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  • 201. Lindgren, P
    et al.
    Borgström, F
    Stålhammar, Jan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Alemao, E
    Jönsson, L
    Determinants of cholesterol goal attainment at 12 months in patients with hypercholesterolaemia not at consensus goal after 3 months of treatment with lipid-lowering drugs2007In: International journal of clinical practice (Esher), ISSN 1368-5031, E-ISSN 1742-1241, Vol. 61, no 8, p. 1410-1414Article in journal (Refereed)
    Abstract [en]

    Background: Less than half of patients in Scandinavian societies achieve target cholesterol values established by consensus coronary prevention panels.

    Methods and results: Using logistic regression analysis, we determined that patients not at consensus cholesterol goals after 3 months of treatment using lipid-lowering medications were significantly more likely to achieve these goals at 12 months if they were treated with an active management strategy (changes in lipid-lowering therapy within 3 months), had a diagnosis of diabetes mellitus, or initiated lipid-lowering more recently, compared with their counterparts without these factors.

    Conclusion: An active management strategy is associated with a higher probability of achieving treatment goals in patients not at goal after 3 months following treatment initiation.

  • 202. Lindholm, Lars Hjalmar
    et al.
    Ekbom, Tord
    Dash, Clive
    Eriksson, Margaretha
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Tibblin, Gösta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Scherstén, Bengt
    The impact of health care advice given in primary care on cardiovascular risk1995In: BMJ (Clinical research ed.), ISSN 0959-8138, Vol. 310, no 6987, p. 1105-1109Article in journal (Refereed)
    Abstract [en]

    Limited additional benefit was gained from being in the group receiving the intensive health care advice. It is difficult to make an important impact on cardiovascular risk in primary care by using only the practice staff. Better methods of communicating the messages need to be devised.

  • 203. Lionis, Christos
    et al.
    Olsen-Faresjo, Ashild
    Anastasiou, Foteini
    Wallander, Mari-Ann
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Johansson, Saga
    Faresjo, Tomas
    Measuring the frequency of functional gastrointestinal disorders in rural Crete: a need for improving primary care physicians' diagnostic skills2005In: Rural Remote Health, ISSN 1445-6354, Vol. 5, no 3, p. 409-Article in journal (Refereed)
    Abstract [en]

    Introduction: Studies of the frequency and aetiology of functional gastrointestinal disorders in the general population have received increasing interest over the past few years; the field seems to be neglected in Southern Europe. The aim of this study was to report on the frequency of functional dyspepsia (FD), irritable bowel syndrome (IBS) and gastroenteritis within the primary care setting, to provide some information on the extent to which the recorded diagnoses in the physicians’ notes fulfil existing diagnostic criteria. Method: A retrospective study was used, where all new cases of these diseases at five primary health care centres in three rural and two semi-rural areas of Crete were identified by scrutinising medical records from 280 000 consecutive visits during a 4 year period. The occurrence rate per 1000 person-years were calculated for the three conditions. We also checked the extent to which the Talley’s criteria for FD and Rome II diagnostic criteria for IBS were followed. Results: Gastroenteritis was revealed to be a quite frequent health problem among the rural population on Crete, while the occurrence rates for other problems, such as dyspepsia and IBS, were found to be lower than expected. IBS was over-represented among women compared with men, OR 2.04 (CI 1.39-3.00). In many cases a diagnosis of FD, IBS or gastroenteritis was evident to the research team on the basis of findings recorded in the notes, but the diagnosis was not recorded by the clinician at the time of consultation. Conclusions: This study yielded two key messages: the first that gastroenteritis is still a frequent health problem, and the second that primary care physicians in rural Crete seem to fail in adequately diagnosing FD and IBS and need further training.

  • 204.
    Lisspers, Karin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Organisation av astmavård och utvärdering av livskvalitet hos astmapatienter inom primärvården: [Halvtidskontroll]2007Report (Other academic)
  • 205.
    Lisspers, Karin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Organisation of Asthma in Primary Care, Quality of Life and Sex-related Aspects in Asthma Outcomes2008Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Objectives: To investigate the organisation of asthma care in primary care and evaluate outcomes for patients attending primary care centres with and without asthma clinics.

    Other objectives were to study the association between quality of life and asthma control in patients in primary care and to analyse sex differences regarding asthma outcomes related to menopausal status.

    Material and methods: Cross-sectional surveys and a patient record study.

    Results: Of all the primary health care centres, 77% had a spirometer and 53% an asthma clinic. At centres with asthma clinics 77% of the patients reported sufficient knowledge of asthma as compared with 65% at centres without asthma clinics (p<0.001). With more time allocated for the nurse, 44% of patients achieved asthma control as compared with 27% at asthma clinics with less time (p<0.003). Patients using short-acting beta-2 agonists more than twice in the last week had clinically significant lower MiniAQLQ scores (5.17 versus 5.91). This finding also held for night awakenings during the previous week (4.42 versus 5.86), courses of oral corticosteroids (5.26 versus 5.64) and reported emergency consultations during the last six months (4.85 versus 5.71). Premenopausal women had significantly lower total MiniAQLQ scores than men in the same age group (5.44 versus 5.89, p<0.001), while no difference was found between postmenopausal women and men of similar ages. The adjusted odds for premenopausal women for asthma exacerbations was 2.0 (95%CI 1.22-3.43) as compared with men in the same age group. No differences were found when comparing postmenopausal women with men of similar ages.

    Conclusions: Half the primary health care centres had an asthma clinic and the majority had access to a spirometer. Patients at primary health care centres with asthma clinics reported better knowledge of their disease, and asthma control is more often achieved if the nurse is allocated more time. Achieving asthma control is associated with better quality of life in patients in primary care. Premenopausal women had lower quality of life and less often asthma control then men of the same ages, while no corresponding difference was found between postmenopausal women and men of similar ages.

    List of papers
    1. Organisation of asthma care in primary health care in Mid-Sweden
    Open this publication in new window or tab >>Organisation of asthma care in primary health care in Mid-Sweden
    Show others...
    2005 (English)In: Primary Care Respiratory Journal, ISSN 1471-4418, E-ISSN 1475-1534, Vol. 14, no 3, p. 147-153Article in journal (Refereed) Published
    Abstract [en]

    AIM: To investigate the organisation of asthma care in 240 primary health care centres (PHCCs) in Mid-Sweden. METHODS: A cross-sectional study. Main outcomes were occurrence and structure of nurse-based asthma clinics according to nationally recommended criteria, and access and use of spirometers. RESULTS: 238 PHCCs (99%) responded. 16% reported a complete, and 37% an incomplete, asthma clinic. 47% of PHCCs had no asthma clinic. The incomplete asthma clinics usually lacked sufficient asthma nurse time, a scheduled nurse surgery and a responsible GP. 77% of the PHCCs had access to a spirometer and on average 19 spirometries/1000 inhabitants/year were performed. There was a large variation in the use of spirometers. CONCLUSION: Half of the PHCCs had an asthma clinic and a majority had access to a spirometer. More frequent use of spirometry and increased time provision for the asthma nurse would be likely to produce a substantial improvement in the standard of asthma care in primary health care.

    Keywords
    Asthma, Primary health care, Quality of health care, Asthma clinic, Spirometer
    National Category
    Public Health, Global Health, Social Medicine and Epidemiology
    Identifiers
    urn:nbn:se:uu:diva-97620 (URN)10.1016/j.pcrj.2005.03.003 (DOI)16701714 (PubMedID)
    Available from: 2008-10-17 Created: 2008-10-17 Last updated: 2017-12-14Bibliographically approved
    2. Primary health care centres with asthma clinics: effects on patients' knowledge and asthma control
    Open this publication in new window or tab >>Primary health care centres with asthma clinics: effects on patients' knowledge and asthma control
    Show others...
    2010 (English)In: Primary Care Respiratory Journal, ISSN 1471-4418, E-ISSN 1475-1534, Vol. 19, no 1, p. 37-44Article in journal (Refereed) Published
    Abstract [en]

    AIM: To evaluate outcomes for patients attending primary care centres with and without asthma clinics. METHODS: A cross-sectional survey at 42 primary health care centres randomly selected according to organisation of asthma care, 14 with complete, 14 with incomplete and 14 with no asthma clinic according to national criteria. 1,477 randomly selected patients 15-45 years received two questionnaires. Outcomes were: patients’ knowledge of asthma; asthma control; and quality of life. RESULTS: Patients attending primary health care centres with asthma clinics reported more knowledge of asthma but similar levels of asthma control and quality of life. Patients who reported they had visited the asthma nurse during the last year had more knowledge but similar asthma control and quality of life compared to patients who reported they had not. However, with more time allocated for the nurse, 44% achieved asthma control compared with 27% at asthma clinics with less time (p<0.003). CONCLUSIONS: Having an asthma clinic at a primary health care centre improves asthma patients’ knowledge of the disease, and better asthma control is achieved if the nurse is allocated more time.

