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  • 1. Abdulhadi, Nadia
    et al.
    Al Shafaee, Mohammed
    Freudenthal, Solveig
    Östenson, Claes-Göran
    Wahlström, Rolf
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och klinisk epidemiologi.
    Patient-provider interaction from the perspectives of type 2 diabetes patients in Muscat, Oman: a qualitative study2007Inngår i: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 7, s. 162-Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Patients' expectations and perceptions of the medical encounter and interactions are important tools in diabetes management. Some problems regarding the interaction during encounters may be related to a lack of communication skills on the part of either the physician or the patient. This study aimed at exploring the perceptions of type 2 diabetes patients regarding the medical encounters and quality of interactions with their primary health-care providers. Methods: Four focus group discussions ( two women and two men groups) were conducted among 27 purposively selected patients ( 13 men and 14 women) from six primary health-care centres in Muscat, Oman. Qualitative content analysis was applied. Results: The patients identified some weaknesses regarding the patient-provider communication like: unfriendly welcoming; interrupted consultation privacy; poor attention and eye contact; lack of encouraging the patients to ask questions on the providers' side; and inability to participate in medical dialogue or express concerns on the patients' side. Other barriers and difficulties related to issues of patient-centeredness, organization of diabetes clinics, health education and professional competency regarding diabetes care were also identified. Conclusion: The diabetes patients' experiences with the primary health-care providers showed dissatisfaction with the services. We suggest appropriate training for health-care providers with regard to diabetes care and developing of communication skills with emphasis on a patient-centred approach. An efficient use of available resources in diabetes clinics and distributing responsibilities between team members in close collaboration with patients and their families seems necessary. Further exploration of the providers' work situation and barriers to good interaction is needed. Our findings can help the policy makers in Oman, and countries with similar health systems, to improve the quality and organizational efficiency of diabetes care services.

  • 2. Agréus, Lars
    et al.
    Talley, Nicholas J
    Sheen, Adrian
    Johansson, Sven-Erik
    Jones, Michael P
    Svärdsudd, Kurt
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och klinisk epidemiologi.
    Predictors and non-predictors of symptom relief in dyspepsia consultations in primary care2008Inngår i: Digestive Diseases, ISSN 0257-2753, E-ISSN 1421-9875, Vol. 26, nr 3, s. 248-255Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVE: We aimed to evaluate if the course of dyspepsia is influenced by medical consultation in primary care. DESIGN, SETTING AND PATIENTS: Australian general practitioners (n = 27) recruited 157 dyspeptic patients, of whom 94 were eligible for follow-up. Dyspepsia, comorbidity, quality of life, emotional status, locus of control and consultation satisfaction were measured at baseline and follow-up (mean 3 months). MAIN OUTCOME MEASURE: Response was defined as improvement of dyspepsia over time on the Nepean Dyspepsia Index score. RESULTS: Dyspepsia improved in 82% (n = 77). There was no significant change in non-gastrointestinal symptoms. Half were worried or stressed by their symptoms, and 85% wanted reassurance, a need that (univariately) differentiated responders from non-responders (p = 0.02). Most patients seen in primary care with dyspepsia improved. If the doctor believed it was likely that the patient would follow their recommendations, the patient was nearly five times as likely to be a responder (OR 4.9, 95% CI 1.2-19.0). The only other significant predictor was acid suppression therapy (OR 3.5, 95% CI 1.1-10.9). CONCLUSION: Most primary care visits for dyspepsia are followed by improvement, which may be predicted in part by indicators of patient compliance. Prescription of acid suppression therapy may also improve outcome in dyspepsia

  • 3.
    Alander, Ture
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och klinisk epidemiologi.
    Svärdsudd, K
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och klinisk epidemiologi.
    Agréus, L
    Functional gastrointestinal disorder is associated with increased non-gastrointestinal healthcare consumption in the general population2008Inngår i: International journal of clinical practice (Esher), ISSN 1368-5031, E-ISSN 1742-1241, Vol. 62, nr 2, s. 234-240Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVES: Comparison of comorbidity and healthcare consumption in primary healthcare subjects with persistent functional gastrointestinal disorder (FGID) and a strictly gastrointestinal (GI) symptom-free group (SSF). METHODS: A stratified sample (n=1428, 21-86 years) of subjects living in the Osthammar community, Sweden, was limited to half of the community and classified through the Abdominal Symptom Questionnaire (ASQ) into two study groups, one with persistent FGID (n=71), another SSF (n=48). Symptoms were re-evaluated by means of the ASQ at a surgery visit, as was healthcare consumption during 2 years, and the levels of anxiety and depression, as measured with the Hospital Anxiety and Depression Scale. Diagnoses were set according to The International Classification of Diseases (ICD)-9 and the 14 diagnostic groups. RESULTS: Of the FGID patients, 97% had a non-GI diagnosis, compared with 100% of SSF (ns). The mean number of doctors' consultations (OR=3.5), phone calls to doctors (OR=3.4), number of prescriptions (OR=2.4) and number of set diagnoses (OR=3.9), anxiety level (OR=11.5) and depression (OR=5.2) were all statistically significantly higher (p<0.05) for FGID than for SSF, while the number of referrals and sick leave were not. Besides a GI diagnosis, there was no significant difference (p>0.05) in the spectrum of morbidity in terms of ICD-9 subgroup classification, except an increased proportion of older SSF subjects with circulatory disorders and hypertension. CONCLUSIONS: Functional gastrointestinal disorders are related to an increased demand on primary healthcare because of an increased overall comorbidity, which signifies a need for a holistic healthcare approach.

  • 4. Andre, Malin
    et al.
    Vernby, Asa
    Odenholt, Inga
    Lundborg, Cecilia Stalsby
    Axelsson, Inge
    Eriksson, Margareta
    Runehagen, Arne
    Schwan, Åke
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och klinisk epidemiologi.
    Molstad, Sigvard
    Diagnosis-prescribing surveys in 2000, 2002 and 2005 in Swedish general practice: Consultations, diagnosis, diagnostics and treatment choices2008Inngår i: Scandinavian Journal of Infectious Diseases, ISSN 0036-5548, E-ISSN 1651-1980, Vol. 40, nr 8, s. 648-654Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The aim of this study is to present diagnostic patterns, diagnostics used and antibiotic treatment in relation to guidelines in 3 repeated diagnosis-prescription studies conducted simultaneously in general practice in 5 Swedish counties, during 1 week in November 2000, 2002 and 2005. General practitioners (GPs) at the participating health centres were asked to complete a form for all patients with symptoms of an infectious disease. During the studied periods a total of 15,371 consultations was registered. Consultations with GPs diagnosed as respiratory tract infection (RTI), especially consultations for sore throat, decreased considerably between y 2000 and 2005. The percentage of patients allocated an RTI diagnosis and prescribed an antibiotic declined significantly from 54% to 49% and the decline was most pronounced among children. Penicillin V remained the dominant antibiotic prescribed throughout the study periods. For lower urinary tract infections there was a significant change in choice of prescribed antibiotics with an increase for pivmecillinam and nitrofurantoin and a decrease for trimethoprim, in accordance with recommendations. The results indicate a quite close adherence to current guidelines, with changes in the pattern of consultations as well as in the management of infectious diseases in general practice in Sweden.

