| 1. |
- Ekesbo, Rickard, et al.
(author)
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Chronic Helicobacter pylori infection in a population in southern Sweden analysed by histopathology, immunoblot and ELISA serology.
- 2006
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In: European Journal of Gastroenterology and Hepathology. - 1473-5687. ; 18:6, s. 589-593
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Journal article (peer-reviewed)abstract
- Background. Many individuals are infected with the bacterium Helicobacter pylori. Some develop ulcers or mucosal atrophy. Aims. To correlate the histological characteristics of the H. pylori-induced gastritis to the immunoblot pattern of the H. pylori infection and to compare the presence of H. pylori bacteria in tissue specimens with ELISA serology and immunoblot analysis. Methods. One hundred and sixty-six consecutive patients were referred to gastroscopy. Forty patients were excluded for various reasons and 126 were included in the study. Results. Twenty-three patients had ulcerations and 25 erosions. Ninety-two (73%) had a chronic gastritis and in 90 (71%) it involved both the antrum and corpus. Ninety-one (72%), of whom 96% had a chronic gastritis, had visible bacteria in the tissue specimens, used as the 'gold standard' for the detection of infection. In patients with chronic gastritis 65 (70%) had positive H. pylori ELISA serology, 27 (30%) had negative H. pylori ELISA, while 76 (83%) had a positive immunoblot pattern. The ELISA positive patients had more advanced chronic gastritis but a lower frequency of metaplasia and atrophy. Acute inflammatory activity in the chronic gastritis had a high immunoreactivity to 120 kDa (CagA) protein and was significantly correlated to antibody reactivity to proteins in the 53-65 kDa range (heat shock proteins) and to a 43 kDa subunit. Metaplasia and atrophy in antrum was associated with a 62 kDa protein band. Conclusion. Almost all H. pylori-infected patients had a pangastritis, visible in both antrum and corpus. Acute inflammatory activity in the chronic gastritis and the presence of metaplasia and atrophy in antrum were associated with a specific immunoblot pattern, indicating infection with more virulent strains. Immunoblot analysis had a better sensitivity than ELISA H. pylori serology.
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| 2. |
- Ekesbo, Rickard, et al.
(author)
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Effects of anti-secretory factor (ASF) on irritable bowel syndrome (IBS)
- 2008
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In: Scandinavian Journal of Primary Health Care. - : Informa UK Limited. - 0281-3432 .- 1502-7724. ; 26:2, s. 106-110
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Journal article (peer-reviewed)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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| 3. |
- Ekesbo, Rickard
(author)
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Helicobacter pylori and Chlamydia pneumoniae in primary care- cardiovascular and gastrointestinal aspects
- 2003
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Doctoral thesis (other academic/artistic)abstract
- Helicobacter pylori and Chlamydia pneumoniae are common infectious agents in the Swedish population, causing gastritis ulcers and respiratory infections. The metabolic syndrome is characterised by overweight, insulin resistance, hypertension, diabetes and dyslipidaemia. Sera from a patient cohort (n=531) originally examined in 1987-89 were investigated for previous infection of H. pylori and C. pneumoniae in order to find possible associations with the metabolic syndrome. When comparing patients who have suffered infections (n=245) from both agents combined with those without infection (n=57) a significant increase in fasting insulin was observed indicating that the double infection may influence peripheral insulin resistance, which in turn could influence manifest disease. In a gastroscopy patients cohort (n=166), we compared the ELISA and immunoblot (IB) serology for H. pylori, with the histological features of the gastric mucosa. The presence of metaplasia and atrophy in the antrum were associated with a more specific immunoblot pattern and immunoblot analysis had a better sensitivity for gastric mucosal changes than ELISA-H. pylori serology. In all patients with chronic gastritis (n=90) significant correlation was seen to the 59 and 65 kDa protein band and in the corpus of the stomach also to a 33 kD protein. Atrophic