    Keywords
    Primary care, asthma management, clinics, knowledge, outcomes, assessment
    National Category
    Respiratory Medicine and Allergy
    Identifiers
    urn:nbn:se:uu:diva-97621 (URN)10.4104/pcrj.2009.00043 (DOI)000208640600007 ()19623471 (PubMedID)
    Available from: 2008-10-17 Created: 2008-10-17 Last updated: 2017-12-14
    3. Quality of life and measures of asthma control in primary health care
    Open this publication in new window or tab >>Quality of life and measures of asthma control in primary health care
    Show others...
    2007 (English)In: Journal of Asthma, ISSN 0277-0903, E-ISSN 1532-4303, Vol. 44, no 9, p. 747-751Article in journal (Refereed) Published
    Abstract [en]

    AIM: To study quality of life and asthma control in primary care. A total of 1,477 patients 15 to 45 years of age received questionnaires regarding asthma control (77% responded) and quality of life, Mini Asthma Quality of Life Questionnaire (MiniAQLQ), (74% responded). Patients using short-acting beta-agonists more than twice in the last week had clinically significant lower MiniAQLQ scores (5.17 versus 5.91). This finding was consistent for night awakenings during the previous week (4.42 versus 5.86), courses of oral corticosteroids (4.82 versus 5.69), and reported emergency consultations during the last 6 months (4.85 versus 5.71). Good asthma control is associated with better quality of life in asthma patients in primary care.

    Keywords
    asthma, primary health care, control, symptoms, quality of life
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:uu:diva-97622 (URN)10.1080/02770900701645298 (DOI)000250923000010 ()17994405 (PubMedID)
    Available from: 2008-10-17 Created: 2008-10-17 Last updated: 2017-12-14Bibliographically approved
    4. Sex-related differences regarding quality of life and asthma control in Swedish asthma patients
    Open this publication in new window or tab >>Sex-related differences regarding quality of life and asthma control in Swedish asthma patients
    Show others...
    (English)Article in journal (Other academic) Submitted
    Identifiers
    urn:nbn:se:uu:diva-97623 (URN)
    Available from: 2008-10-17 Created: 2008-10-17 Last updated: 2011-08-09Bibliographically approved
  • 206.
    Lisspers, Karin
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Andersson, F
    Gustafsson, D
    Hasselgren, Mikael
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Johansson, Gunnar
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Leppert, J
    Ställberg, Björn
    Svärdsudd, Kurt
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Ger otillräckligt astmakontroll sämre livskvalitet hos patienter med astma i primärvården?: rapport från AIM-studien2002Conference paper (Other academic)
  • 207.
    Lisspers, Karin
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Ställberg, Björn
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Arne, Mats
    Bröms, Kristina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Hasselgren, Mikael
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Johansson, Gunnar
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Odebäck, P
    Svärdsudd, Kurt
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Jansson, Christer
    Kvinnor har sämre astmakontroll: resultat från Praxisstudien2006Conference paper (Other academic)
  • 208.
    Lisspers, Karin
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Ställberg, Björn
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm , Centrum för klinisk forskning i D län (CKFD).
    Broms, Kristina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Hasselgren, Mikael
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Johansson, Gunnar
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Odeback, Peter
    Arne, Mats
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Janson, Christer
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Svärdsudd, Kurt
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Organisation of asthma and COPD care in primary health care in Mid-Sweden2006Conference paper (Refereed)
    Abstract [en]

    Objective: To investigate the organisation of primary health care with regard to management of asthma and COPD and relate it to the guidelines and quality indicators for organisation stated by the Swedish National Board of Health and Welfare and to an earlier study in the area. Background: The Swedish National Board of Health and Welfare assessed quality indicators for the organisation and equipment for asthma and COPD in primary health care in 2004. These are spirometer, pulse oximeter for assessing respiratory impairment, nebuliser for emergency treatment and an asthma/COPD clinic for patient education. Method: A postal survey in 2005 to 56 randomly selected primary health care centres in Mid-Sweden. The survey included questions about access to an asthma/COPD clinic, spirometer, pulse oximeter, nebuliser, organisation for smoking cessation and rehabilitation. Results: All centres answered the survey. 93% had a spirometer, 83% pulse oximeter, 90% nebuliser and 64% asthma/COPD clinic. 65% had access to a program for smoking cessation within primary care. Regarding resources for COPD patients 63% centres had access to physiotherapy, 71% to occupational therapy, 41% to a dietician and 93% to a social welfare official or psychologist. Conclusion: The possibilities to offer patients with asthma and COPD sufficient care is good regarding access to diagnostic tools as spirometers and pulse oximeters and nebulisers, while access to education through an asthma/COPD clinic is insufficient. Compared to the results from the AIM-study in 2000 primary health care centres with asthma clinics have increased from 52% to 64% and access to spirometer from 76% to 93%. Only two-thirds of the centres can offer a program for smoking cessation which is insufficient. The study shows that many centres have the resources to start pulmonary rehabilitation for patients with COPD.

  • 209.
    Lisspers, Karin
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Ställberg, Björn
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm , Centrum för klinisk forskning i D län (CKFD).
    Hasselgren, Mikael
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Johansson, Gunnar
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Svärdsudd, Kurt
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Organisation of asthma care in primary health care in Mid-Sweden2005In: Primary Care Respiratory Journal, ISSN 1471-4418, E-ISSN 1475-1534, Vol. 14, no 3, p. 147-153Article in journal (Refereed)
    Abstract [en]

    AIM: To investigate the organisation of asthma care in 240 primary health care centres (PHCCs) in Mid-Sweden. METHODS: A cross-sectional study. Main outcomes were occurrence and structure of nurse-based asthma clinics according to nationally recommended criteria, and access and use of spirometers. RESULTS: 238 PHCCs (99%) responded. 16% reported a complete, and 37% an incomplete, asthma clinic. 47% of PHCCs had no asthma clinic. The incomplete asthma clinics usually lacked sufficient asthma nurse time, a scheduled nurse surgery and a responsible GP. 77% of the PHCCs had access to a spirometer and on average 19 spirometries/1000 inhabitants/year were performed. There was a large variation in the use of spirometers. CONCLUSION: Half of the PHCCs had an asthma clinic and a majority had access to a spirometer. More frequent use of spirometry and increased time provision for the asthma nurse would be likely to produce a substantial improvement in the standard of asthma care in primary health care.

  • 210.
    Lisspers, Karin
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Ställberg, Björn
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i D län (CKFD). Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Hasselgren, Mikael
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Johansson, Gunnar
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Svärdsudd, Kurt
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Primary health care centres with asthma clinics: effects on patients' knowledge and asthma control2010In: Primary Care Respiratory Journal, ISSN 1471-4418, E-ISSN 1475-1534, Vol. 19, no 1, p. 37-44Article in journal (Refereed)
    Abstract [en]

    AIM: To evaluate outcomes for patients attending primary care centres with and without asthma clinics. METHODS: A cross-sectional survey at 42 primary health care centres randomly selected according to organisation of asthma care, 14 with complete, 14 with incomplete and 14 with no asthma clinic according to national criteria. 1,477 randomly selected patients 15-45 years received two questionnaires. Outcomes were: patients’ knowledge of asthma; asthma control; and quality of life. RESULTS: Patients attending primary health care centres with asthma clinics reported more knowledge of asthma but similar levels of asthma control and quality of life. Patients who reported they had visited the asthma nurse during the last year had more knowledge but similar asthma control and quality of life compared to patients who reported they had not. However, with more time allocated for the nurse, 44% achieved asthma control compared with 27% at asthma clinics with less time (p<0.003). CONCLUSIONS: Having an asthma clinic at a primary health care centre improves asthma patients’ knowledge of the disease, and better asthma control is achieved if the nurse is allocated more time.

  • 211.
    Lisspers, Karin
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Ställberg, Björn
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm , Centrum för klinisk forskning i D län (CKFD).
    Hasselgren, Mikael
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Johansson, Gunnar
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Svärdsudd, Kurt
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Quality of life and measures of asthma control in primary health care2007In: Journal of Asthma, ISSN 0277-0903, E-ISSN 1532-4303, Vol. 44, no 9, p. 747-751Article in journal (Refereed)
    Abstract [en]

    AIM: To study quality of life and asthma control in primary care. A total of 1,477 patients 15 to 45 years of age received questionnaires regarding asthma control (77% responded) and quality of life, Mini Asthma Quality of Life Questionnaire (MiniAQLQ), (74% responded). Patients using short-acting beta-agonists more than twice in the last week had clinically significant lower MiniAQLQ scores (5.17 versus 5.91). This finding was consistent for night awakenings during the previous week (4.42 versus 5.86), courses of oral corticosteroids (4.82 versus 5.69), and reported emergency consultations during the last 6 months (4.85 versus 5.71). Good asthma control is associated with better quality of life in asthma patients in primary care.