  • 5. André, Malin
    et al.
    Vernby, Åsa
    Odenholt, Inga
    Lundborg, Cecilia Stålsby
    Axelsson, Inge
    Eriksson, Margareta
    Runehagen, Arne
    Schwan, Åke
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och klinisk epidemiologi.
    Mölstad, Sigvard
    Allmänläkare förskrec mindre antibiotika men utnyttjade CRP-test mer: Diagnos–förskrivningsstudier för åren 2000–2005 [General practitioners prescribed less antibiotics but used the CRP test more. Diagnosis-prescription studies in 2000-2005]2008Inngår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 105, nr 41, s. 2851-2854Artikkel i tidsskrift (Fagfellevurdert)
  • 6.
    Arne, Mats
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Lungmedicin och allergologi.
    Lisspers, Karin
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och klinisk epidemiologi.
    Ställberg, Björn
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och klinisk epidemiologi. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i D län (CKFD).
    Boman, Gunnar
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Lungmedicin och allergologi.
    Hedenström, Hans
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Klinisk fysiologi.
    Janson, Christer
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Lungmedicin och allergologi.
    Emtner, Margareta
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Sjukgymnastik. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Lungmedicin och allergologi.
    How often is diagnosis of COPD confirmed with spirometry?2010Inngår i: Respiratory Medicine, ISSN 0954-6111, E-ISSN 1532-3064, Vol. 104, nr 4, s. 550-556Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Chronic obstructive pulmonary disease (COPD) is an important cause of morbidity and mortality worldwide. Diagnosis is customarily confirmed with spirometry, but there are few studies on documented spirometry use in everyday clinical practice. Methods: In a cross-sectional survey and study of the medical records of primary and secondary care COPD patients aged 18-75 in a Swedish region, patients with COPD were randomly selected from the registers of 56 primary care centres and 14 hospital outpatient clinics. Spirometry data at diagnosis ±6 months were analyzed. Results: From 1,114 patients with COPD, 533 with a new diagnosis of COPD during the four-year study period were identified. In 59% (n=316), spirometry data in connection with diagnosis were found in the medical records. Spirometry data with post-bronchodilator forced expiratory volume in one second (FEV1)/ vital capacity (VC) ratios were available in 45% (n=241). FEV1/VC ratio <0.70 were found in 160 patients, which corresponds to 30% of the patients with a new diagnosis. Lower age, female gender, current smoking, higher body mass index (BMI) and shorter forced exhalation time were related to COPD diagnosis despite an FEV1/VC ratio of ≥0.70. The most common problem in the quality assessment was an insufficient exhalation time. Conclusions: Only a third of Swedish patients with COPD had their diagnosis confirmed with spirometry. Our data indicate that female gender, current smoking, higher BMI and short exhalation time increase the risk of being diagnosed with COPD without fulfilling the spirometric criteria for the disease.

  • 7. Aro, P.
    et al.
    Ronkainen, J.
    Storskrubb, T.
    Bolling-Sternevald, E.
    Svärdsudd, Kurt
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och klinisk epidemiologi.
    Talley, N.J.
    Junghard, O.
    Johansson, S.E.
    Wiklund, I.
    Agréus, L.
    Validation of the translation and cross-cultural adaptation into Finnish of the Abdominal Symptom Questionnaire, the Hospital Anxiety and Depression Scale and the Complaint Score Questionnaire2004Inngår i: Scandinavian Journal of Gastroenterology, ISSN 0036-5521, E-ISSN 1502-7708, Vol. 39, nr 12, s. 1201-8Artikkel i tidsskrift (Fagfellevurdert)
  • 8.
    Arrelöv, Britt
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och klinisk epidemiologi.
    Borgquist, Lars
    Svärdsudd, Kurt
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och klinisk epidemiologi.
    Influence of local structural factors on physicians' sick-listing practice: a population-based study2005Inngår i: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 15, nr 5, s. 470-4Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Physicians have a central role as gatekeepers to the social security system, includingsick-listing. Variation in physicians’ sick-listing practices has been demonstrated in several studies. Theobjective of this study was to determine whether local structural factors affect sick-listing practice.Methods: A total of 57 563 consecutive sick-listing certificates, issued during 4 months in 1995 and2 months in 1996, were collected from the local branches of the National Social Insurance Office ineight Swedish counties. County code, local community population size and presence of a hospital in thearea were used as indicators of local structural factors. Length of the sick-listing certificates and of thesick-listing episodes were used as outcome variables. Results: After ajustment for the influence of categoryof issuing physician, patients’ age, sex and diagnosis (‘case mix’), and type of certificate there was alarge variation of the length of the sick-listing certificates and of the sick-listing episodes betweencounties, between communities of various size and between communities with or without a hospitalin the area. All these factors were independently and significantly correlated to the length of thecertificate and of the sick-listing episode. Conclusions: The results support the hypothesis that physicians’sick-listing practice is influenced by local structural factors.

  • 9.
    Bardel, Annika
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och klinisk epidemiologi.
    Kvinnors hälsa och läkemedelskonsumtion: (halvtidskontroll)2003Rapport (Annet vitenskapelig)
  • 10.
    Bardel, Annika
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och klinisk epidemiologi.
    Svärdsudd, Kurt
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och klinisk epidemiologi.
    Wallander, Mari-Ann
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och klinisk epidemiologi.
    Några prediktoter för läkemedelsanvändning hos 35-65-åriga kvinnor i Mellansverige1999Konferansepaper (Annet vitenskapelig)
  • 11.
    Bardel, Annika
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och klinisk epidemiologi.
    Svärdsudd, Kurt
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och klinisk epidemiologi.
    Wallander, Mari-Ann
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och klinisk epidemiologi.
    Symtomrapportering hos kvinnor med och utan HRT-behandling2001Inngår i:  , 2001, s. OB25P-Konferansepaper (Annet vitenskapelig)
  • 12.
    Bardel, Annika
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och klinisk epidemiologi.
    Wallander, Mari-Ann
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och klinisk epidemiologi.
    Svärdsudd, Kurt
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och klinisk epidemiologi.
    Factors associated with adherence to drug theraphy: a population-based study2006Konferansepaper (Annet vitenskapelig)
  • 13.
    Bardel, Annika
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och klinisk epidemiologi.
    Wallander, Mari-Ann
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och klinisk epidemiologi.
    Svärdsudd, Kurt
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och klinisk epidemiologi.
    Factors associated with adherence to drug therapy: a population-based study2007Inngår i: European Journal of Clinical Pharmacology, ISSN 0031-6970, E-ISSN 1432-1041, Vol. 63, nr 3, s. 307-314Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective  To investigate adherence to prescription in a female population aged 35–65 years.

    Design  Postal questionnaire study of 2991 randomly sampled 35- to 64-year-old women in seven provinces of central Sweden. Methods  The study was performed in 1995 as a cross-sectional postal questionnaire study in seven counties in central Sweden. The questionnaire was sent to a random sample of 4200 women between the ages of 35 and 64, of whom 2991 (71.2%) responded. The questionnaire asked about drugs prescribed during the past year and about factors potentially affecting adherence. Results  The same women had different degrees of adherence to different medications. A large number of factors were associated with adherence. Multivariate analysis revealed that age, scheduled check-up, perceived importance of medication, concerns about medication safety and taking medication for a respiratory or a cardiovascular disease were significantly related to adherence. Adherence ranged from 15–98% depending on these factors, and was the lowest among young women who regarded their medication as unimportant and who had no scheduled check-up; the highest reported adherence was found among elderly women who regarded their medication as important and who had a scheduled check-up. Conclusion  Factors that were associated with the perceived importance of medication had a positive effect on adherence, while concerns about medication safety had a negative effect.

  • 14.
    Bardel, Annika
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och klinisk epidemiologi.
    Wallander, Mari-Ann
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och klinisk epidemiologi.
    Svärdsudd, Kurt
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och klinisk epidemiologi.
    Hormone replacement therapy and symptom reporting in menopausal women: A population-based study of 35-65-year-old women in mid-Sweden2002Inngår i: Maturitas, Vol. 41, s. 7-15Artikkel i tidsskrift (Fagfellevurdert)
  • 15.
    Bardel, Annika
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och klinisk epidemiologi.
    Wallander, Mari-Ann
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och klinisk epidemiologi.
    Svärdsudd, Kurt
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och klinisk epidemiologi.
    Reported current use of prescription drugs and some of its determinants among 35-65-year-old women in mid-Sweden: A population-based study2000Inngår i: Journal of Clinical Epidemiology, Vol. 53, s. 647-653Artikkel i tidsskrift (Fagfellevurdert)
  • 16.
    Bardel, Annika
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och klinisk epidemiologi.
    Wallander, Mari-Ann
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och klinisk epidemiologi.
    Wedel, Hans
    Svärdsudd, Kurt
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och klinisk epidemiologi.
    Age-specific symptom prevalence in women 35-64 years old: A population-based study2009Inngår i: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 9, s. 37-Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: Symptom prevalence is generally believed to increase with age. The aim of this study was to evaluate the age specific prevalence of 30 general symptoms among Swedish middle-aged women. METHODS: A cross-sectional postal questionnaire study in seven Swedish counties in a random sample of 4,200 women 35-64 years old, with 2,991 responders. Thirty general symptoms included in the Complaint Score subscale of the Gothenburg Quality of Life Instrument were used. RESULTS: Four groups of age specific prevalence patterns were identified after adjustment for the influence of educational level, perceived health and mood, body mass index, smoking habits, use of hormone replacement therapy, and use of other symptom relieving therapy. Only five symptoms (insomnia, leg pain, joint pain, eye problems and impaired hearing) increased significantly with age. Eleven symptoms (general fatigue, headache, irritability, melancholy, backache, exhaustion, feels cold, cries easily, abdominal pain, dizziness, and nausea) decreased significantly with age. Two symptoms (sweating and impaired concentration) had a biphasic course with a significant increase followed by a significant decrease. The remaining twelve symptoms (difficulty in relaxing, restlessness, overweight, coughing, breathlessness, diarrhoea, chest pain, constipation, nervousness, poor appetite, weight loss, and difficulty in urinating) had stable prevalence with age. CONCLUSION: Symptoms did not necessarily increase with age instead symptoms related to stress-tension-depression decreased.

