 37. |
- Helgesson, Östen, 1957, et al.
(författare)
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Quality of life in cancer survivors as observed in a population study of Swedish women
- 2007
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Ingår i: Scandinavian Journal of Primary HealthCare. - : Informa UK Limited. - 0281-3432 .- 1502-7724. ; 25:4, s. 220-5
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Tidskriftsartikel (refereegranskat)abstract
- Objective. To investigate quality of life, measured by the SF-36 scales, in a population-based sample of women who have survived cancer at any site and, specifically, breast cancer. Design. A representative cohort of women was observed over 24 years with regard to cancer prevalence, incidence, and quality of life. Setting. Gothenburg, Sweden. Subjects. A total of 1462 women aged 38-60 years at baseline. Main outcome measures. Differences in quality of life between cancer survivors and cancer-free controls measured by the SF-36 Short Form Health Survey, with adjustment for age and additionally for social status, and history of major disease (diabetes, stroke, and myocardial infarction) at follow-up in 1992-93. Results. In women who had survived cancer, a lower feeling of general health was the only score found to be significantly associated with having had cancer. Similar analysis was conducted separately for breast cancer cases. Survivors of breast cancer reported lower vitality and when controlled for major disease also lower general health compared with women who had not had cancer. All other results were independent when adjusted for social status, and also for history of major disease. Conclusions. Women who have survived cancer report lowered general health, and breast cancer cases lowered vitality, but considering the non-significant results for the other scores and summary scales it can be concluded that the well-being of women who have survived a cancer on the whole did not differ profoundly from that of other women.
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| 38. |
- Hellenius, ML, et al.
(författare)
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Reduction of high cholesterol levels associated with younger age and longer education in a primary health care programme for cardiovascular prevention
- 2005
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Ingår i: Scandinavian Journal of Primary Health Care. - : Informa UK Limited. - 0281-3432 .- 1502-7724. ; 23:2, s. 75-81
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Tidskriftsartikel (refereegranskat)abstract
- Objective. To study possible social predictors for reduction of hyperlipidaemia in subjects offered lifestyle intervention in primary health care after an opportunistic screening. Setting. Primary health care in Sollentuna, Sweden. Design. Follow-up study of changes in high lipid levels in men and women aged 20-60 years participating in a voluntary screening and cardiovascular prevention programme. Subjects and main outcome measures. A total of 1904 individuals had a follow-up visit registered after a mean of 466 days. Men and women with raised lipid levels (serum cholesterol&GE; 6.5 mmol/l, and/or triglycerides&GE; 2.3 mmol/l) at baseline were compared with normolipidaemic participants. Data on social characteristics such as education, occupation, marital status, and income were collected from national censuses. Associations between socioeconomic factors and changes in lipid levels were studied. Results. Men and women with hyperlipidaemia were generally (p<0.001) older (men 6-8 years, women 8-10 years) and less educated than normolipidaemic subjects. Significant predictors for reducing hypercholesterolaemia were younger age, OR 0.97 (0.95-1.00) for increasing age, and longer education, OR 0.47 (0.24-0.91) for low education (<9 years). Foreign-born subjects were more likely to achieve a high success rate in reducing hypercholesterolaemia, OR 3.43 (1.00-11.8), than the Swedish-born. No significant predictors were detected for reduction of high triglyceride levels. Conclusion. A successful reduction of high cholesterol levels was associated with younger age and longer education in a primary health care-based programme for cardiovascular prevention.
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| 39. |
- Håkansson, Anders, et al.
(författare)
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Family medicine in the Baltic countries
- 2008
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Ingår i: Scandinavian Journal of Primary Health Care. - : Informa UK Limited. - 0281-3432 .- 1502-7724. ; 26:2, s. 67-69
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
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| 40. |
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| 41. |
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| 42. |
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| 43. |
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| 44. |
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| 45. |
- Landström, Björn, 1954, et al.
(författare)
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Working behaviour of competent general practitioners: personal styles and deliberate strategies.