  • 212.
    Lisspers, Karin
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Ställberg, Björn
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Janson, Christer
    Johansson, Gunnar
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Svärdsudd, Kurt
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Sex-related differences regarding quality of life and asthma control in Swedish asthma patientsArticle in journal (Other academic)
  • 213.
    Lisspers, Karin
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Ställberg, Björn
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Jansson, Christer
    Arne, Mats
    Bröms, Kristina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Hasselgren, Mikael
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Johansson, Gunnar
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Odebäck, P
    Svärdsudd, Kurt
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Organisation av astma- och KOL-vård i primärvården i Mellansverige: resultat från Praxisstudien 20052005Conference paper (Other academic)
  • 214.
    Lisspers, Karin
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Ställberg, Björn
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Johansson, Gunnar
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Bröms, Kristina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Hasselgren, Mikael
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Arne, Mats
    Odebäck, P
    Svärdsudd, Kurt
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Jansson, Christer
    Gender differences and asthma control in asthma patients2006Conference paper (Other academic)
  • 215. Löfdahl, Claes-Goran
    et al.
    Tilling, Björn
    Ekström, Tommy
    Jörgensen, Leif
    Johansson, Gunnar
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Larsson, Kjell
    COPD health care in Sweden - A study in primary and secondary care2010In: Respiratory Medicine, ISSN 0954-6111, E-ISSN 1532-3064, Vol. 104, no 3, p. 404-411Article in journal (Refereed)
    Abstract [en]

    Objectives: To map out-patients with Chronic Obstructive Pulmonary Disease (COPD) with special reference to patients suffering from acute exacerbations, and to describe COPI) health care structure and process in Swedish clinical. practice in a real life setting. Design: Retrospective, non-interventional, epidemiological survey. Setting: 141 hospital based out patient clinics (OPC, n = 30) and primary health care clinics (PC, n = 111) were included in the structure evaluation. Subjects: 1004 COPI) diagnosed patients from 100 of the centres (OPC, n = 26) participated in the process evaluation. Methods: All Swedish OPC (n = 40) and a random sample of 180 PC were asked to answer a questionnaire regarding COPI) care. In addition, data from 10 randomly selected patients with a documented COPI) disease were analysed from the centres. Results: Spirometers were available at all OPCs and at 99% of the PCs. Spirometry had been performed in 52% of PC-patients and in 89% of OPC-patients during the last 2 years prior to the study. More severe patients, as judged by investigator and lung function data, were treated at OPCs than at PCs. Physiotherapists, occupational therapists and dieticians were available at >80% of centres. Exacerbation rate was higher at PCs without a specialized nurse, 2.2/year versus 0.9/year at centres with a specialized nurse. Conclusions: Special attention to COPD, marked by a specialised nurse in primary care improves the quality, as assessed by a tower number of exacerbations. The structure of COPD care in Sweden for diagnosed individuals seems satisfactory, but could be improved mainly through higher availability and educational activities.

  • 216. Ma, X-Q
    et al.
    Cao, Y
    Wang, R
    Yan, X
    Zhao, Y
    Zou, D
    Wallander, Mari-Ann
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Johansson, Saga
    Liu, W
    Gu, Z
    Zhao, J
    He, J
    Prevalence of, and factors associated with, gastroesophageal reflux disease: a population-based study in Shanghai, China2009In: Diseases of the esophagus, ISSN 1120-8694, E-ISSN 1442-2050, Vol. 22, no 4, p. 317-322Article in journal (Refereed)
    Abstract [en]

    The prevalence of gastroesophageal reflux disease (GERD) in China is lower than that in the Western countries, but appears to be increasing. The aim of this pilot study was to evaluate the prevalence of GERD in Shanghai, China, and to explore which population characteristics where associated with GERD. A sample of 1200 adult inhabitants of Shanghai, selected using randomized, stratified, multi-stage sampling, completed Mandarin translations of the Reflux Disease Questionnaire and GERD Impact Scale. Potential risk factors for GERD were examined by nested case-control analysis, using Cochran-Armitage trend testing and logistic regression analysis. The response rate was 86.2%; 919 responses were suitable for analysis. The prevalence of GERD, defined as heartburn and/or regurgitation of any frequency during the previous week, was 6.2% in Shanghai. Obesity and urban dwelling were associated with GERD (odds ratio 3.4, 95% confidence interval 1.3-9.3; and odds ratio 3.6, 95% confidence interval 1.2-10.4, respectively). The prevalence of GERD in Shanghai agreed with previous Chinese studies. GERD in Shanghai was associated with obesity and residency in an urban environment.

  • 217. Martin-Merino, E
    et al.
    Ruigomez, A
    Garcia Rodriguez, LA
    Wallander, Mari-Ann
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Johansson, Saga
    Depression and treatment with antidepressants are associated with the development of gastro-oesophageal reflux disease2010In: Alimentary Pharmacology and Therapeutics, ISSN 0269-2813, E-ISSN 1365-2036, Vol. 31, no 10, p. 1132-1140Article in journal (Refereed)
    Abstract [en]

    Background The roles of depression and antidepressants in triggering reflux symptoms remain unclear. Aim To compare the incidence of gastro-oesophageal reflux disease (GERD) in individuals with and without a depression diagnosis and to evaluate risk factors for a GERD diagnosis. The relationship between antidepressant treatment and GERD was also assessed. Methods The Health Improvement Network UK primary care database was used to identify patients with incident depression and an age- and sex-matched control cohort with no depression diagnosis. Incident GERD diagnoses were identified during a mean follow-up of 3.3 years. Furthermore, we performed nested case-control analyses where odds ratios (OR) with 95% confidence intervals (CI) were estimated by unconditional logistic regression in multivariable models. Results The incidence of GERD was 14.2 per 1000 person-years in the depression cohort and 8.3 per 1000 person-years in the control cohort. The hazard ratio of GERD in patients with depression compared with controls was 1.72 (95% CI: 1.60-1.85). Among patients with depression, tricyclic antidepressant use was associated with an increased risk of GERD (OR: 1.71; 95% CI: 1.34-2.20), while selective serotonin reuptake inhibitors were not associated with GERD. Conclusions A depression diagnosis is associated with an increased risk of a subsequent GERD diagnosis, particularly in individuals using tricyclic antidepressants.

  • 218. Martin-Merino, Elisa
    et al.
    Ruigomez, Ana
    Wallander, Mari-Ann
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Johansson, Saga
    Alberto Garcia-Rodriguez, Luis
    Prevalence, incidence, morbidity and treatment patterns in a cohort of patients diagnosed with anxiety in UK primary care2010In: Family Practice, ISSN 0263-2136, E-ISSN 1460-2229, Vol. 27, no 1, p. 9-16Article in journal (Refereed)
    Abstract [en]

    Background. Anxiety disorders are common and can cause substantial quality of life impairment. Objective. The aim of this study was to investigate the frequency of anxiety in UK primary care. Treatment patterns and factors associated with an anxiety diagnosis were also assessed. Methods. The Health Improvement Network was used to identify all patients aged 10-79 years with a new diagnosis of anxiety in 2002-04 (n = 40 873) and age-, sex- and calendar-year-matched controls (n = 50 000). A nested case-control analysis was used to quantify potential risk factors for anxiety by multivariate logistic regression. Results. The prevalence of anxiety was 7.2% and the incidence was 9.7 per 1000 person-years. Incidence and prevalence were highest in women and young adults (20-29 years). Anxiety was associated with heavy alcohol use, smoking and addiction problems as well as stress, sleep and depression disorders. Anxiety patients used health care services more frequently than controls. Among patients diagnosed with anxiety, 63% were treated pharmacologically. Antidepressants accounted for almost 80% of prescriptions. Conclusions. The prevalence and incidence of anxiety are high in UK primary care and are almost twice as high in women than in men. Anxiety is associated with other psychiatric morbidity as well as frequent health care use. Antidepressants are the most commonly used pharmacological treatment.

  • 219. Martín-Merino, E
    et al.
    Ruigómez, A
    Johansson, Saga
    Wallander, Mari-Ann
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    García-Rodriguez, LA
    Study of a cohort of patients newly diagnosed with depression in general practice: prevalence, incidence, comorbidity, and treatment patterns2010In: Primary care companion to the Journal of clinical psychiatry, ISSN 1523-5998, Vol. 12, no 1, p. PCC.08m00764-Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To estimate the prevalence and incidence of depression; investigate its association with risk factors including comorbidities and drug and health care use; and describe treatment patterns of depression in primary care using The Health Improvement Network database. METHOD: In this cohort study, subjects with a first recorded diagnosis of depression (Read code) between January 1, 2002, and December 31, 2004 (n=47,170) were identified from a source population of 1,287,829 subjects aged 10-79 years. A comparison group was sampled from the same population and frequency matched to the depression cohort by age, sex, and calendar year (n=50,000). Depression diagnoses were validated using physician-completed questionnaires. Odds ratios and 95% CIs for the relationship of depression with a range of factors were estimated using unconditional logistic regression in a nested case-control analysis. RESULTS: The prevalence of depression was 11.23% (95% CI, 11.18-11.28). This prevalence decreased with increasing age and was higher in women than in men. The incidence was 13.89 per 1,000 person-years (95% CI, 13.82-14.08). Depression was associated with frequent use of health services, smoking, pregnancy in the previous year, anxiety, stress, sleep disorders, digestive and respiratory disorders, and pain. In the trimester following diagnosis, 82% of cases were treated-98% with antidepressants and 81.5% with selective serotonin reuptake inhibitors (SSRIs). CONCLUSIONS: We found a high prevalence and incidence of depression diagnoses in primary care in the United Kingdom. Following diagnosis, the majority of individuals were prescribed SSRIs. A diagnosis of depression is associated with a number of prior comorbidities, which could mask the depression. This fact should be taken into account when screening individuals in primary care.