  • 17. Bellamy, David
    et al.
    Bouchard, Jacques
    Henrichsen, Svein
    Johansson, Gunnar
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och klinisk epidemiologi.
    Langhammer, Arnulf
    Reid, Jim
    van Weel, Chris
    Buist, Sonia
    International Primary Care Respiratory Group (IPCRG) Guidelines: management of chronic obstructive pulmonary disease (COPD)2006Inngår i: Primary Care Respiratory Journal, ISSN 1471-4418, E-ISSN 1475-1534, Vol. 15, nr 1, s. 48-57Artikkel i tidsskrift (Fagfellevurdert)
  • 18.
    Berglund, Lars
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Uppsala kliniska forskningscentrum (UCR). Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Geriatrik.
    Berne, Christian
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper.
    Svärdsudd, Kurt
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och klinisk epidemiologi.
    Garmo, Hans
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Uppsala kliniska forskningscentrum (UCR).
    Melhus, Håkan
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper.
    Zethelius, Björn
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Geriatrik.
    Seasonal variations of insulin sensitivity from a euglycemic insulin clamp in elderly men2012Inngår i: Upsala Journal of Medical Sciences, ISSN 0300-9734, E-ISSN 2000-1967, Vol. 117, nr 1, s. 35-40Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Introduction

    Seasonal variations in hemoglobin-A1c have been reported in diabetic patients, but the underlying mechanisms have not been elucidated.

    Aims

    To study if insulin sensitivity, insulin secretion, and fasting plasma glucose showed seasonal variations in a Swedish population-based cohort of elderly men.

    Methods

    Altogether 1117 men were investigated with a euglycemic insulin clamp and measurements of fasting plasma glucose and insulin secretion after an oral glucose tolerance test. Values were analyzed in linear regression models with an indicator variable for winter/summer season and outdoor temperature as predictors.

    Results

     During winter, insulin sensitivity (M/I, unit = 100 × mg × min-1 × kg-1/(mU × L-1)) was 11.0% lower (4.84 versus 5.44, P = 0.0003), incremental area under the insulin curve was 16.4% higher (1167 versus 1003 mU/L, P = 0.007). Fasting plasma glucose was, however, not statistically significantly different (5.80 versus 5.71 mmol/L, P = 0.28) compared to the summer season. There was an association between outdoor temperature and M/I (0.57 units increase (95% CI 0.29–0.82, P < 0.0001) per 10°C increase of outdoor temperature) independent of winter/summer season. Adjustment for life-style factors, type 2 diabetes, and medication did not alter these results.Read More:http://informahealthcare.com/doi/abs/10.3109/03009734.2011.628422

    Conclusions

    Insulin sensitivity showed seasonal variations with lower values during the winter and higher during the summer season. Inverse compensatory variations of insulin secretion resulted in only minor variations of fasting plasma glucose. Insulin sensitivity was associated with outdoor temperature. These phenomena should be further investigated in diabetic patients.

  • 19.
    Berglund, Lars
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Geriatrik. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Uppsala kliniskt forskningscentrum (UCR).
    Berne, Christian
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper.
    Svärdsudd, Kurt
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och klinisk epidemiologi.
    Garmo, Hans
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Uppsala kliniskt forskningscentrum (UCR).
    Zethelius, Björn
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Geriatrik.
    Early Insulin Response and Insulin Sensitivity are Equally Important as Predictors of Glucose Tolerance after Correction for Measurement Errors2009Inngår i: Diabetes Research and Clinical Practice, ISSN 0168-8227, E-ISSN 1872-8227, Vol. 86, nr 3, s. 219-224Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Aims: We estimated measurement error (ME) corrected effects of   insulin sensitivity (M/I), from euglycaemic insulin clamp, and insulin   secretion, measured as early insulin response (EIR) from oral glucose   tolerance test (OGTT), on fasting plasma glucose, HbA1c and type 2   diabetes longitudinally and cross-sectional.   Methods: : In a population-based study (n = 1128 men) 17 men made   replicate measurements to estimate ME at age 71 years. Effect of 1 SD   decrease of predictors M/I and EIR on longitudinal response variables   fasting plasma glucose (FPG) and HbA1c at follow-ups up to 11 years,   were estimated using uncorrected and ME-corrected (with the regression   calibration method) regression models.   Results: : Uncorrected effect on FPG at age 77 years was larger for M/I   than for EIR (effect difference 0.10 mmol/l, 95% CI 0.00;0.21), while   ME-corrected effects were similar (0.02 mmol/l, 95% CI -0.13;0.15   mmol/l). EIR had greater ME-corrected impact than M/I on HbA1c at age   82 years (-0.11%, -0.28; -0.01%).   Conclusions: : Due to higher ME effect of EIR on glycaemia is   underestimated as compared with M/I. By correcting for ME valid   estimates of relative contributions of insulin secretion and insulin   sensitivity on glycaemia are obtained.

  • 20.
    Berglund, Lars
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap.
    Garmo, Hans
    Lindbäck, Johan
    Svärdsudd, Kurt
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och klinisk epidemiologi.
    Zethelius, Björn
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap.
    Maximum likelihood estimation of correction for dilution bias in simple linear regression using replicates from subjects with extreme first measurements2008Inngår i: Statistics in Medicine, ISSN 0277-6715, E-ISSN 1097-0258, Vol. 27, nr 22, s. 4397-4407Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The least-squares estimator of the slope in a simple linear regression model is biased towards zero when the predictor is measured with random error. A corrected slope may be estimated by adding data from a reliability study, which comprises a subset of subjects from the main study. The precision of this corrected slope depends on the design of the reliability study and estimator choice.Previous work has assumed that the reliability study constitutes a random sample from the main study. A more efficient design is to use subjects with extreme values on their first measurement. Previously, we published a variance formula for the corrected slope, when the correction factor is the slope in the regression of the second measurement on the first. In this paper we show that both designs improve by maximum likelihood estimation (MLE). The precision gain is explained by the inclusion of data from all subjects for estimation of the predictor's variance and by the use of the second measurement for estimation of the covariance between response and predictor. The gain of MLE enhances with stronger true relationship between response and predictor and with lower precision in the predictor measurements. We present a real data example on the relationship between fasting insulin, a surrogate market, and true insulin sensitivity measured by a gold-standard euglycaemic insulin clamp, and simulations, where the behavior of profile-likelihood-based confidence intervals is examined. MLE was shown to be a robust estimator for non-normal distributions and efficient for small sample situations.

  • 21. Bergman, David
    et al.
    Arnetz, Bengt
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Socialmedicin.
    Wahlström, Rolf
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och klinisk epidemiologi.
    Sandahl, Christer
    Effects of dialogue groups on physicians' work environment2007Inngår i: Journal of Health Organisation & Management, ISSN 1477-7266, E-ISSN 1758-7247, Vol. 21, nr 1, s. 27-38Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Abstract: Purpose – The purpose of this study is to evaluate whether dialogue groups for physicians can improve their psychosocial work environment. Design/methodology/approach – The study assessed the impact of eight dialogue groups, which involved 60 physicians at a children's clinic in one of the main hospitals in Stockholm. Psychosocial work environment measures were collected through a validated instrument sent to all physicians (n=68) in 1999, 2001 and 2003. Follow-up data were collected after the termination of the groups. Findings – The overall score of organizational and staff wellbeing, as assessed by the physicians at the clinic, deteriorated from 1999 until 2003 and then improved 2004. This shift in the trend coincided with the intervention. No other factors which might explain this shift could be identified. Research limitations/implications – In a naturalistic study of this kind it is not possible to prove any causal relationships. A controlled survey of management programmes concerning the work environment among physicians would be of interest for further research. Practical implications – The results suggest that dialogue groups may be one way to improve the psychosocial work environment for physicians. Originality/value – There is a lack of intervention studies regarding the efficacy of management programmes directed toward physicians, concerning the effects on professional and personal wellbeing. This is the first time dialogue groups have been studied within a health care setting.