gastritis and metaplasia in the antrum were significantly correlated with immunoreactivity to the 62 kDa protein (p<0.001 vs. p<0.002). Atrial fibrillation, with largely unknown origin, is the most common form of cardiac arrythmia demanding treatment. In comparing a population with this condition at a cardiology clinic (n=54) with a matched control population (n=54) from the same geographical area we found a significant independent association between atrial fibrillation and seropositivity for the combination of H. pylori and C. pneumoniae infection. Anti-Secretory Factor (ASF) is a protein with potent anti-inflammatory and anti-secretory properties. The pathophysiology of IBS, a common disorder often impairing quality of life, is unknown but a disturbance of motility, sensitivity and secretory processes has been observed. In order to improve the general condition, half of a group of patients (n=82) with IBS were given special processed cereals for eight weeks and the remaining half were randomly given placebo diet. Both groups significantly improved in their general well-being after eight weeks of treatment but no difference was seen between the groups. Patients with H. pylori infection (n=11) showed a tendency towards benefiting from the active treatment (p=0.08). In a sub-group of patients with loose stools (n=14) the ASF level increased in the active diet group. In the individual patients there was also a significant correlation between the improvement of symptoms and the change of the ASF plasma levels (p<0.05). In conclusion, we have shown that chronic infections with H. pylori and C. pneumoniae may affect the biological processes in several organ systems. The common pathophysiological pathway is probably a chronic inflammation where either the histological changes or the agents mediating the inflammation are of greatest importance, e.g. cytokines.
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| 4. |
- Ekesbo, Rickard, et al.
(author)
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Lack of adherence to hypertension treatment guidelines among GPs in southern Sweden-A case report- based survey
- 2012
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In: BMC Family Practice. - : Springer Science and Business Media LLC. - 1471-2296. ; 13
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Journal article (peer-reviewed)abstract
- Background: General practitioners (GPs) often fail to correctly adhere to guidelines for the treatment of hypertension. The reasons for this are unclear, but could be related to lack of knowledge in assessing individual patients' cardiovascular disease risk. Our aim was to investigate how GPs in southern Sweden adhere to clinical guidelines for the treatment of hypertension when major cardiovascular risk factors are taken into consideration. Method: A questionnaire with five genuine cases of hypertension with different cardiovascular risk profiles was sent to a random sample of GPs in southern Sweden (n = 109) in order to investigate the attitude towards blood pressure (BP) treatment when major cardiovascular risk factors were present. Results: In general, GPs who responded tended to focus on the absolute target BP rather than assessing the entire cardiovascular risk factor profile. Thus, cases with the highest risk of cardiovascular disease were not treated accordingly. However, there was also a tendency to overtreat the lowest risk individuals. Furthermore, the BP levels for initiating pharmacological treatment varied widely (systolic BP 140-210 mmHg). ACE inhibitors (70%) were the most common first choice of pharmacological treatment. Conclusion: In this study, GPs in Southern Sweden were suggesting, for different cases, either under- or overtreatment in relation to current guidelines for treatment of hypertension. On reason may be that they failed to correctly assess individual cardiovascular risk factor profiles. Key points: Despite international and national clinical guidelines on the treatment of hypertension, general practitioners often fail to correctly assess the cardiovascular risk for patients in a clinical setting. Most GPs use target blood pressure levels but do not consider other cardiovascular risk factors. Both under- and overtreatment of high and low cardiovascular risk groups were seen in this study.
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| 5. |
- Gerward, Sofia, et al.
(author)
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Trends in out-of-hospital ischaemic heart disease deaths 1992 to 2003 in southern Sweden.