  • 220. McAfee, AT
    et al.
    Rodríguez, LAG
    Goettsch, WG
    González-Pérez, A
    Johansson, Saga
    Ming, EE
    Wallander, Mari-Ann
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Herings, RMC
    Characteristics and drug utilization patterns of new users of rosuvastatin and other statins in four countries2010In: Minerva Cardioangiologica: Journal on Cardiovascular Pathophysiology, Clinical Medicine and Therapy, ISSN 0026-4725, E-ISSN 1827-1618, Vol. 58, no 6, p. 611-622Article in journal (Refereed)
    Abstract [en]

    AIM: This study was undertaken to increase understanding of the utilization of a newly introduced statin through evaluation of characteristics of 'real-life' patients in a pharmacoepidemiology program in the USA, the Netherlands, the UK and Canada. METHODS: This was an observational analysis of prospectively collected data from primary care patients classified as new users of rosuvastatin or any other statin. New users (naïve or switched initiators) of rosuvastatin were compared with initiators of other statins, as identified from automated healthcare databases in the first 1 to 2 years of rosuvastatin availability. Demographics, statin doses, previous statin use and other lipid-lowering therapies, and relevant comorbidities were recorded. The main outcome measure was proportion of naïve and non-naïve statin users in patients prescribed rosuvastatin or 'other statins'. RESULTS: Among 346.547 new statin users identified in the cohorts, 46.838 (13.5%) were new users of rosuvastatin and most (84.1%) were statin-naïve. Patients receiving rosuvastatin were more likely to have been previously treated with another statin or non-statin lipid-lowering therapy and tended to be younger, compared with first users of other statins. CONCLUSION: These findings suggest that rosuvastatin is preferentially prescribed to patients who have not responded satisfactorily to established treatment.

  • 221. Mikaelsson, B
    et al.
    Andersson, L
    Arrelöw, Britt
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Melander, H
    Norrmén, Gunilla
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Olsson, B
    Sjöberg, Inger
    Neurocentrum, Akademiska sjukhuset, Uppsala.
    Uddgård, A
    Wallman, Thorne
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i D län (CKFD).
    Svärdsudd, Kurt
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Hur kan problemen med den ökande sjukfrånvaron minskas?2000In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 97, no 13, p. 1576-1578Article in journal (Refereed)
  • 222. Mikaelsson, B
    et al.
    Arrelöv, B
    Sjöberg, I
    Wallman, Thorne
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i D län (CKFD).
    Svärdsudd, Kurt
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Minskning av sjukfrånvaron utan formella regeländringar2001In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 98, no 18, p. 2216-2008Article in journal (Refereed)
  • 223. Mikaelsson, B
    et al.
    Arrelöw, Britt
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Melander, H
    Normén, Gunilla
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Olsson, B
    Sjöberg, Inger
    Rehab/neurocentrum, Akademiska sjukhuset, Uppsala.
    Uddgård, A
    Wallman, Thorne
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i D län (CKFD).
    Svärdsudd, Kurt
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Varför ökar sjukfrånvaron?1999In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 96, no 39, p. 4160-4162Article in journal (Refereed)
  • 224.
    Molinder, Herdis
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Wallander, Mari-Ann
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Hallberg, Margareta
    Bodemar, G
    Dyspepsia - acid or stress?: a study of controversy -- abandoned by experts, finalized in clinical practice?1999In: Scandinavian Journal of Gastroenterology, ISSN 0036-5521, E-ISSN 1502-7708, Vol. 34, no 11, p. 1057-1064Article in journal (Refereed)
  • 225.
    Molinder, Herdis
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Wallander, Mari-Ann
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Svärdsudd, Kurt
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Bodemar, G
    The introduction of H2-receptor antagonists to Scandinavia:  effects of experts' opinions1998In: Scandinavian Journal of Gastroenterology, ISSN 0036-5521, E-ISSN 1502-7708, Vol. 33, no 3, p. 224-230Article in journal (Refereed)
  • 226.
    Nilsson, Harriet
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Cell Biology.
    Dragomir, Anca
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Cell Biology.
    Lazorova, Lucia
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Pharmacy, Department of Pharmacy.
    Johannesson, Marie
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Roomans, Godfried M
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Cell Biology.
    CFTR and tight junctions in cultured bronchial epithelial cells2010In: Experimental and molecular pathology (Print), ISSN 0014-4800, E-ISSN 1096-0945, Vol. 88, no 1, p. 118-127Article in journal (Refereed)
    Abstract [en]

    Airway epithelial salt and water transport takes place through paracellular and transcellular pathways. This transport depends critically on the epithelial sodium channel (ENaC) and the cystic fibrosis transmembrane conductance regulator (CFTR), operating in concert with the paracellular pathway through the tight junctions (TJs). Normal (16HBE14o-), cystic fibrosis (CFBE41o-), and corrected CFBE41o- (CFBE41o pCep4) airway epithelial cell lines were cultured under isotonic conditions. Transepithelial electrical resistance (TEER) was measured as indicator of the tightness of the cultures. Morphology was investigated by immunofluorescence and paracellular permeability by lanthanum nitrate or [14C] mannitol as permeability markers. CFBE41o pCep4 cells developed lower TEER than CFBE41o- cells. Addition of a specific inhibitor of CFTR (CFTRinh-172) to 16HBE14o- and CFBE pCep4 cells resulted in a time-dependent increase in TEER whereas stimulation of CFTR by IBMX and forskolin caused a decrease. Permeability to lanthanum and [14C] mannitol was lower in 16HBE14o- cells exposed to CFTRinh-172 and in CFBE41o- cells compared to untreated 16HBE14o- and CFBE41o pCep4 cells, respectively. 16HBE14o- cells exposed to IBMX and forskolin showed higher permeability to lanthanum but lower permeability to [14C] mannitol compared to control. Immunofluorescence revealed a disorganisation of F-actin and a-tubulin in 16HBE14o- cells exposed to CFTRinh-172, which was not seen in untreated cultures. A higher degree of disorganised F-actin and a-tubulin was also seen in CFBE41o- cells compared to CFBE41o- pCep4 cells. Changes in F-actin and a-tubulin in 16HBE14o- cells exposed to IBMX and forskolin were also seen, although these were less apparent. These results suggest the possibility of an interaction between the activity of CFTR and the TJ protein complex, probably via the cytoskeleton.

  • 227. Nilsson, P.
    et al.
    Cederholm, Jan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Eliasson, B.
    Eeg-Olofsson, K.
    Zethelius, Björn
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Geriatrics.
    Gudbjornsdottir, S.
    SYSTOLIC BLOOD PRESSURE AND RISK OF CARDIOVASCULAR DISEASE IN TYPE 2 DIABETIC PATIENTS, ON ANTIHYPERTENSIVE TREATMENT OR NOT: NATIONAL DATA2010In: Journal of Hypertension, ISSN 0263-6352, E-ISSN 1473-5598, Vol. 28, p. E220-E220Article in journal (Other academic)
  • 228. Nilsson, P M
    et al.
    Cederholm, Jan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Eeg-Olofsson, K
    Eliasson, B
    Zethelius, Björn
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Geriatrics.
    Gudbjörnsdóttir, S
    Pulse pressure strongly predicts cardiovascular disease risk in patients with type 2 diabetes from the Swedish National Diabetes Register (NDR)2009In: Diabetes & Metabolism, ISSN 1262-3636, E-ISSN 1878-1780, Vol. 35, no 6, p. 439-446Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: To analyze pulse pressure (PP) as a risk predictor for coronary heart disease (CHD), stroke and cardiovascular disease (CVD; CHD and/or stroke) in type 2 diabetic patients. METHODS: A total of 11,128 female and male type 2 diabetic patients with known baseline PP values and no CVD, aged 50-74 years, were followed for a mean duration of 5.6 years (1998-2003). A subgroup of 5521 patients with known mean PP values (mean values at baseline and at the end of the study) was also included. RESULTS: Hazard ratios (HRs) with 95% CI for fatal/nonfatal CHD with baseline or mean PP>or=75mmHg, compared to <75mmHg, were 1.23 (1.07-1.40; P=0.003) and 1.32 (1.07-1.62; P=0.009), respectively, after adjusting for mean blood pressure (MBP), age, gender, diabetes duration, HbA(1c), body mass index (BMI), lipid-reducing drugs, microalbuminuria > 20microg/min, antihypertensive drugs and hypoglycaemic treatment, using Cox regression analyses. Fully-adjusted respective HRs for stroke were 1.17 (0.98-1.39) and 1.21 (0.90-1.61) and, for CVD, 1.23 (1.10-1.37; P<0.001) and 1.28 (1.07-1.52; P=0.007). Fully-adjusted HRs for baseline PP increased per quartile and, CHD, stroke or CVD, were 1.09 (1.03-1.16; P=0.004), 1.14 (1.05-1.23; P=0.002) and 1.11 (1.05-1.17; P<0.001), respectively. The data suggest that, if a mean PP>or=75mmHg were to be avoided, then 15% and 17% of CHD and or CVD, cases, respectively, in such a cohort might be prevented after multivariable adjustments, with a further 10% of cases avoided if also adjusted for MBP and age. Increasing baseline MBP, age and microalbuminuria were independently and significantly associated (P<0.001) with increasing baseline or mean PP. CONCLUSION: Increased PP is a powerful independent risk predictor of CVD in type 2 diabetic patients, and lowering PP can lead to a marked reduction in risk.