  • 22. Bergman, David
    et al.
    Savage, Carl
    Wahlström, Rolf
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och klinisk epidemiologi.
    Sandahl, Christer
    Teaching group dynamics - do we know what we are doing?: An approach to evaluation2008Inngår i: Medical teacher, ISSN 0142-159X, E-ISSN 1466-187X, Vol. 30, nr 1, s. 55-61Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Research into the efficacy of programs of leadership and group dynamics in undergraduate medical education is sparse. Aims: The aim of this study was to apply and test a pre-post evaluation design of a one-week experiential learning based course of group dynamics. Methods: Two questionnaires were sent to 160 medical students, before and after the course. The response rate was acceptable (73%). Results: While there was a small change in attitudes towards openness in their professional role and group dynamics, there was a major change in two subgroups of students to these topics. The students who were least interested in collaborative constructivist learning and those students who mainly looked for practical value were the students who changed their attitudes most towards openness in their professional role. Conclusions: It appears that those students who would be least likely to voluntarily attend such a course were the ones who learned the most. This study does not allow for any generalizations regarding the outcome of experiential learning of group dynamics, but it is an argument for the use of systematic evaluations in order to identify students who can benefit from courses aimed at improving profound knowledge.

  • 23. Billström, R
    et al.
    Björkegren, Karin
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och klinisk epidemiologi.
    Anemier2010Inngår i: Läkemedelsboken 2009-2010., Sundbyberg: AlfaPrint , 2010, , s. 1236s. 205-213Kapittel i bok, del av antologi (Annet vitenskapelig)
  • 24.
    Björkegren, Karin
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och klinisk epidemiologi.
    Ageing, homocysteine and methylmalonic acid2000Inngår i: Clinical Pearls News, ISSN 1058-4595, Vol. 10Artikkel i tidsskrift (Fagfellevurdert)
  • 25.
    Björkegren, Karin
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och klinisk epidemiologi.
    Atrofisk gastrit, malabsorption och B12-brist2007Inngår i: Rondellen, ISSN 1654-5974, Vol. 27Artikkel i tidsskrift (Annet vitenskapelig)
  • 26.
    Björkegren, Karin
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och klinisk epidemiologi.
    B12- och folatbrist hos äldre: ska vi behandla?2001Inngår i: Nordisk geriatrik, ISSN 1403-2082, Vol. 2, s. 25-26Artikkel i tidsskrift (Fagfellevurdert)
  • 27.
    Björkegren, Karin
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och klinisk epidemiologi.
    Folat och kobalamin i mjölkprodukter2004Inngår i: Rondellen, ISSN 1654-5974, nr 19Artikkel i tidsskrift (Annet (populærvitenskap, debatt, mm))
  • 28.
    Björkegren, Karin
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och klinisk epidemiologi.
    Folat och kobalamin i primärvården: dags för symposium2002Inngår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 99, nr 8, s. 820-820Artikkel i tidsskrift (Fagfellevurdert)
  • 29.
    Björkegren, Karin
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och klinisk epidemiologi.
    Homocystein: en markör för B12- och folatbrist1996Inngår i: Medicinskt magasin, ISSN 1102-8637, nr 1, s. 2s. 29-31Artikkel, forskningsoversikt (Annet (populærvitenskap, debatt, mm))
  • 30.
    Björkegren, Karin
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och klinisk epidemiologi.
    Homocystein i plasma: Bristmarkör och riskmarkör1999Inngår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 96, nr 8, s. 867-868Artikkel i tidsskrift (Fagfellevurdert)
  • 31.
    Björkegren, Karin
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och klinisk epidemiologi.
    Injektionskrävande B12-brist2002Inngår i: Rondellen, ISSN 1654-5974, Vol. 13Artikkel i tidsskrift (Annet (populærvitenskap, debatt, mm))
  • 32.
    Björkegren, Karin
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och klinisk epidemiologi.
    The future of homocysteine: Paradigm shift in homocysteine research2007Inngår i: Rondellen, ISSN 1654-5974, Vol. 27Artikkel, forskningsoversikt (Annet vitenskapelig)
  • 33.
    Björkegren, Karin
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och klinisk epidemiologi.
    Vitamin B12, kronisk trötthet och injektionsbehandling1999Inngår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 96, nr 50, s. 5610-5610Artikkel i tidsskrift (Fagfellevurdert)
  • 34.
    Björkegren, Karin
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och klinisk epidemiologi.
    Sandström, H
    Norberg, B
    Westman, G
    Kobalaminopeni: incidens och prevalens i Sverige1998Inngår i: Kontroverser kring vitamin B12: kunskap, kompetens, kommunikation / [ed] Karin Björkegren & Lars Engstedt, Klippan: Pedagogförl. , 1998, s. 121-31Kapittel i bok, del av antologi (Annet (populærvitenskap, debatt, mm))
  • 35.
    Björkegren, Karin
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och klinisk epidemiologi.
    Svärdsudd, Kurt
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och klinisk epidemiologi.
    Elevated serum levels of methylmalonic acid and homocysteine in elderly people: a population-based intervention study1999Inngår i: Journal of Internal Medicine, ISSN 0954-6820, E-ISSN 1365-2796, Vol. 246, nr 6, s. 603-611Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVES:

    There is uncertainty amongst clinicians about the definitions of cobalamin and folate deficiency and therefore about the indications for treatment. In this report we present the results of systematic cobalamin and folic acid treatment based upon serum cobalamin, total homocysteine (tHcy) and methylmalonic acid (MMA) analyses in a population-based sample.

    SUBJECTS:

    A 20% random sample of persons 70 years or older in a defined geographical area were invited to a survey (n = 266). Sixty-nine persons who had serum cobalamin < 300 pmol L-1 and serum MMA >/=0.37 micromol L-1 or serum tHcy >/=15 micromol L-1 and who had no cobalamin or folic acid substitution were selected for treatment.

    INTERVENTIONS:

    Initially all 69 patients were given cobalamin orally or intramuscularly. Those who remained high in tHcy were in addition given folic acid treatment.

    MAIN OUTCOME MEASURES:

    Serum cobalamin, serum MMA and serum tHcy.

    RESULTS:

    After 6 months of cobalamin treatment, serum MMA became normal in 13 out of 15 persons. Mean serum tHcy decreased but was normalized in only 15 out of 56 persons. After 3 months of folic acid treatment added to those who still had an abnormal serum tHcy, serum tHcy had normalized in all but one person.

    CONCLUSIONS:

    Cobalamin treatment normalizes increased MMA values and combined cobalamin and folic acid treatment normalizes tHcy, suggesting a pretreatment deficiency of tissue cobalamin and folate in spite of normal serum cobalamin and folate values in the majority of cases.

  • 36.
    Björkegren, Karin
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och klinisk epidemiologi.
    Svärdsudd, Kurt
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och klinisk epidemiologi.
    Reported symptoms and clinical findings in relation to serum cobalamin, folate, methylmalonic acid and total homocysteine among elderly Swedes: a population-based study2003Inngår i: Journal of Internal Medicine, ISSN 0954-6820, E-ISSN 1365-2796, Vol. 254, nr 4, s. 343-352Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVES:

    The early stages of tissue B12 or folate deficiency often cause diagnostic problems. In this report, the levels of serum cobalamin, folate, methylmalonic acid (MMA) and total homocysteine (tHcy), and their relationships with clinical findings and reported symptoms in a representative random population sample are presented.

    DESIGN:

    Cohort study.

    SETTING:

    A general central Swedish population 70 years or older.

    SUBJECTS AND METHODS:

    A 20% random sample of persons 70 years or older in a defined geographical area were invited to a survey. A total of 235 (85%) persons responded, of whom 161 had no interfering diseases or medication. Blood specimens for serum cobalamin, folate, MMA and tHcy analyses were drawn.

    MAIN OUTCOME MEASURES:

    Presence of anaemic, gastrointestinal, neurological and psychiatric symptoms, obtained by questionnaire, and vibration sense measurement and findings at a physical and Mini Mental State Examination.