- 2012
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In: Scandinavian Journal of Public Health. - : SAGE Publications. - 1651-1905 .- 1403-4948. ; 40:4, s. 340-347
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Journal article (peer-reviewed)abstract
- AIMS: In western countries out-of-hospital ischaemic heart disease (IHD) deaths account for approximately 50-70% of all IHD deaths. The objective was to examine the trends in out-of-hospital IHD deaths in the Region of Skåne in southern Sweden, in different sex- and age-groups. METHODS: All 14,347 persons (range 24-110 years) in Skåne who died out-of-hospital between 1992 and 2003 from IHD (I410-I414; I20-I25) as the underlying cause of death. Subjects with previous admission for IHD since 1970 were excluded. Data were retrieved from the Swedish National Cause of Death and Patient Register. Age-standardized IHD mortality rates and trends were calculated using Poisson regression analysis. RESULTS: Age-standardized annual out-of-hospital IHD mortality rates from 1992-2003 decreased in men from 177±13 to 103±9/100,000 inhabitants (-4.7%; p<0.001) and in women from 142±11 to 96±9/100,000 (-2.7%; p<0.001). In men, the annual change in age-standardized IHD mortality rates were -5.3 % (p<0.001), -4.0 % (p<0.001) and -4.7 % (p<0.001), respectively, in the age groups 20-64 years, 65-74 years and ≥75 years. Corresponding figures in women were -4.4 % (p<0.001), -2.4 % (p=0.003) and -2.5 % (p<0.001). The proportion of IHD deaths occurring out-of-hospital was in these age groups 50%, 40% and 35% respectively. CONCLUSIONS: In Skåne, out-of-hospital mortality in IHD deaths decreased significantly between 1992 and 2003. The decrease is more pronounced in men than women, and at the end of the study period in 2003, rates were almost equal. The proportion of IHD deaths occurring outside hospital was higher in younger people than in older people.
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| 6. |
- Lexner, Jesper, et al.
(author)
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Well-being and dietary adherence in patients with coeliac disease depending on follow-up
- 2021
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In: Scandinavian Journal of Gastroenterology. - : Informa UK Limited. - 0036-5521 .- 1502-7708. ; 56:4, s. 382-390
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Journal article (peer-reviewed)abstract
- Objective: It is not clear how follow-up of coeliac disease should be optimally organised. In Malmö, Sweden, patients are followed up by general practitioners (GP), but in Linköping by gastroenterologists (GE). The aim of this study was to investigate if there were any differences in well-being and dietary adherence depending on type of follow-up. Methods: All adult patients with newly diagnosed biopsy-verified coeliac disease in the cities between 2010 and 2014 were offered to participate. Data was retrieved comprising demography, laboratory analyses, questionnaires (Gastrointestinal Symptoms Rating Scale, Short Health Scale, Multidimensional Fatigue Inventory, Psychological General Well-being Index and Short Form 36) and follow-up. Results: In the GP cohort 39/73 patients and in the GE cohort 58/121 agreed to participate (mean age 43 and 44 years, 69 and 60% women, respectively). A follow-up to a dietician was carried out in 31% and 93% of patients, respectively (p <.001). In the GP group 28% had eaten gluten-containing food during the last 4 weeks compared to 9% in the GE group (p =.01). Despite this, no differences could be seen in vitamin or mineral levels. The questionnaires did not indicate any major discrepancies in subjective health. Conclusion: Irrespective of the design of the follow-up physical and mental well-being were comparable. Dietary adherence was not quite as good in the GP group but follow-up in a primary care setting can still be a suitable and equivalent alternative. However, it is crucial that the dietary counselling is structured in a way that ensures dietary adherence.
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| 7. |
- Midlöv, Patrik, et al.
(author)
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Barriers to adherence to hypertension guidelines among GPs in southern Sweden: A survey.
- 2008
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In: Scandinavian Journal of Primary Health Care. - : Informa UK Limited. - 0281-3432 .- 1502-7724. ; 26, s. 154-159
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Journal article (peer-reviewed)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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| 8. |
- Platonov, Pyotr, et al.
(author)
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Permanent atrial fibrillation in patients without structural heart disease is not associated with signs of infection by Chlamydia pneumoniae and Helicobacter pylori.