  • 229. Nilsson, P M
    et al.
    Gudbjörnsdottir, S
    Eliasson, B
    Cederholm, Jan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Hypertension in diabetes: trends in clinical control in repeated large-scale national surveys from Sweden2003In: Journal of Human Hypertension, ISSN 0950-9240, E-ISSN 1476-5527, Vol. 17, no 1, p. 37-44Article in journal (Refereed)
    Abstract [en]

    Hypertension in diabetes is an important and treatable cardiovascular risk factor. Treatment targets from guidelines cannot always be achieved in everyday clinical practice. It is therefore of great importance to monitor trends in hypertension control in defined populations. Patients with type I diabetes (range 6685-10100; treated hypertension 21-29%) or with type II diabetes (range 15935-22605; treated hypertension 47-56%) were included in four national samples between 1996 and 1999. This screening was part of the procedures for the National Diabetes Register in Sweden, which monitors trends in clinical practice and risk factors for patients with diabetes, recruited both in primary health care and at the hospital level. A favourable trend in mean and median blood pressure levels was noticed during the 4-year study period, based either on data from repeated surveys or on repeated measures in the same individual, both for type I diabetes (mean: -2/-2 mmHg; P < 0.01) and for type II diabetes (mean: -5/-3 mmHg; P < 0.001). Correspondingly, the proportion of hypertensive patients in acceptable control of blood pressure (less than or equal to140/ 85 mmHg) increased (P < 0.001) both in type I diabetes (52.0-57.9%) and in type 11 diabetes (22.4-33.3%). It was concluded that hypertension is a widespread cardiovascular risk factor in patients with diabetes, especially systolic hypertension. A trend for a better systolic blood pressure control during the late 1990s in hypertensive patients with type II diabetes in Sweden could translate into substantial (estimated) clinical benefits in cardiovascular and diabetes-related morbidity. The National Diabetes Register makes a quality assessment of the hypertension treatment possible.

  • 230. Nilsson, P M
    et al.
    Gudbjörnsdottir, S
    Eliasson, B
    Cederholm, Jan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Smoking is associated with increased HbA1c values and microalbuminuria in patients with diabetes: data from the National Diabetes Register in Sweden2004In: Diabetes & Metabolism, ISSN 1262-3636, E-ISSN 1878-1780, Vol. 30, no 3, p. 261-268Article in journal (Other academic)
    Abstract [en]

    OBJECTIVES:

    The aim was to examine trends in the proportion of smoking in diabetes patients, and to study associations between smoking, glycaemic control, and microalbuminuria.

    METHODS:

    Smoking habits were reported to the Swedish National Diabetes Register (NDR), with data from hospitals and primary health care. Patient characteristics included were age, gender, type of treatment, diabetes duration, HbA1c, BMI, blood pressure, antihypertensive and lipid-lowering drugs, and microalbuminuria.

    RESULTS:

    The proportion of smokers in type 1 diabetes was 12-15% during 1996-2001, it was high in females<30 years (12-16%), and was higher in the age group 30-59 years (13-17%) than in older (6-9%) patients. The corresponding proportion of smoking in type 2 diabetes was 10-12%, higher in those less than 60 years of age (17-22%) than in older (7-9%) patients. Smoking type 1 and type 2 patients in 2001 had higher mean HbA1c but lower mean BMI values than non-smokers. Smokers also had higher frequencies of microalbuminuria, in both type 1 (18 vs 14%) and type 2 (20% vs 13%) diabetes. Multiple logistic regression analyses disclosed that smoking was independently associated with elevated HbA1c levels (p<0.001) and microalbuminuria (p<0.001), but negatively with BMI (p<0.001), in both type 1 and type 2 diabetes.

    CONCLUSIONS:

    Smoking in patients with diabetes was widespread, especially in young female type 1, and in middle-aged type 1 and type 2 diabetes patients, and should be the target for smoking cessation campaigns. Smoking was associated with both poor glycaemic control and microalbuminuria, independently of other study characteristics.

  • 231. Nilsson, Peter M
    et al.
    Cederholm, Jan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Eeg-Olofsson, Katarina
    Eliasson, Björn
    Zethelius, Björn
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Geriatrics.
    Fagard, Robert
    Gudbjörnsdóttir, Soffia
    Smoking as an independent risk factor for myocardial infarction or stroke in type 2 diabetes: a report from the Swedish National Diabetes Register2009In: European Journal of Cardiovascular Prevention & Rehabilitation, ISSN 1741-8267, E-ISSN 1741-8275, Vol. 16, no 4, p. 506-512Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Few earlier studies have analysed smoking as a risk factor for myocardial infarction (MI) or stroke in type 2 diabetic patients. DESIGN AND METHODS: A longitudinal study involved 13 087 female and male patients with type 2 diabetes from the Swedish National Diabetes Register with no previous MI or stroke at baseline, aged 30-74 years, and with data available for all analysed variables, followed up for mean 5.7 years. RESULTS: Adjusted hazard ratios (HRs) for smoking and first-incident fatal/nonfatal MI, stroke and total mortality were 1.7 [95% confidence interval (CI): 1.4-2.0; P<0.001], 1.3 (95% CI: 1.1-1.6; P = 0.006) and 1.8 (95% CI: 1.5-2.2; P<0.001), respectively, by Cox regression analysis, adjusted for age, sex, diabetes duration, hypoglycaemic treatment, haemoglobin A1c, blood pressure, body mass index, microalbuminuria, antihypertensive and lipid-lowering drugs. Adjusted HR was higher for fatal MI, 2.1 (95% CI: 1.7-2.7; P<0.001), than for nonfatal MI, 1.4 (95% CI: 1.2-1.7; P<0.001). The highest HRs were observed in more frequently smoking (22%), middle-aged patients (age <60 years) for fatal/nonfatal MI, 2.3 (95% CI: 1.8-3.1; P<0.001) and for total mortality, 2.5 (95% CI: 1.6-3.8, P<0.001), whereas lower HRs were observed in older and less smoking patients. With predicted cessation of smoking in patients aged below 60 years, 24% (95% CI: 15-33%) of cases of fatal/nonfatal MI and 24% (11-37%) of cases of total mortality may have been prevented. CONCLUSION: The risk for MI and total mortality associated with smoking is high in type 2 diabetes, especially in more frequently smoking, middle-aged patients, and was higher for MI than for stroke, and also higher for fatal than for nonfatal events. Smoking cessation would strongly affect risk reduction.

  • 232. Nilsson, Peter M
    et al.
    Cederholm, Jan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Gudbjörnsdottir, Soffia
    Eliasson, Björn
    Predictors of successful long-term blood pressure control in type 2 diabetic patients: data from the Swedish National Diabetes Register (NDR)2005In: Journal of Hypertension, ISSN 0263-6352, E-ISSN 1473-5598, Vol. 23, no 12, p. 2305-11Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Hypertension in patients with diabetes is a well recognized cardiovascular risk factor for which the benefits of treatment are strongly evidence based. Less is known about predictors for successful long-term blood pressure control in these patients, including the potential role of body mass index (BMI), glycaemic control, microalbuminuria and smoking. MATERIAL AND METHODS: We used longitudinal data on risk factor levels from repeated clinical surveys of 1759 type 2 diabetic patients in the Swedish National Diabetes Register (NDR), a nationwide annual registration of quality indicators in diabetes care. Subjects with successful blood pressure (BP) control (systolic BP < 135 mmHg and diastolic BP < 85 mmHg) at baseline in 1997, in 2001, and at follow-up in 2003, were compared to subjects with BP control >or= 135/85 mmHg. RESULTS: Logistic regression analysis disclosed that successful BP control during the study period was predicted by lower BMI (P < 0.001), a lower frequency of microalbuminuria (P = 0.002), and lower age (P < 0.001) at baseline in 1997, and was still associated with lower BMI (P < 0.001), a lower frequency of microalbuminuria (P = 0.01) and lower age (P < 0.001) at follow-up. Successful BP control was also associated at follow-up with a lower frequency of the metabolic syndrome (30 versus 75%) and lower predicted 10-year risks [United Kingdom Prospective Diabetes Study (UKPDS) Risk Engine] of coronary heart disease (14 versus 29%) and stroke (10 versus 22%) (all P < 0.001). CONCLUSION: A lower BMI and absence of microalbuminuria were strong independent predictors of long-term successful BP control in type 2 diabetic patients, also characterized by a lower frequency of the metabolic syndrome and lower 10-year risk of cardiovascular disease. This implies the long-term benefits on BP control of lifestyle measures as well as control of microalbuminuria.

  • 233. Nilsson, PM
    et al.
    Gudbjörnsdottir, Soffia
    Cederholm, Jan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Diabetes och tobak: dubbla hot mot hälsan2002In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 99, no 20, p. 2281-2282Article in journal (Other academic)
    Abstract [en]

    Smoking is a serious risk factor for cardiovasculardisease, retinopathy, and nephropathy in patientswith diabetes. Furthermore, epidemiological studieshave shown that heavy smokers run an increasedprospective risk of developing type 2 diabetes,probably due both to the fact that smoking is a mar-ker for an unhealthy lifestyle and that smoking vianicotine may deteriorate glucose metabolism bynegatively influencing insulin sensitivity. In Swe-den, data from the National Diabetes Register(NDR) has shown that the prevalence of smoking intype 2 diabetes patients followed in primary healthcare is almost as high as in the non-diabetic popu-lation, at least in middle-aged subjects (about 20%).This alarming situation must be dealt with by usingnew and effective methods to promote anti-smo-king. If support by group sessions can be organisedfor patients with type 2 diabetes who are smokers,in combination with pharmacological approaches(nicotine, bupropion) it is hoped that the rate ofsmoking cessation can substantially increase. Suchprojects are currently under-way within the prima-ry health care in southern Sweden.

  • 234.
    Norrmén, Gunilla
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    To be or not to be Sick Certified with Special Reference to Physician and Patient Related Factors2010Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Objectives The aim of this thesis was to assess the importance of general practitioners (GP) and patient related factors for the GPs’ decision to sick certify or not to sick certify the patients.