    RESULTS:

    Among a large number of symptoms and clinical findings that traditionally have been linked to vitamin B12 or folate tissue deficiency, only changes in the tongue mucosa and mouth angle stomatitis turned out to be significantly associated with abnormal serum tHcy and serum folate levels. There were no relationships to serum cobalamin and serum MMA.

    CONCLUSIONS:

    Changes in the oral mucosa were the only signs and symptoms found in this study, indicating that these may be the very early markers of metabolic defects. The traditional symptoms of vitamin deficiency may appear later in the course.

  • 37.
    Björkegren, Karin
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och klinisk epidemiologi.
    Svärdsudd, Kurt
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och klinisk epidemiologi.
    Serum cobalamin, folate, methylmalonic acid and total homocysteine as vitamin B12 and folate tissue deficiency markers amongst elderly Swedes: a population-based study2001Inngår i: Journal of Internal Medicine, ISSN 0954-6820, E-ISSN 1365-2796, Vol. 249, nr 5, s. 423-32Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVES

    The possibilities of detecting tissue cobalamin and folate deficiency are under debate. In this report the levels of serum cobalamin, folate, methylmalonic acid (MMA) and total homocysteine (tHcy) and their interrelations in a representative random population sample are presented.

    DESIGN

    Cohort study.

    SETTING

    A general mid-Swedish population.

    SUBJECTS

    A 20% random sample of persons 70 years or older in a defined geographical area were invited to a survey. A total of 235 (85%) persons responded, out of whom 224 had no interfering diseases.

    MAIN OUTCOME MEASURES

    Serum cobalamin, folate, MMA and tHcy.

    RESULTS

    The serum levels of cobalamin, folate, MMA and tHcy were all correlated to cobalamin and folic acid treatment. They were also correlated to the intake of multivitamin preparations. In addition, serum cobalamin was higher in untreated women than in men but not correlated to age. Serum folate was correlated neither to sex nor age. Serum tHcy and MMA were both directly correlated to age but MMA not to sex. MMA was inversely correlated to serum cobalamin but not to serum folate, whereas serum tHcy was inversely correlated to serum cobalamin, folate and creatinine. Neither serum cobalamin, folate, MMA nor tHcy had any significant correlation to haemoglobin, erythrocyte volume fraction (EVF) or mean red cell volume. Half of the study population had abnormal MMA or tHcy levels, suggesting a latent or overt tissue deficiency of cobalamin or folate.

    CONCLUSIONS

    A substantial proportion of the elderly general population had signs of low tissue levels of cobalamin or folate. Amongst those who took multivitamin preparations this proportion was much lower.

  • 38.
    Björkegren, Karin
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och klinisk epidemiologi.
    Wallander, Mari-Ann
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och klinisk epidemiologi.
    Johansson, Saga
    Svärdsudd, Kurt
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och klinisk epidemiologi.
    General symptom reporting in female fibromyalgia patients and referents: a population-based case-referent study2009Inngår i: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 9, s. 402-Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: Fibromyalgia is characterized by widespread musculoskeletal pain and palpation tenderness. In addition to these classic symptoms, fibromyalgia patients tend to report a number of other complaints. What these other complaints are and how often they are reported as compared with related referents from the general population is not very well known. We therefore hypothesized that subjects with fibromyalgia report more of a wide range of symptoms as compared with referents of the same sex and age from the general population. METHODS: 138 women with diagnosed fibromyalgia in primary health care and 401 referents from the general population matched to the cases by sex, age and residential area responded to a postal questionnaire where information on marital status, education, occupational status, income level, immigrant status, smoking habits physical activity, height and weight history and the prevalence of 42 defined symptoms was sought. RESULTS: The cases had lower educational and income levels, were more often unemployed, on sick leave or on disability pension and were more often first generation immigrants than the referents. They were also heavier, shorter and more often had a history of excessive food intake and excessive weight loss. When these differences were taken into account, cases reported not only significantly more presumed fibromyalgia symptoms but also significantly more of general symptoms than the referents. The distribution of symptoms was similar in subjects with fibromyalgia and referents, indicating a generally higher symptom reporting level among the former. CONCLUSION: Subjects with fibromyalgia had a high prevalence of reported general symptoms than referents. Some of these differences may be a consequence of the disorder while others may reflect etiological processes.

  • 39.
    Björkegren, Karin
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och klinisk epidemiologi.
    Wallander, Mari-Ann
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och klinisk epidemiologi.
    Johansson, Saga
    Svärdsudd, Kurt
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och klinisk epidemiologi.
    Skillnader i socioekonomiska faktorer och rapporterade symtom mellan fibromyalgipatienter och kontroller: en populationsbaserad fall- kontrollstudie2006Konferansepaper (Annet vitenskapelig)
  • 40. Björklund, L
    et al.
    Wallander, Mari-Ann
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och klinisk epidemiologi.
    Johansson, Saga
    Lesén, E
    Aspirin in cardiology: benefits and risks2009Inngår i: International journal of clinical practice (Esher), ISSN 1368-5031, E-ISSN 1742-1241, Vol. 63, nr 3, s. 468-477Artikkel, forskningsoversikt (Fagfellevurdert)
    Abstract [en]

    AIMS: To review the current knowledge of the benefits and risks of long-term aspirin therapy for the prevention of cardiovascular disease. METHODS: Relevant articles published in English between 1996 and 2006 were obtained from the Current Contents Science Edition, EMBASE and MEDLINE databases. RESULTS: Secondary aspirin prophylaxis is effective in reducing the risk of ischaemic events in patients with cardiovascular disease. However, its utility in reducing primary ischaemic events is more controversial; it appears to reduce the incidence of ischaemic stroke, but increase the incidence of haemorrhagic stroke. Aspirin therapy can also lead to an increased risk of gastrointestinal ulcers, upper gastrointestinal bleeding and other haemorrhagic complications. Lower doses of aspirin are associated with a reduced risk of gastrointestinal side effects and are equally effective in reducing cardiovascular risk. Co-therapy with non-steroidal anti-inflammatory drugs, clopidogrel or warfarin increases the risk of gastrointestinal side effects, while co-therapy with proton pump inhibitors reduces it. CONCLUSIONS: Both the benefits and risks need to be considered carefully when prescribing aspirin, particularly in primary prevention. Patients should be prescribed lower doses rather than higher doses of aspirin in line with prescribing guidelines. Co-prescription of a proton pump inhibitors may be necessary in patients at high risk for upper gastrointestinal complications.

  • 41.
    Bogefeldt, Johan
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och klinisk epidemiologi.
    Low Back Pain: With Special Reference to Prevalence, Diagnosis, Treatment and Prognosis2009Doktoravhandling, med artikler (Annet vitenskapelig)
    Abstract [en]

    Objectives. Ascertain if there has been a secular trend in 3-months prevalence of casually reported back pain. Evaluate if such back pain predicts concurrent health as well as future sick leave, disability pension, hospitalization and survival. Study differences in diagnostic assessment and labelling between physicians. Evaluate if a comprehensive manual therapy programme reduces sickness absence.

    Materials and methods. Combined population samples from 1973 to 2003 with a total of 12,891 observations with self-reported back pain and covariates. 7,074 of these individuals were followed for an average of 8.5 years and outcomes were self-reported health as well as official register data on sick leave, disability pension, hospitalisation and mortality. The Gotland Low Back Pain Study, a randomised controlled trial with participation of two general practitioners and two orthopaedic surgeons treating 160 patients with acute/subacute low back pain, with 10 weeks diagnostic evaluation and treatment and a two-year follow up.

    Results. Back pain prevalence increased 16% per ten years (OR 1.16, 95%CI 1.11-1.22). Back pain was negatively associated with self-rated health (p<0.0001), increased the risk of disability pension (p<0.002), and hospital admissions (p<0.0005), but not number of days in hospital, sick leave or mortality. General practitioners used terms from manual medicine and reported more pseudoradicular pain, while orthopaedic surgeons used non-specific pain labels, reported more true radicular pain and used more x-ray examinations. Among those on sick leave at baseline, manual therapy patients showed faster return to work (HR 1.62, 95%CI 1.006–2.60) and a lower point-prevalence of sick leave than reference patients at end of treatment period (ratio 0.35, 95% CI 0.13–0.97) but not after two years.