- 2008
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In: Acta Cardiologica. - 0001-5385. ; 63:4, s. 479-484
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Journal article (peer-reviewed)abstract
- OBJECTIVE: The objective of this study was to explore the role of Chlamydia pneumoniae and Helicobacter pylori infections in patients with idiopathic permanent atrial fibrillation. METHODS AND RESULTS: Sera from 72 patients with permanent atrial fibrillation without structural heart disease (mean age 69.6 years, 23 women) were analysed for IgG antibodies against Chlamydia pneumoniae and Helicobacter pylori and compared in a I:I age- and sex-matched case:control manner with those pooled from a healthy reference population of 72 individuals from the same geographical area. After excluding patients with other possible or definite factors known either to cause atrial fibrillation or to affect the prevalence of seropositivity to these agents, the frequency of seropositivity due to one or both of the infectious agents was compared. Serum C-reactive protein (CRP) level was assessed using immunoturbidimetry technique. Both agents were equally common in men and women. Neither seropositivity to Chlamydia pneumoniae (76% vs. 83%, patients vs. control subjests, ns) nor to Helicobacter pylori (57% contra 55%, patients vs. controls, ns) alone reached significance in the comparisons between patients with atrial fibrillation and control subjects. Serum CRP was higher in patients with AF (5.3 mg/L vs. 2.8 mg/L, P < 0.001). CONCLUSIONS: Though presence of permanent AF is associated with elevated CRP levels, this elevation is not the result of earlier infections with Chlamydia pneumoniae or Helicobacter pylori or their combination.
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| 9. |
- Stengaard-Pedersen, K, et al.
(author)
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Celecoxib 200 mg q.d. is efficacious in the management of osteoarthritis of the knee or hip regardless of the time of dosing
- 2004
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In: Rheumatology. - : Oxford University Press (OUP). - 1462-0332 .- 1460-2172. ; 43:5, s. 592-595
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Journal article (peer-reviewed)abstract
- Objectives. The primary objective was to demonstrate equivalence between a.m. and p.m. dosing of celecoxib 200 mg q.d. An equivalence assessment of q.d. vs b.i.d. dosing was a secondary objective. Methods. In this randomized, double-blind study, patients with symptomatic osteoarthritis of the knee or hip were randomized to receive celecoxib 200 mg q.d. a.m., celecoxib 200 mg q.d. p.m. or celecoxib 100 mg b.i.d. The primary outcome variable, measured at week 12 on a 0- to 10-point integrated scale, was patient satisfaction-assessment (pain relief, walking/bending, and willingness to continue medication). Equivalence was declared if the 95% confidence interval (CI) of the difference (a.m. q.d. vs p.m. q.d., b.i.d. vs q.d.) fell within the interval of -2 to +2. Results. A total of 697 patients were enrolled in this trial. For the a.m. vs p.m. comparison, the 95% CIs were within the prespecified equivalence criteria for all three measures of patient satisfaction: pain relief, mean -0.2, 95% CI -0.53 to 0.68; ability to walk and bend, mean -0.2, 95% CI -0.54 to 0.64; willingness to continue medication, mean -0.7, 95% CI -0.98 to 0.49. The 95% CIs for the q.d. vs b.i.d. comparison were also within the -2 to +2 interval. Conclusion. Regardless of the time of day at which celecoxib 200 mg q.d. is administered, patients are equally satisfied with the pain relief, ability to walk and bend, and willingness to continue medication.
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| 10. |
- Stenman, Emelie, et al.