    Study population and methods The data were obtained from a cross-sectional questionnaire study of GP-patient consultations. 65 GPs responded to one questionnaire about themselves and one questionnaire about each of the altogether 642 consultations. The patients responded to a questionnaire about themselves and the consultation, altogether 521 consultations. Various combinations of the three questionnaires were used in the four papers on which this thesis is based.

    Results Among GPs, long experience of family medicine and working part-time were significant determinants for issuing more sick leave certificates. Complaints perceived as clearly somatic by the physician decreased the chance of sick certifications, and complaints resulting in severe limitation of occupational work capacity, as assessed by the patient as well as the physician, increased the chance of sick certification, as did appointments for loco-motor complaints. Among work related factors, high ‘authority over decisions’ and high ‘social support’ were associated with reduced sickness certification probability. Worrying about illness or injury risks from work increased sickness certification. GPs and their patients took a fairly similar view to statements on health related and insurance system related matters. GPs’ opinions seem to have a greater impact than patients’ on the GPs’ decision to sickness certify a patient or not.

    Conclusions A number of patient and GP related factors were associated with the probability of getting sick certified. The patient’s own judgement of impaired work ability was important for sickness certification, but a shared judgement and decision between the GP and the patient appears probable in most cases.

    List of papers
    1. Impact of physician-related factors on sickness certification in primary health care
    Open this publication in new window or tab >>Impact of physician-related factors on sickness certification in primary health care
    2006 (English)In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 24, no 2, p. 104-109Article in journal (Refereed) Published
    Abstract [en]

    OBJECTIVE: To investigate what factors are associated with physicians' decisions on whether or not to sickness certify the patient at a consultation. DESIGN: Questionnaire survey sent to physicians in general practice and their patients. SETTING: General practitioners in Orebro county, central Sweden. SUBJECTS: Sixty-five physicians with up to 10 patients each. MAIN OUTCOME MEASURE: Whether a sickness certificate was issued. RESULTS: Physicians with long experience in family medicine and those working part time issued more sickness certificates when all encounters with patients were considered. When only musculoskeletal problems were studied physicians with long experience or who were trained in social insurance medicine as undergraduates issued more sickness certificates. When only appointments for infections were studied, part-time physicians issued more sickness certificates. No impact of the physicians' sex on sickness certifying was found.

    CONCLUSIONS: Length of professional experience and physicians' working time appear to influence practices in sickness certifying.

    Keywords
    Absenteeism, consultation, primary care, professional competence, sick leave
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:uu:diva-80569 (URN)10.1080/02813430500525433 (DOI)000237470000009 ()16690559 (PubMedID)
    Available from: 2007-03-21 Created: 2007-03-21 Last updated: 2017-12-14Bibliographically approved
    2. How primary health care physicians make sick listing decisions: The impact of medical factors and functioning
    Open this publication in new window or tab >>How primary health care physicians make sick listing decisions: The impact of medical factors and functioning
    2008 (English)In: BMC Family Practice, ISSN 1471-2296, E-ISSN 1471-2296, BMC Fam Pract, ISSN 1471-2296, Vol. 9, p. 3:1-9Article in journal (Refereed) Published
    Abstract [en]

    Background: The decision to issue sickness certification in Sweden for a patient should be based on the physician's assessment of the reduction of the patient's work capacity due to a disease or injury, not on psychosocial factors, in spite of the fact that they are known as risk factors for sickness absence. The aim of this study was to investigate the influence of medical factors and functioning on sick listing probability. Methods: Four hundred and seventy-four patient-physician consultations, where sick listing could be an option, in general practice in Orebro county, central Sweden, were documented using physician and patient questionnaires. Information sought was the physicians' assessments of causes and consequences of the patients' complaints, potential to recover, diagnoses and prescriptions on sick leave, and the patients' view of their family and work situation and functioning as well as data on the patients' former and present health situation. The outcome measure was whether or not a sickness certificate was issued. Multivariate analyses were performed. Results: Complaints entirely or mainly somatic as assessed by the physician decreased the risk of sick listing, and complaints resulting in severe limitation of occupational work capacity, as assessed by the patient as well as the physician, increased the risk of sick listing, as did appointments for locomotor complaints. The results for patients with infectious diseases or musculoskeletal diseases were partly similar to those for all diseases. Conclusion: The strongest predictors for sickness certification were patient's and GP's assessment of reduced work capacity, with a striking concordance between physician and patient on this assessment. When patient's complaints were judged to be non-somatic the risk of sickness certification was enhanced.

    National Category
    Public Health, Global Health, Social Medicine and Epidemiology
    Research subject
    Family Medicine
    Identifiers
    urn:nbn:se:uu:diva-13897 (URN)10.1186/1471-2296-9-3 (DOI)000254051200001 ()18208594 (PubMedID)
    Available from: 2008-08-07 Created: 2008-08-07 Last updated: 2017-12-11Bibliographically approved
    3. The association of patient's family, leisure time, and work situation with sickness certification in primary care in Sweden
    Open this publication in new window or tab >>The association of patient's family, leisure time, and work situation with sickness certification in primary care in Sweden
    2010 (English)In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 28, no 2, p. 76-81Article in journal (Refereed) Published
    Abstract [en]

    Objective: To investigate associations between patients’ family, leisure time and work related factors and physicians' measure whether or not to sickness certify the patient in connection with the consultation. Design: Questionnaire survey to physicians in general practice and their patients. Setting: General practitioners (GPs) and their patients in Örebro county, Sweden. Subjects: 474 patient-physician consultations from 65 physicians with up to ten patients each. Main outcome measure: Whether or not a sickness certificate was issued. Results: Among work related factors, high ‘authority over decisions’ and high "social support" correlated with 30% or more reduced sickness certification probability. Worrying about becoming ill or being injured from work correlates to almost doubled sickness certification risk. Among family and leisure time variables, only living with a common law partner and having no children correlated to increased sickness certification risk. In addition to analyses of the whole group (all diagnoses), the two largest diagnostic subgroups, infectious diseases and musculoskeletal diseases, were examined. For the infectious diseases subgroup, high demands in work correlated to increased sickness certification risk, while in the musculoskeletal diseases subgroup, worry about work related injury or illness was the main factor correlating to increased risk for sickness certification. Conclusions: Work related factors were the most important factors related to sickness certification in this study. Determinants for sickness certification risk differed between diagnostic subgroups.

    Keywords
    Family medicine, sick leave, work capacity, work strain, work demands, authority over decisions, social support
    National Category
    General Practice
    Research subject
    Family Medicine
    Identifiers
    urn:nbn:se:uu:diva-120555 (URN)10.3109/02813431003765265 (DOI)000279026600003 ()20429740 (PubMedID)
    Projects
    Försäkringsmedicin
    Available from: 2010-03-13 Created: 2010-03-13 Last updated: 2018-01-12Bibliographically approved
    4. Influence on sickness certification of opinions and attitudes towards health related and insurance system related matters among general practitioners and their patients
    Open this publication in new window or tab >>Influence on sickness certification of opinions and attitudes towards health related and insurance system related matters among general practitioners and their patients
    (English)Manuscript (preprint) (Other academic)
    Abstract [en]

    Aim: The aim of this study was to evaluate the influence of patients’ and physicians’ opinions and attitudes towards health related and insurance system related matters on sickness certification in primary health care.

    Methods: 474 patient-physician consultations in general practice in Örebro county, central Sweden, in which sickness certification was an option were documented using physician and patient questionnaires. The outcome measure was whether or not a sickness certificate was issued. Possible determinants were variables indicating the patient’s and the physician’s extent of agreement with statements concerning health and social insurance matters.

    Results: GPs and their patients took a fairly similar view to the statements. After multivariate analysis, attitudes expressed by the GPs’ were significantly more frequently related to their decision to sick certify or not, than were patients’ attitudes on the same items. The variables with the strongest impact were found when GPs expressed confidence in physicians’ knowledge of working life and when patients’ gave credit to employers’ willingness to keep disabled people in work. Such attitudes were in general associated with less sickness certification. Patients with musculoskeletal diseases, having met a GP who meant that patients should be allowed sick leave when not mentally well, were more often sick certified.

    Conclusions: Opinions among GPs and patients influence on sickness certification risk in several ways. GPs’ opinions seem to have a greater impact than patients’ on the GPs’ decision to sick certify a patient or not.

    Keywords
    Sick leave, family medicine, primary care, sickness certification, attitude
    National Category
    General Practice
    Research subject
    Family Medicine
    Identifiers
    urn:nbn:se:uu:diva-120556 (URN)
    Projects
    Försäkringsmedicin
    Available from: 2010-03-13 Created: 2010-03-13 Last updated: 2018-01-12
  • 235.
    Norrmén, Gunilla
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Svärdsudd, Kurt
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Andersson, Dan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Impact of physician-related factors on sickness certification in primary health care2006In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 24, no 2, p. 104-109Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To investigate what factors are associated with physicians' decisions on whether or not to sickness certify the patient at a consultation. DESIGN: Questionnaire survey sent to physicians in general practice and their patients. SETTING: General practitioners in Orebro county, central Sweden. SUBJECTS: Sixty-five physicians with up to 10 patients each. MAIN OUTCOME MEASURE: Whether a sickness certificate was issued. RESULTS: Physicians with long experience in family medicine and those working part time issued more sickness certificates when all encounters with patients were considered. When only musculoskeletal problems were studied physicians with long experience or who were trained in social insurance medicine as undergraduates issued more sickness certificates. When only appointments for infections were studied, part-time physicians issued more sickness certificates. No impact of the physicians' sex on sickness certifying was found.