    Conclusions. There was a strong secular trend towards increase in self-reported back pain from 1973 to 2003. Such pain had a negative effect on some of the health outcomes and does not appear to be harmless. Physicians from different specialities labelled the condition differently. The manual therapy programme proved to be more effective than the established treatment regarding return to work.

    Delarbeid
    1. Medical and social consequences of back pain: a longitudinal study of 7,074 men and women sampled from the general population
    Åpne denne publikasjonen i ny fane eller vindu >>Medical and social consequences of back pain: a longitudinal study of 7,074 men and women sampled from the general population
    Vise andre…
    (svensk)Manuskript (Annet (populærvitenskap, debatt, mm))
    HSV kategori
    Identifikatorer
    urn:nbn:se:uu:diva-108069 (URN)
    Tilgjengelig fra: 2009-09-06 Laget: 2009-09-06 Sist oppdatert: 2012-08-24bibliografisk kontrollert
    2. Diagnostic differences between general practitioners and orthopaedic surgeons in low back pain patients
    Åpne denne publikasjonen i ny fane eller vindu >>Diagnostic differences between general practitioners and orthopaedic surgeons in low back pain patients
    2007 (engelsk)Inngår i: Upsala Journal of Medical Sciences, ISSN 0300-9734, E-ISSN 2000-1967, Vol. 112, nr 2, s. 199-212Artikkel i tidsskrift (Fagfellevurdert) Published
    Abstract [en]

    Background. There is a growing consensus on low back pain treatment. However, whether this extends to diagnostic labelling is still largely unknown. The aim of this report was to compare the diagnostic assessment of low back pain patients between general practitioners trained in manual therapy and orthopaedic surgeons. Methods. Population-based randomized controlled trial in which 160 patients with acute or sub-acute low back pain were assessed and treated by general practitioners or orthopaedic surgeons. Information on diagnoses and use of diagnostic imaging was obtained from medical records and physician questionnaires covering the ten-week treatment period. The Quebec Task Force classification and free text analysis were used to group diagnostic labels. Results: At baseline there were no significant differences in medical history, findings at physical examination and distribution of the Quebec Task Force diagnostic classification between the patient groups, indicating that they were similar. However, there were significant differences in physicians' use of diagnostic labels for local pain and their characterisation of radiating pain. General practitioners used more terms from manual medicine and reported more pseudoradicular pain than orthopaedic surgeons, who used non-specific pain labels, reported more true radicular pain and used more x-ray examinations. Differences were found at all times from first visit to ten week follow-up. Conclusions: There were significant differences in diagnostic assessment and use of diagnostic radiology between general practitioners and orthopaedic surgeons.

    HSV kategori
    Identifikatorer
    urn:nbn:se:uu:diva-11765 (URN)000253452000007 ()17578820 (PubMedID)
    Tilgjengelig fra: 2007-10-17 Laget: 2007-10-17 Sist oppdatert: 2017-12-11bibliografisk kontrollert
    3. Sick leave reductions from a comprehensive manual therapy programme for low back pain: the Gotland Low Back Pain Study
    Åpne denne publikasjonen i ny fane eller vindu >>Sick leave reductions from a comprehensive manual therapy programme for low back pain: the Gotland Low Back Pain Study
    2008 (engelsk)Inngår i: Clinical Rehabilitation, ISSN 0269-2155, E-ISSN 1477-0873, Vol. 22, nr 6, s. 529-41Artikkel i tidsskrift (Fagfellevurdert) Published
    Abstract [en]

    OBJECTIVE: To evaluate if a comprehensive manual therapy programme reduces sick leave due low back pain and facilitates return to work more than the conventional optimized activating care. DESIGN: A randomized controlled trial over a 10-week period with a two-year follow-up. SETTING: Primary health care and Visby Hospital, Municipality of Gotland, Sweden. SUBJECTS: One hundred and sixty patients (70 women, 90 men, ages 20-55 years) with acute or subacute low back pain with or without pain radiation into the legs. INTERVENTIONS: Standardized optimized activating care (n = 71) versus a comprehensive pragmatic manual therapy programme including specific corticosteroid injections (n = 89). MAIN MEASURES: Sick leave measured as net sick leave volume, point prevalence and return to work. RESULTS: After 10 weeks, significantly more manual therapy patients than reference patients had returned to work (hazards ratio 1.62, 95% confidence interval (CI) 1.006-2.60, P<0.05), and among those on sick leave at baseline, significantly fewer were still on sick leave (8/58 versus 13/40, ratio 0.35, 95% CI 0.13-0.97, P<0.05). For all other measures there were inconclusive differences in favour of the manual therapy group. No significant differences remained after two years. CONCLUSIONS: The manual therapy programme used in this study decreased sick leave and increased return to work more than the standardized optimized activating care only up to 10 weeks but not up to two years.

    HSV kategori
    Identifikatorer
    urn:nbn:se:uu:diva-17529 (URN)10.1177/0269215507087294 (DOI)000257151400006 ()18511533 (PubMedID)
    Tilgjengelig fra: 2008-06-27 Laget: 2008-06-27 Sist oppdatert: 2018-01-12bibliografisk kontrollert
    4. Age and time trends in back pain prevalence among men and women sampled from the general population
    Åpne denne publikasjonen i ny fane eller vindu >>Age and time trends in back pain prevalence among men and women sampled from the general population
    Vise andre…
    (engelsk)Manuskript (Annet vitenskapelig)
    HSV kategori
    Forskningsprogram
    Allmänmedicin
    Identifikatorer
    urn:nbn:se:uu:diva-108068 (URN)
    Tilgjengelig fra: 2009-09-06 Laget: 2009-09-06 Sist oppdatert: 2018-01-13bibliografisk kontrollert
  • 42.
    Bogefeldt, Johan P
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och klinisk epidemiologi.
    Grunnesjö, Marie I
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och klinisk epidemiologi.
    Svärdsudd, Kurt F
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och klinisk epidemiologi.
    Blomberg, Stefan I E
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och klinisk epidemiologi.
    Diagnostic differences between general practitioners and orthopaedic surgeons in low back pain patients2007Inngår i: Upsala Journal of Medical Sciences, ISSN 0300-9734, E-ISSN 2000-1967, Vol. 112, nr 2, s. 199-212Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background. There is a growing consensus on low back pain treatment. However, whether this extends to diagnostic labelling is still largely unknown. The aim of this report was to compare the diagnostic assessment of low back pain patients between general practitioners trained in manual therapy and orthopaedic surgeons. Methods. Population-based randomized controlled trial in which 160 patients with acute or sub-acute low back pain were assessed and treated by general practitioners or orthopaedic surgeons. Information on diagnoses and use of diagnostic imaging was obtained from medical records and physician questionnaires covering the ten-week treatment period. The Quebec Task Force classification and free text analysis were used to group diagnostic labels. Results: At baseline there were no significant differences in medical history, findings at physical examination and distribution of the Quebec Task Force diagnostic classification between the patient groups, indicating that they were similar. However, there were significant differences in physicians' use of diagnostic labels for local pain and their characterisation of radiating pain. General practitioners used more terms from manual medicine and reported more pseudoradicular pain than orthopaedic surgeons, who used non-specific pain labels, reported more true radicular pain and used more x-ray examinations. Differences were found at all times from first visit to ten week follow-up. Conclusions: There were significant differences in diagnostic assessment and use of diagnostic radiology between general practitioners and orthopaedic surgeons.

  • 43.
    Bogefeldt, Johan P
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och klinisk epidemiologi.
    Grunnesjö, Marie I
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och klinisk epidemiologi.
    Svärdsudd, Kurt F
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och klinisk epidemiologi.
    Blomberg, Stefan I E
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och klinisk epidemiologi.
    Sick leave reductions from a comprehensive manual therapy programme for low back pain: the Gotland Low Back Pain Study2008Inngår i: Clinical Rehabilitation, ISSN 0269-2155, E-ISSN 1477-0873, Vol. 22, nr 6, s. 529-41Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVE: To evaluate if a comprehensive manual therapy programme reduces sick leave due low back pain and facilitates return to work more than the conventional optimized activating care. DESIGN: A randomized controlled trial over a 10-week period with a two-year follow-up. SETTING: Primary health care and Visby Hospital, Municipality of Gotland, Sweden. SUBJECTS: One hundred and sixty patients (70 women, 90 men, ages 20-55 years) with acute or subacute low back pain with or without pain radiation into the legs. INTERVENTIONS: Standardized optimized activating care (n = 71) versus a comprehensive pragmatic manual therapy programme including specific corticosteroid injections (n = 89). MAIN MEASURES: Sick leave measured as net sick leave volume, point prevalence and return to work. RESULTS: After 10 weeks, significantly more manual therapy patients than reference patients had returned to work (hazards ratio 1.62, 95% confidence interval (CI) 1.006-2.60, P<0.05), and among those on sick leave at baseline, significantly fewer were still on sick leave (8/58 versus 13/40, ratio 0.35, 95% CI 0.13-0.97, P<0.05). For all other measures there were inconclusive differences in favour of the manual therapy group. No significant differences remained after two years. CONCLUSIONS: The manual therapy programme used in this study decreased sick leave and increased return to work more than the standardized optimized activating care only up to 10 weeks but not up to two years.

