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- Munthe, Christian, 1962
(author)
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Informed Consent and Quality of Available Information
- 1998
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In: Fourth World Congress of the International Association of Bioethics, Tokyo, November 4-7, 1998.
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Conference paper (other academic/artistic)abstract
- Standard versions of the requirement of informed consent state that patients who are offered to enter a clinical trial of a medical procedure should be informed about risks and possible benefits of this procedure (compared to available alternatives) in order to facilitate a rational decision whether or not to participate. However, in many real cases where new medical procedures are to be clinically tested for the first time the information available for such communication to prospective patients is very scarce, vague and/or uncertain. This phenomenon is illustrated by the clinical introduction of new procedures in reproductive medicine, such as preimplantation genetic diagnosis (PGD). Regarding such procedures, it has ben argued that, in such cases, the quality of the available information may be too low for the obtaining of informed consent to be possible, even if it is successfully communicated. Others, instead, holds that informed consent may always be obtained regardless of the quality of the available information. Unfortunately, the standard litterature on informed consent give no clue as to which of these interpretations is correct. This issue is explored by connecting the concept of informed consent to ethical ideas of respect for autonomy and ideas of rational decision making. It is argued, first, that low quality of available information regarding the risks and possible benefits of a medical procedure may indeed make the obtaining of informed consent from patients to undergo this procedure impossible even in theory. However, it is also argued that whether or not this is the case must be relativized to the actual needs and desires of individual patients. Thus, regarding one and the same procedure, informed consent may be impossible to obtain from some patients due to the low quality of the available information regarding this procedure, but still be possible to obtain from other patients.
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- Andersson, H. Ingemar, 1950-
(author)
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Chronic pain : epidemiological studies in a general population
- 1998
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Doctoral thesis (other academic/artistic)abstract
- The aim was to study the epidemiology of chronic pain (> 3 months duration) and factors associated to pain prevalence, prognosis, health care and medication in a general population. A cross-sectional mailed survey to a random population sample (n = 1806) was followed by a clinical examination and a prospective study of three selected groups. Pain related diagnoses from primary health care was monitored and compared with pain prevalence. The most important findings were: - a high total prevalence of chronic pain, 55.2%, without gender difference but varying by age and socioeconomic level. About one fourth (12.8%) reported high pain intensity and functional impairments. Women experienced pain at more locations and with higher intensity. - in a multivariate analysis increasing age, female gender, low education, high work strain, depression and insomnia were associated with chronic pain. - widespread pain showed a worse 2- year prognosis compared with neck shoulder pain. - musculoskeletal location of pain dominated, myalgia and myofascial pain being the most common symptom descriptions. - co-morbidity with chronic pain was common. More hypertensives and an increased level of serum uric acid associated to widepread pain indicated possible metabolic connections to pain. - smoking (current and previous) was associated with low-back and widespread pain. - chronic pain had a substantial influence of primary health care-seeking and medication; high pain intensity being the most important predictor of care and medication. - pain related diagnoses in primary health care increased between 1987 and 1996. Chronic pain, mainly with musculoskeletal location, is a community health problem. A multi-factorial approach in prevention and treatment on the basis of present knowledge is necessary.
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| 4. |
- Andersson, H. Ingemar, 1950-, et al.
(author)
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Widespread musculoskeletal chronic pain associated with smoking : an epidemiological study in a general rural population
- 1998
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In: Scandinavian Journal of Rehabilitation Medicine. - 0036-5505 .- 1940-2228. ; 30:3, s. 185-191
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Journal article (peer-reviewed)abstract
- Data on smoking and pain symptoms from a random sample (n = 1806) of a general population were used to evaluate the association between chronic pain at various locations and smoking. In both genders current smoking was associated with reports of increased pain in low back, neck and with multiple locations. In a multiple logistic regression analysis current smoking was associated with an increase in widespread chronic musculoskeletal pain (OR 1.60, CI 1.04-2.46, in relation to non-smokers) and chronic low back pain (OR 1.58, CI 1.13-2.20, in relation to non-smokers). A dose-response relationship was found between the daily cigarette consumption and the prevalence of chronic low back pain. Smoking is associated not only with low back pain but also with chronic widespread musculoskeletal pain. No conclusive decrease in pain prevalence was found after quitting smoking. Further studies are necessary to elucidate an aetiologic relationship between smoking and chronic pain.
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| 5. |
- Andersson, Ingemar H
(author)
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Chronic pain. Epidemiological studies in a general population
- 1998
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Doctoral thesis (other academic/artistic)abstract
- The aim was to study the epidemiology of chronic pain (> 3 months duration) and factors associated to pain prevalence, prognosis, health care and medication in a general population. A cross-sectional mailed survey to a random population sample (n = 1806) was followed by a clinical examination and a prospective study of three selected groups. Pain related diagnoses from primary health care was monitored and compared with pain prevalence. The most important findings were: - a high total prevalence of chronic pain, 55.2%, without gender difference but varying by age and socioeconomic level. About one fourth (12.8%) reported high pain intensity and functional impairments. Women experienced pain at more locations and with higher intensity. - in a multivariate analysis increasing age, female gender, low education, high work strain, depression and insomnia were associated with chronic pain. - widespread pain showed a worse 2- year prognosis compared with neck shoulder pain. - musculoskeletal location of pain dominated, myalgia and myofascial pain being the most common symptom descriptions. - co-morbidity with chronic pain was common. More hypertensives and an increased level of serum uric acid associated to widepread pain indicated possible metabolic connections to pain. - smoking (current and previous) was associated with low-back and widespread pain. - chronic pain had a substantial influence of primary health care-seeking and medication; high pain intensity being the most important predictor of care and medication. - pain related diagnoses in primary health care increased between 1987 and 1996. Chronic pain, mainly with musculoskeletal location, is a community health problem. A multi-factorial approach in prevention and treatment on the basis of present knowledge is necessary.
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| 6. |
- Claesson, Cecilia B., et al.
(author)
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Drug use in Swedish nursing homes
- 1998
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In: Clinical drug investigation. - 1173-2563 .- 1179-1918. ; 16:6, s. 441-52
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Journal article (peer-reviewed)
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| 10. |
- Friis, Robert, et al.
(author)
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Review of social epidemiologic research on migrants' health : findings, methodological cautions, and theoretical perspectives
- 1998
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In: Scandinavian journal of social medicine. - : SAGE Publications. - 0300-8037. ; 26, s. 173-
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Journal article (peer-reviewed)abstract
- The phenomenon of world-wide immigration and migration has major implications for the health of the migrants in addition to its impact upon social and other service providers. Studies of migrants that utilize social epidemiologic methods fall within the traditional boundaries of descriptive and analytic approaches; this article reviews some of the studies that exemplify these approaches. It then suggests specific methodological issues and cautions pertaining to research on migrants and provides a theoretical model for organizing the diverse research studies that have been conducted. By stimulating discussion regarding social epidemiologic research on migrants' health, this model is intended to serve as a compass point for future research and needed interventions.
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