    CONCLUSIONS: Length of professional experience and physicians' working time appear to influence practices in sickness certifying.

  • 236.
    Norrmén, Gunilla
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Svärdsudd, Kurt
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Andersson, Dan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Influence on sickness certification of opinions and attitudes towards health related and insurance system related matters among general practitioners and their patientsManuscript (preprint) (Other academic)
    Abstract [en]

    Aim: The aim of this study was to evaluate the influence of patients’ and physicians’ opinions and attitudes towards health related and insurance system related matters on sickness certification in primary health care.

    Methods: 474 patient-physician consultations in general practice in Örebro county, central Sweden, in which sickness certification was an option were documented using physician and patient questionnaires. The outcome measure was whether or not a sickness certificate was issued. Possible determinants were variables indicating the patient’s and the physician’s extent of agreement with statements concerning health and social insurance matters.

    Results: GPs and their patients took a fairly similar view to the statements. After multivariate analysis, attitudes expressed by the GPs’ were significantly more frequently related to their decision to sick certify or not, than were patients’ attitudes on the same items. The variables with the strongest impact were found when GPs expressed confidence in physicians’ knowledge of working life and when patients’ gave credit to employers’ willingness to keep disabled people in work. Such attitudes were in general associated with less sickness certification. Patients with musculoskeletal diseases, having met a GP who meant that patients should be allowed sick leave when not mentally well, were more often sick certified.

    Conclusions: Opinions among GPs and patients influence on sickness certification risk in several ways. GPs’ opinions seem to have a greater impact than patients’ on the GPs’ decision to sick certify a patient or not.

  • 237.
    Norrmén, Gunilla
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Svärdsudd, Kurt
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Andersson, Dan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    The association of patient's family, leisure time, and work situation with sickness certification in primary care in Sweden2010In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 28, no 2, p. 76-81Article in journal (Refereed)
    Abstract [en]

    Objective: To investigate associations between patients’ family, leisure time and work related factors and physicians' measure whether or not to sickness certify the patient in connection with the consultation. Design: Questionnaire survey to physicians in general practice and their patients. Setting: General practitioners (GPs) and their patients in Örebro county, Sweden. Subjects: 474 patient-physician consultations from 65 physicians with up to ten patients each. Main outcome measure: Whether or not a sickness certificate was issued. Results: Among work related factors, high ‘authority over decisions’ and high "social support" correlated with 30% or more reduced sickness certification probability. Worrying about becoming ill or being injured from work correlates to almost doubled sickness certification risk. Among family and leisure time variables, only living with a common law partner and having no children correlated to increased sickness certification risk. In addition to analyses of the whole group (all diagnoses), the two largest diagnostic subgroups, infectious diseases and musculoskeletal diseases, were examined. For the infectious diseases subgroup, high demands in work correlated to increased sickness certification risk, while in the musculoskeletal diseases subgroup, worry about work related injury or illness was the main factor correlating to increased risk for sickness certification. Conclusions: Work related factors were the most important factors related to sickness certification in this study. Determinants for sickness certification risk differed between diagnostic subgroups.

  • 238.
    Norrmén, Gunilla
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Svärdsudd, Kurt
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Andersson, Dan K G
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    How primary health care physicians make sick listing decisions: The impact of medical factors and functioning2008In: BMC Family Practice, ISSN 1471-2296, E-ISSN 1471-2296, BMC Fam Pract, ISSN 1471-2296, Vol. 9, p. 3:1-9Article in journal (Refereed)
    Abstract [en]

    Background: The decision to issue sickness certification in Sweden for a patient should be based on the physician's assessment of the reduction of the patient's work capacity due to a disease or injury, not on psychosocial factors, in spite of the fact that they are known as risk factors for sickness absence. The aim of this study was to investigate the influence of medical factors and functioning on sick listing probability. Methods: Four hundred and seventy-four patient-physician consultations, where sick listing could be an option, in general practice in Orebro county, central Sweden, were documented using physician and patient questionnaires. Information sought was the physicians' assessments of causes and consequences of the patients' complaints, potential to recover, diagnoses and prescriptions on sick leave, and the patients' view of their family and work situation and functioning as well as data on the patients' former and present health situation. The outcome measure was whether or not a sickness certificate was issued. Multivariate analyses were performed. Results: Complaints entirely or mainly somatic as assessed by the physician decreased the risk of sick listing, and complaints resulting in severe limitation of occupational work capacity, as assessed by the patient as well as the physician, increased the risk of sick listing, as did appointments for locomotor complaints. The results for patients with infectious diseases or musculoskeletal diseases were partly similar to those for all diseases. Conclusion: The strongest predictors for sickness certification were patient's and GP's assessment of reduced work capacity, with a striking concordance between physician and patient on this assessment. When patient's complaints were judged to be non-somatic the risk of sickness certification was enhanced.

  • 239. Olafsdottir, Eydis
    et al.
    Andersson, Dan K.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Stefánsson, Eina
    Visual acuity in a population with regular screening for type 2 diabetes mellitus and eye disease2007In: Acta Ophthalmologica Scandinavica, ISSN 1395-3907, E-ISSN 1600-0420, Vol. 85, no 1, p. 40-45Article in journal (Refereed)
    Abstract [en]

    Purpose: Regular screening for both diabetes mellitus and diabetic eye disease should be the gold standard in preventing diabetic blindness. In the community of Laxå, County of Örebro, Sweden, such screening has been carried out since 1983. We evaluate visual impairment and blindness in this population.

    Methods: All persons in the community of Laxå with a diagnosis of type 2 diabetes mellitus (n = 276) participated in the study. An age- and gender-matched control group (n = 259) was assembled. Best corrected visual acuity (BCVA) was tested in all participants, and a detailed eye examination performed by an ophthalmologist.

    Results: No significant statistical differences were seen between the diabetes and control groups regarding visual acuity (VA). In all, 2.9% of the diabetes patients and 1.2% of the controls had BCVA ≤ 0.1. Only one person in the diabetes group was blind as a result of diabetic retinopathy. In both groups the leading cause of blindness was age-related macular degeneration. In a logistic regression analysis we found that in both the diabetes and the control populations, increasing age was related to worsening BCVA (odds ratio [OR] 1.13, 95% confidence interval [CI] 1.10–1.16 versus OR 1.16, 95% CI 1.13–1.19), as was female gender in the diabetes group only (OR 2.73, 95% CI 1.69–4.40).

    Conclusions: In a population that is carefully screened for diabetes mellitus and provided with regular screening for diabetic retinopathy, the loss of vision from diabetic retinopathy is uncommon.

  • 240.
    Olai, Lena
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Life After a Stroke Event: With Special Reference to Aspects on Prognosis, Health and Municipality Care Utilization, and Life Satisfaction Among Patients and Their Informal Caregivers2010Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Objectives. The aim of this thesis was to study the prognosis, health care utilization and health situation in stroke patients, and informal caregiver burden during the first post-stroke year.

    Material and methods. 390 patients, 65 years or older, discharged from hospital after a stroke, were followed with repeated patient interviews, patient record and register data, and hospital staff and informal caregiver questionnaires.

    Results. Prognosis assessments performed by hospital staff at discharge regarding the course of events during the following year were highly accurate and were mainly influenced by the patient’s pre- and post-morbid state. The risk of dying or having a new stroke decreased rapidly during the early post-morbid phase. Health care utilization, in hospitals as well as in primary health care, and municipal social service support was considerably higher after the stroke than before, but the utilization of services was lower than previously reported. Health problem prevalence according to interview and record scrutiny was modest, peaked early after discharge and then declined. Support from informal caregivers increased significantly after discharge and remained high during the first post-stroke year. The support given was mainly determined by patient functional ability, distance to patient, relation to patient, municipal social service support provided, and patient sex. The informal caregivers reported considerable strain and burden, with significantly higher levels of anxiety and depression than the stroke patients. Moreover, there was a parallel between the patient’s and the caregiver’s situation regarding anxiety, emotional and social situation, and home, social and outdoor activities.

    Conclusion. Hospital staff prognosis assessments of patient outcomes during the next year were highly accurate. Risk of recurrence and mortality, and health problem prevalence was high in the early post-stroke period, and than declined. Health care utilization and municipality social support increased over time. Informal caregivers reported considerable strain and burden.

    List of papers
    1. Prognosis assessment in stroke patients at discharge from hospital
    Open this publication in new window or tab >>Prognosis assessment in stroke patients at discharge from hospital
    2007 (English)In: Age and Ageing, ISSN 0002-0729, E-ISSN 1468-2834, Vol. 36, no 2, p. 184-189Article in journal (Refereed) Published
    Abstract [en]

    Background: Accurate prognostic assessments of need of help, health and dwelling situation in stroke patients are important for patient management, rehabilitation, discharge planning, and for providing reliable information to patients and their relatives. Objective: To analyse factors affecting the accuracy of discharge prognosis assessments. Design: Prospective study of stroke patients discharged from hospital. Setting: two cities in central Sweden. Subjects: Three hundred and ninety stroke patients, 65 years or older, living in their own homes and having no dementia diagnosis prior to hospital admission. Methods: At discharge, physicians, nurses, occupational therapists and physiotherapists in the Departments of Internal Medicine and Geriatrics were asked to make an individual prognosis assessment regarding patients' need for help, health and dwelling situation at 3 and 12 months after admission to hospital. Results: The prognosis assessments were on average accurate in 68.4% (3 months) and 61.5% (12 months), far better than chance (33.3%). There were no significant differences between staff categories. The accuracy was influenced by a number of patient linked factors, such as activity degree, household situation before admission, and Mini Mental State Examination level and need of help measured 1 week after discharge, and ranged from 22 to 89%, depending on factor combinations. Conclusions: Prognosis assessments based on clinical judgement were on average quite accurate but the accuracy varied markedly with patient linked factors. Feedback of outcome might be one way to further improve the accuracy of prognosis assessment.