  • 44.
    Bogefeldt, Johan P
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och klinisk epidemiologi.
    Wallman, Thorne
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och klinisk epidemiologi. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i D län (CKFD).
    Eriksson, Margaretha
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och klinisk epidemiologi.
    Welin, Lennart
    Department of Heart and Lung Diseases, Sahlgren Academy.
    Eriksson, Henry
    Department of Heart and Lung Diseases, Sahlgren Academy.
    Johansson, Saga
    Department of Heart and Lung Diseases, Sahlgren Academy OCH Department of Epidemiology, AstraZeneca R6D, Mölndal , Sweden.
    Grunnesjö, Marie I
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och klinisk epidemiologi.
    Svärdsudd, Kurt F
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och klinisk epidemiologi.
    Age and time trends in back pain prevalence among men and women sampled from the general populationManuskript (Annet vitenskapelig)
  • 45.
    Bogefeldt, Johan P
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och klinisk epidemiologi.
    Wallman, Thorne
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och klinisk epidemiologi. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i D län (CKFD).
    Palmer, Ed
    Eriksson, Margaretha
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och klinisk epidemiologi.
    Johansson, Saga
    Eriksson, Henry
    Welin, Lennart
    Grunnesjö, Marie I
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och klinisk epidemiologi.
    Svärdsudd, Kurt F
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och klinisk epidemiologi.
    Medical and social consequences of back pain: a longitudinal study of 7,074 men and women sampled from the general populationManuskript (Annet (populærvitenskap, debatt, mm))
  • 46. Bolander-Gouille, C
    et al.
    Björkegren, Karin
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och klinisk epidemiologi.
    Folat- och B12-brist: kliniskt betydelsefullt inte minst för kvinnor2002Inngår i: Incitament, ISSN 1103-503X, Vol. 11, nr 2, s. 181-187Artikkel i tidsskrift (Annet (populærvitenskap, debatt, mm))
    Abstract [sv]

    Under det senaste decenniet har det blivit uppenbart att vitamin-B12-brist är betydligt vanligare än man tidigare trott. Också folatbrist har hamnat i fokus, bl a därför att dess betydelse för förebyggande av fosterskador belysts i flera studier.

  • 47. Brook, RA
    et al.
    Wahlqvist, P
    Kleinman, NL
    Wallander, Mari-Ann
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och klinisk epidemiologi.
    Campbell, SM
    Smeeding, JE
    Cost of gastro-oesophageal reflux disease to the employer: a perspective from the United States2007Inngår i: Alimentary Pharmacology and Therapeutics, ISSN 0269-2813, E-ISSN 1365-2036, Vol. 26, nr 6, s. 889-898Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND

    Employers pay more than just salary for their employees. Previous studies have largely focused on direct medical and prescription drug costs of gastro-oesophageal reflux disease (GERD), and few have reported on total absenteeism costs.

    AIMS

    To examine the annual cost of illness of GERD in an employed US population by benefit category and by place of service for direct medical costs.

    METHODS

    Retrospective data analysis from 2001 to 2004. International Classification of Diseases (ICD)-9 codes (530.1, 530.10, 530.11, 530.12, 530.19, 530.81, 787.1x, 787.2x or 251.5x) were used to identify employees with and without GERD (the control group). Measures included medical and prescription drug claims, plus indirect costs for sick leave, short- and long-term disability, and workers' compensation. For a subset of the population, the direct medical claims were analysed by place of service.

    RESULTS

    Data were available for 267,269 eligible employees of which 11,653 had gastro-oesophageal reflux disease. GERD was associated with a mean incremental cost of US $3,355 per employee of which direct medical costs accounted for 65%, prescription drug costs 17%, and indirect costs 19%. The place of service 'out-patient hospital or clinic' accounted for the largest part (47%) of the difference in medical costs.

    CONCLUSIONS

    GERD is associated with substantial direct and indirect costs, which highlight the importance of managing the disease effectively.

  • 48.
    Bröms, Kristina
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och klinisk epidemiologi.
    A Nationwide Study of Asthma and Allergy in Swedish Preschool Children: with Special Reference to Environment, Daycare, Prevalence, Co-ocurrence and Incidence2010Doktoravhandling, med artikler (Annet vitenskapelig)
    Abstract [en]

    Aim: The aim of this project was to study the age and sex specific occurrence of atopic and non-atopic asthma and other atopic manifestations in a nationwide sample of Swedish pre-school children.

    Methods: All 70 allergen avoidance day-care centres (AADC) with 84 sections and 140 matched ordinary day-care centres with 440 sections in 62 municipalities across Sweden were sampled. In 2000 the staff at each section responded to a questionnaire on indoor and outdoor environment at the section. In 2002 parents of 5,886 children attending the AADCs and ODCs responded to a postal questionnaire regarding symptoms indicating prevalent asthma, allergic rhinitis, eczema, and food, furred pet and pollen allergy and other data in their children. In 2007, parents of 4255 children responded to an almost identical follow-up questionnaire.

    Results: The AADCs had far more strict rules than ODCs on furred pets and smoking at home and on perfume use, and the indoor environment was better, owing to better cleaning. The age specific asthma prevalence was curvilinear with a peak at age 3 of 11.4% among boys and 9.8% among girls. In addition the prevalence increased by municipality population density, a proxy for degree of urbanisation. There was a highly significant co-occurrence between all asthma-atopic manifestations, but there was no evidence of ordered sequence of manifestation onset. The asthma incidence was highly dependent on presence or absence of co-occurrence variables. Given the variable mix in the present study population, the annual asthma incidence ranged from 0.6% to 1.2%.

    Conclusions: AADCs had more strict rules and a better indoor environment than ODCs. The asthma prevalence was affected by age, sex and degree of urbanisation. There was close co-occurrence between all asthma and atopic manifestations but no evidence of ordered sequence of onsets. The annual asthma incidence was strongly dependent of co-occurrence conditions.

    Delarbeid
    1. A nationwide study of indoor and outdoor environments in allergen avoidance and conventional daycare centers in Sweden
    Åpne denne publikasjonen i ny fane eller vindu >>A nationwide study of indoor and outdoor environments in allergen avoidance and conventional daycare centers in Sweden
    2006 (engelsk)Inngår i: Indoor Air, ISSN 0905-6947, E-ISSN 1600-0668, Vol. 16, nr 3, s. 227-35Artikkel i tidsskrift (Fagfellevurdert) Published
    Abstract [en]

    Sweden has had specialized 'allergen avoidance daycare centers' (AADC) since 1979. The aim was to compare AADC with ordinary daycare centers (ODC). Through contacts with municipalities and hospitals, 72 AADC were identified. For each AADC, the two nearest ODCs served as controls. A questionnaire was sent to the local directors of the 216 daycare centers (531 sections), 83% responded. A total of 39% of the ODCs had ever had dampness/molds, 12% were near (<500 m) stables/farms, 23% were closer than 50 m to a heavy trafficked road, and 13% were exposed to wood smoke in winter. Only 11% of the AADCs had any child with furred pets at home, while 97% of the ODCs had children with furred pets. Bans on smoking at home and on perfumes were more common at the AADCs (P = 0.001). Fewer AADCs had PVC floors (OR = 0.53; P = 0.01), dampness/molds (OR = 0.55; P = 0.04), shelves (OR 3.03; P = 0.001), curtains (OR = 1.67; P = 0.047), and flowers (OR = 0.03; P < 0.001), while more had daily floor cleaning (OR = 19.9; P = 0.004), weekly wiping of furniture (OR = 11.0; P = 0.001), and washing of pillows/mattresses (OR = 2.74; P = 0.005) and curtains (OR = 9.07; P = 0.001). In conclusion, allergy avoidance daycare centers differ from other daycare centers, and may have better indoor environments. PRACTICAL IMPLICATIONS: There is a need to improve the indoor environments of daycare centers, including reduction of building dampness and molds. Allergen avoidance daycare centers (AADC) in Sweden differ from ordinary daycare centers in many respects, with fewer indoor and building factors related to dust, allergens and irritants. This shows that the indoor environments of daycare centers can be improved. Data suggest that AADC may have lower levels of pet allergens, and this is beneficial for children with pet allergy. The effects of these improvements on indoor exposures and health of the children need to be further evaluated.