(author)
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Study protocol: a multi-professional team intervention of physical activity referrals in primary care patients with cardiovascular risk factors-the Dalby lifestyle intervention cohort (DALICO) study
- 2012
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In: BMC Health Services Research. - : Springer Science and Business Media LLC. - 1472-6963. ; 12
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Journal article (peer-reviewed)abstract
- Background: The present study protocol describes the trial design of a primary care intervention cohort study, which examines whether an extended, multi-professional physical activity referral (PAR) intervention is more effective in enhancing and maintaining self-reported physical activity than physical activity prescription in usual care. The study targets patients with newly diagnosed hypertension and/or type 2 diabetes. Secondary outcomes include: need of pharmacological therapy; blood pressure/plasma glucose; physical fitness and anthropometric variables; mental health; health related quality of life; and cost-effectiveness. Methods/Design: The study is designed as a long term intervention. Three primary care centres are involved in the study, each constituting one of three treatment groups: 1) Intervention group (IG): multi-professional team intervention with PAR, 2) Control group A (CA): physical activity prescription in usual care and 3) Control group B: treatment as usual (retrospective data collection). The intervention is based on self-determination theory and follows the principles of motivational interviewing. The primary outcome, physical activity, is measured with the International Physical Activity Questionnaire (IPAQ) and expressed as metabolic equivalent of task (MET)-minutes per week. Physical fitness is estimated with the 6-minute walk test in IG only. Variables such as health behaviours; health-related quality of life; motivation to change; mental health; demographics and socioeconomic characteristics are assessed with an electronic study questionnaire that submits all data to a patient database, which automatically provides feed-back to the health-care providers on the patients' health status. Cost-effectiveness of the intervention is evaluated continuously and the intermediate outcomes of the intervention are extrapolated by economic modelling. Discussions: By helping patients to overcome practical, social and cultural obstacles and increase their internal motivation for physical activity we aim to improve their physical health in a long- term perspective. The targeted patients belong to a patient category that is supposed to benefit from increased physical activity in terms of improved physiological values, mental status and quality of life, decreased risk of complications and maybe a decreased need of medication.
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| 11. |
- Tovar, Juscelino, et al.
(author)
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A diet based on multiple functional concepts improves cardiometabolic risk parameters in healthy subjects
- 2012
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In: Nutrition & Metabolism. - : Springer Science and Business Media LLC. - 1743-7075. ; 9:29
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Journal article (peer-reviewed)abstract
- Background: Different foods can modulate cardiometabolic risk factors in persons already affected by metabolic alterations. The objective of this study was to assess, in healthy overweight individuals, the impact of a diet combining multiple functional concepts on risk markers associated with cardiometabolic diseases (CMD). Methods: Fourty-four healthy women and men (50-73 y.o, BMI 25-33, fasting glycemia <= 6.1 mmol/L) participated in a randomized crossover intervention comparing a multifunctional (active) diet (AD) with a control diet (CD) devoid of the "active" components. Each diet was consumed during 4 wk with a 4 wk washout period. AD included the following functional concepts: low glycemic impact meals, antioxidant-rich foods, oily fish as source of long-chain omega-3 fatty acids, viscous dietary fibers, soybean and whole barley kernel products, almonds, stanols and a probiotic strain (Lactobacillus plantarum Heal19/DSM15313). Results: Although the aim was to improve metabolic markers without promoting body weight loss, minor weight reductions were observed with both diets (0.9-1.8 +/- 0.2%; P < 0.05). CD did not modify the metabolic variables measured. AD promoted significant changes in total serum cholesterol (-26 +/- 1% vs baseline; P < 0.0001), LDL-cholesterol (-34 +/- 1%; P < 0.0001), triglycerides (-19 +/- 3%; P = 0.0056), LDL/HDL (-27 +/- 2%; P < 0.0001), apoB/apoA1 (-10 +/- 2%; P < 0.0001), HbA1c (-2 +/- 0.4%; P = 0.0013), hs-CRP (-29 +/- 9%; P = 0.0497) and systolic blood pressure (-8 +/- 1%, P = 0.0123). The differences remained significant after adjustment for weight change. After AD, the Framingham cardiovascular risk estimate was 30 +/- 4% (P < 0.0001) lower and the Reynolds cardiovascular risk score, which considers CRP values, decreased by 35 +/- 3% (P < 0.0001). Conclusion: The improved biomarker levels recorded in healthy individuals following the multifunctional regime suggest preventive potential of this dietary approach against CMD.
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