- 2006
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Ingår i: Scandinavian journal of primary health care. - : Informa UK Limited. - 0281-3432 .- 1502-7724. ; 24:2, s. 122-8
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To study how competent GPs perform their work within the consultation and in relation to the team and practice organization. DESIGN: Ethnographic study with thick description. A participant observation of the GP was followed by a personal interview. A substantial description was elaborated that was analysed qualitatively. SETTING: Primary care surgeries in Sweden. SUBJECTS: A number of competent GPs. RESULTS: Two main categories emerged, deliberated strategy and personal style. These categories set up the individual pattern of working behaviour for each GP. A behaviour that is a deliberate strategy for one GP for the other belongs to his or her personal style. Common denominators in the overall working behaviour were attention to the patient as a person, practising patient-centred medicine, saving the consultations from disturbances, rejecting taking over responsibilities from the patients, and safeguarding own autonomy. CONCLUSION: The transition of deliberate, favourable strategies into one's personal style is an important aspect of professional development. A well-developed personal style is necessary to obtain the spontaneous interchange between attentive listening and detachment characteristic of patient-centeredness.
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| 46. |
- Lendahls, Lena, et al.
(författare)
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When do adolescents become smokers?
- 2008
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Ingår i: Scandinavian Journal of Primary Health Care. - 0281-3432 .- 1502-7724. ; 1, s. 1-6
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Tidskriftsartikel (refereegranskat)
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| 47. |
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| 48. |
- Lindström, Kjell, 1946-, et al.
(författare)
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Can selective serotonin inhibitor drugs in elderly patients in nursing homes be reduced?
- 2007
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Ingår i: Scandinavian Journal of Primary Health Care. - London : Informa Healthcare. - 0281-3432 .- 1502-7724. ; 25:1, s. 3-8
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To investigate whether treatment with selective serotonin reuptake inhibitors (SSRIs) could be withdrawn for elderly residents who had been on treatment for at least one year and to evaluate a method for systematic drug review. DESIGN: Open, prospective, interventional study. SETTING: Four counties in Sweden. SUBJECTS: Elderly residents at 19 nursing homes, with ongoing treatment with SSRIs for more than one year. MAIN OUTCOME MEASURES: Clinical evaluation, registration of drugs used and rating with Montgomery-Asberg Depression Rating Scale (MADRS). A semi-structured telephone interview with 15 participating physicians and 19 nurses. RESULTS: About one-third of all 822 residents in the nursing homes had ongoing antidepressant treatment, predominantly with SSRIs; 75% of them had been treated with SSRIs for at least one year and 119 (60%) of these were considered eligible for the study. The intervention was judged successful in 52% of these residents of whom 88% had a MADRS rating of less than 20 points. The GPs and the nurses experienced the method as practicable. CONCLUSIONS: Withdrawal of SSRI treatment was successful in the majority of cases. The MADRS may be a valuable addition to clinical evaluation when deciding whether to end or continue SSRI treatment.
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| 49. |
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| 50. |
- Midlöv, Patrik, et al.
(författare)
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Barriers to adherence to hypertension guidelines among GPs in southern Sweden: A survey.
- 2008
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Ingår i: Scandinavian Journal of Primary Health Care. - : Informa UK Limited. - 0281-3432 .- 1502-7724. ; 26, s. 154-159
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Tidskriftsartikel (refereegranskat)abstract
- Objective. To evaluate barriers to adherence to hypertension guidelines among publicly employed general practitioners (GPs). Design. Questionnaire-based survey distributed to GPs in 24 randomly selected primary care centres in the Region of Skåne in southern Sweden. Subjects. A total of 109 GPs received a self-administered questionnaire and 90 of them responded. Main outcome measures. Use of risk assessment programmes. Reasons to postpone or abstain from pharmacological treatment for the management of hypertension. Results. Reported managing of high blood pressure (BP) varied. In all, 53% (95% CI 42-64%) of the GPs used risk assessment programmes and nine out of 10 acknowledged blood pressure target levels. Only one in 10 did not inform the patients about these levels. The range for immediate initiating pharmacological treatment was a systolic BP 140-220 (median 170) mmHg and diastolic BP 90-110 (median 100) mmHg. One-third (32%; 95% CI 22-42%) of the GPs postponed or abstained from pharmacological treatment of hypertension due to a patient's advanced age. No statistically significant associations were observed between GPs' gender, professional experience (i.e. in terms of specialist family medicine and by number of years in practice), and specific reasons to postpone or abstain from pharmacological treatment of hypertension. Conclusion. These data suggest that GPs accept higher blood pressure levels than recommended in clinical guidelines. Old age of the patient seems to be an important barrier among GPs when considering pharmacological treatment for the management of hypertension.
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