    Emneord
    Air Pollutants, Air Pollution; Indoor/*analysis, Allergens/*analysis, Animals, Antigens; Dermatophagoides/analysis, Cats, Child Day Care Centers, Child; Preschool, Cockroaches, Dogs, Dust/analysis, Environmental Monitoring, Facility Design and Construction, Humans, Questionnaires, Sick Building Syndrome, Sweden, Ventilation
    HSV kategori
    Identifikatorer
    urn:nbn:se:uu:diva-81290 (URN)10.1111/j.1600-0668.2005.00420.x (DOI)16683941 (PubMedID)
    Tilgjengelig fra: 2008-06-25 Laget: 2008-06-25 Sist oppdatert: 2017-12-14bibliografisk kontrollert
    2. Effect of degree of urbanisation on age and sex-specific asthmaprevalence in Swedish preschool children
    Åpne denne publikasjonen i ny fane eller vindu >>Effect of degree of urbanisation on age and sex-specific asthmaprevalence in Swedish preschool children
    Vise andre…
    2009 (engelsk)Inngår i: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 9, s. 303-Artikkel i tidsskrift (Fagfellevurdert) Published
    Abstract [en]

    Background: There are few studies on age and sex-specific asthma   prevalence in the age range 1-6 years. The purpose of this report was   to estimate age and sex specific asthma prevalence in preschool   children and to analyse the influence of possible demographic and   geographic determinants.   Methods: All 70 allergen avoidance day-care centres and 140 matched   ordinary day-care centres across Sweden were sampled. The parents of   all 8,757 children attending these day-care centres received the   International Study of Asthma and Allergies in Childhood (ISAAC)   written questionnaire, supplemented with questions on medical   treatment, physician assessed asthma diagnosis, and other asthma   related questions. The response rate was 68%.   Results: The age specific asthma prevalence, adjusted for the   underlying municipality population size, was among boys 9.7% at age 1,   11.1% at age 2, 11.4 at age 3, 10.5 at age 4, 8.7 at age 5, and 6.4 at   age 6. The corresponding proportions among girls were 8.9%, 9.9%, 9.8%,   8.8%, 7.0%, and 5.0%, on average 9.6% for boys and 8.2% for girls,   altogether 8.9%. In addition to age and sex the prevalence increased by   municipality population density, a proxy for degree of urbanisation.   Moreover, there was a remaining weak geographical gradient with   increasing prevalence towards the north and the west.   Conclusion: The age-specific asthma prevalence was curvilinear with a   peak around age 3 and somewhat higher for boys than for girls. The   asthma prevalence increased in a slowly accelerating pace by   municipality population density as a proxy for degree of urbanisation.

    HSV kategori
    Forskningsprogram
    Allmänmedicin
    Identifikatorer
    urn:nbn:se:uu:diva-120578 (URN)10.1186/1471-2458-9-303 (DOI)000270673700001 ()19695101 (PubMedID)
    Tilgjengelig fra: 2010-03-15 Laget: 2010-03-15 Sist oppdatert: 2017-12-12bibliografisk kontrollert
    3. Prevalence and co-occurrence of asthma and allergic manifestations in preschool children
    Åpne denne publikasjonen i ny fane eller vindu >>Prevalence and co-occurrence of asthma and allergic manifestations in preschool children
    Vise andre…
    (engelsk)Manuskript (preprint) (Annet vitenskapelig)
    Abstract [en]

    Background: It has been claimed that preschool children may embark on ‘the atopic march’, which means that atopic manifestations show up one after another in a certain order. The aim of this study was to make an in-depth analysis of the co-occurrence of asthma and atopic manifestations.

    Methods: Parents of 5886 children 1-6 years of age, sampled from day-care centres in 62 municipalities all over Sweden, responded to a postal questionnaire regarding symptoms indicating prevalent asthma, allergic rhinitis, eczema, food allergy, furred pet and pollen allergy and other data in their children. Age specific prevalence of asthma, rhinitis, eczema, and food allergy was computed, adjusted for municipality population size.

    Results: The overall prevalence of asthma was 8.9%, of eczema 21.7%, of rhinitis 8.1%, and of food allergy 6.6%. There was a highly significant co-occurrence between all asthma-atopic manifestations. Presence of pet allergy was the manifestation showing the closest co-occurrence with presence of asthma, presence of pollen allergy with presence of rhinitis, and presence of food allergy with presence of eczema. Assessed from plots of age specific prevalence of asthma, rhinitis, eczema and food allergy the prevalence of all manifestations increased from one to three years of age and then decreased, except for rhinitis where the prevalence increased until six years of age. There was no evidence of a rank order of asthma and allergy manifestation onset.

    Conclusions: There was close co-occurrence between all asthma-atopic manifestations but no evidence of a rank order of onsets.

    Emneord
    asthma, rhinitis, eczema, food allergy, epidemiology
    HSV kategori
    Forskningsprogram
    Allmänmedicin
    Identifikatorer
    urn:nbn:se:uu:diva-120585 (URN)
    Tilgjengelig fra: 2010-03-15 Laget: 2010-03-15 Sist oppdatert: 2018-01-12
    4. A nationwide study of asthma incidence and its determinants in preschool children during five years of follow up
    Åpne denne publikasjonen i ny fane eller vindu >>A nationwide study of asthma incidence and its determinants in preschool children during five years of follow up
    (engelsk)Manuskript (preprint) (Annet vitenskapelig)
    Abstract [en]

    Background: Many studies on asthma prevalence have been published, but the number of studies on asthma incidence in preschool children is limited.

    A number of studies on asthma prevalence have been published, but there are few studies on asthma incidence in preschool children. In this project a nationwide sample of preschool children were followed with the aim to estimate 5-year asthma incidence and its determinants.

    Methods: Parents of 5886 children 1-6 years of age, sampled from day-care centres in 62 municipalities all over Sweden, responded in 2002 to a baseline postal questionnaire with questions regarding symptoms indicating possible asthma or atopic conditions, and a number of other variables. In 2007, 4255 of the parents responded to an almost identical questionnaire.

    Results: A large number of potential baseline determinants for 5-year asthma incidence were identified. Of these, food allergy, wheezing last 12 months, rhinitis, parental rhinitis, parental asthma, ever asthma, age, and eczema, on rank order of importance, remained significant in multivariate logistic regression analysis. The asthma incidence was highly dependent on presence or absence of these variables. Given the variable mix in the present study population, the incidence ranged from 2.9% in the oldest to 5.8% in the youngest children, corresponding to an annual asthma incidence of 0.6% to 1.2%.

    Conclusions: The incidence of asthma is highly dependent on the composition of the underlying population. However, an annual incidence in range a half to one percent in preschool children in the general population appears probable.

    Emneord
    asthma, incidence rate, preschool children, determinants, parental atopy
    HSV kategori
    Forskningsprogram
    Allmänmedicin
    Identifikatorer
    urn:nbn:se:uu:diva-120591 (URN)
    Tilgjengelig fra: 2010-03-15 Laget: 2010-03-15 Sist oppdatert: 2018-01-12
  • 49.
    Bröms, Kristina
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och klinisk epidemiologi.
    En nationell studie av allergibarns hälsa i allergiförskolor och konventionella förskolor: [Halvtidskontroll]2008Rapport (Annet vitenskapelig)
  • 50.
    Bröms, Kristina
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och klinisk epidemiologi.
    Bråbäck, L
    Norbäck, Dan
    Sundelin, K
    Svärdsudd, Kurt
    Miljöenkät: allergiförskolor jämfört med vanliga skolor2001Konferansepaper (Annet vitenskapelig)
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