    Keywords
    prognosis assessment, outcome, functional capacity, health situation, dwelling, stroke, elderly
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:uu:diva-10401 (URN)10.1093/ageing/afl146 (DOI)000244959500014 ()17178766 (PubMedID)
    Available from: 2007-03-22 Created: 2007-03-22 Last updated: 2017-12-11Bibliographically approved
    2. Survival, hazard function for a new event, and healthcare utilization among stroke patents ≥65 Years
    Open this publication in new window or tab >>Survival, hazard function for a new event, and healthcare utilization among stroke patents ≥65 Years
    2009 (English)In: Stroke, ISSN 0039-2499, E-ISSN 1524-4628, Vol. 40, no 11, p. 3585-3590Article in journal (Refereed) Published
    Abstract [en]

    Background and Purpose — The natural history of stroke is still incompletely understood. The aim of this study was to present detailed data on survival, recurrence, and all types of healthcare utilization before and after a stroke event in patients with stroke.

    Methods — Three hundred ninety stroke survivors constituted the study population. Information on survival data during 5 years of follow-up, all hospital admissions since 1971, all outpatient and primary care consultations, and all municipal social service support during the year before and after the index stroke admission and patient interviews 1 week after discharge were obtained.

    Results — The risk of death or a new stroke was high in the early phase after admission but then decreased rapidly during the next few months. Mortality during the first 5 years was influenced by age and functional ability, whereas the risk of stroke recurrence was influenced by number of previous strokes, hypertension diagnosis, and sex. On a day-by-day basis, 35% were dependent on municipal support before and 65% after the stroke. The corresponding proportions in outpatient care were 6% and 10%, and for hospital inpatient care 1% to 2% and 2% to 3%. Of the health care provided, nursing care dominated.

    Conclusions — The risk of dying or having a new stroke event decreased sharply during the early postmorbid phase. Healthcare utilization increased after discharge but was still moderate on a day-by-day basis, except for municipal social service support, which was substantial.

    Keywords
    epidemiology, hazard function, health care utilization, municipal support, recurrence
    National Category
    Medical and Health Sciences
    Research subject
    Caring Sciences
    Identifiers
    urn:nbn:se:uu:diva-112848 (URN)10.1161/STROKEAHA.109.556720 (DOI)000271160300030 ()
    Available from: 2010-01-21 Created: 2010-01-21 Last updated: 2017-12-12Bibliographically approved
    3. Health problems in elderly patients during the first post-stroke year
    Open this publication in new window or tab >>Health problems in elderly patients during the first post-stroke year
    2012 (English)In: Upsala Journal of Medical Sciences, ISSN 0300-9734, E-ISSN 2000-1967, Vol. 117, no 3, p. 318-327Article in journal (Refereed) Published
    Abstract [en]

    Background. A wide range of health problems has been reported in elderly post-stroke patients. Aim. The aim of this study was to analyse the prevalence and timing of health problems identified by patient interviews and scrutiny of primary health care and municipality elderly health care records during the first post-stroke year.

    Methods. A total of 390 consecutive patients, >= 65 years, discharged alive from hospital after a stroke event, were followed for 1 year post-admission. Information on the health care situation during the first post-stroke year was obtained from primary health care and municipal elderly health care records and through interviews with the stroke survivors, at 1 week after discharge, and 3 and 12 months after hospital admission.

    Results. More than 90% had some health problem at some time during the year, while based on patient record data only 4-8% had problems during a given week. The prevalence of interview-based health problems was generally higher than record-based prevalence, and the ranking order was moderately different. The most frequently interview-reported problems were associated with perception, activity, and tiredness, while the most common record-based findings indicated pain, bladder and bowel function, and breathing and circulation problems. There was co-occurrence between some problems, such as those relating to cognition, activity, and tiredness.

    Conclusions. Almost all patients had a health problem during the year, but few occurred in a given week. Cognitive and communication problems were more common in interview data than record data. Co-occurrence may be used to identify subtle health problems.

    Keywords
    stroke, elderly, health problems, outcome
    National Category
    General Practice
    Research subject
    Caring Sciences
    Identifiers
    urn:nbn:se:uu:diva-112871 (URN)10.3109/03009734.2012.674572 (DOI)000307186800009 ()
    Available from: 2010-01-21 Created: 2010-01-21 Last updated: 2018-01-12Bibliographically approved
    4. Life situation among informal caregivers to stroke patients
    Open this publication in new window or tab >>Life situation among informal caregivers to stroke patients
    (English)Manuscript (preprint) (Other academic)
    Abstract [en]

    Background and Purpose Stroke related problems may affect the life situation of not only stroke patients but also their informal caregivers. The objective of this study was to assess life situation aspects in stroke patients and their informal caregivers during the first post-stroke year.

    Methods 377 patients surviving a stroke event were followed during the first post stroke year with interviews 1 week after discharge from hospital and three and twelve months after the index stroke admission. Their informal caregivers answered questionnaires in connection to the interviews. In both groups information based on the Hospital Anxiety and Depression Scale (HAD), the Nottingham Health Profile (NHP), and GQL-Activity Scale was obtained. Additional information was sought among patients on their health situation and Mini Mental State Examination (MMSE) score, and among informal caregivers on the nature and amount of assistance provided, measured as support score and number of hours per week and perceived caregiver burden (CB) score.

    Results Before index admission 85% of informal caregivers provided on average five hours’ care per week and 8-10 support score. The corresponding numbers after discharge were 91%, 10 hours per week and 13-15 support score. Support determinants were patient’s functional ability, distance to patient’s home, relation to patient, municipality social service support given. CB score determinants were municipality support given, relation to patient, functional ability, and patient age. The caregivers had higher anxiety and depression scores than the patients. Significant associations between caregiver and patient responses were found for HAD anxiety, NHP emotional and social, and GQL activity score.

    Conclusions The informal caregivers reported a significant caregiver burden. There was a parallel situation between patients’ and caregivers’ situation.

    Keywords
    stroke, elderly, informal caregiver, life situation
    National Category
    General Practice
    Research subject
    Caring Sciences
    Identifiers
    urn:nbn:se:uu:diva-112873 (URN)
    Available from: 2010-01-21 Created: 2010-01-21 Last updated: 2018-01-12Bibliographically approved
  • 241.
    Olai, Lena
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Omne-Pontén, Marianne
    Borgquist, Lars
    Svärdsudd, Kurt
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Life situation among informal caregivers to stroke patientsManuscript (preprint) (Other academic)
    Abstract [en]

    Background and Purpose Stroke related problems may affect the life situation of not only stroke patients but also their informal caregivers. The objective of this study was to assess life situation aspects in stroke patients and their informal caregivers during the first post-stroke year.

    Methods 377 patients surviving a stroke event were followed during the first post stroke year with interviews 1 week after discharge from hospital and three and twelve months after the index stroke admission. Their informal caregivers answered questionnaires in connection to the interviews. In both groups information based on the Hospital Anxiety and Depression Scale (HAD), the Nottingham Health Profile (NHP), and GQL-Activity Scale was obtained. Additional information was sought among patients on their health situation and Mini Mental State Examination (MMSE) score, and among informal caregivers on the nature and amount of assistance provided, measured as support score and number of hours per week and perceived caregiver burden (CB) score.

    Results Before index admission 85% of informal caregivers provided on average five hours’ care per week and 8-10 support score. The corresponding numbers after discharge were 91%, 10 hours per week and 13-15 support score. Support determinants were patient’s functional ability, distance to patient’s home, relation to patient, municipality social service support given. CB score determinants were municipality support given, relation to patient, functional ability, and patient age. The caregivers had higher anxiety and depression scores than the patients. Significant associations between caregiver and patient responses were found for HAD anxiety, NHP emotional and social, and GQL activity score.

    Conclusions The informal caregivers reported a significant caregiver burden. There was a parallel situation between patients’ and caregivers’ situation.

  • 242.
    Olai, Lena
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm , Center for Clinical Research Dalarna.
    Omne-Pontén, Marianne
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm , Center for Clinical Research Dalarna.
    Borgquist, Lars
    Svärdsudd, Kurt
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Prognosis assessment in stroke patients at discharge from hospital2007In: Age and Ageing, ISSN 0002-0729, E-ISSN 1468-2834, Vol. 36, no 2, p. 184-189Article in journal (Refereed)
    Abstract [en]

    Background: Accurate prognostic assessments of need of help, health and dwelling situation in stroke patients are important for patient management, rehabilitation, discharge planning, and for providing reliable information to patients and their relatives. Objective: To analyse factors affecting the accuracy of discharge prognosis assessments. Design: Prospective study of stroke patients discharged from hospital. Setting: two cities in central Sweden. Subjects: Three hundred and ninety stroke patients, 65 years or older, living in their own homes and having no dementia diagnosis prior to hospital admission. Methods: At discharge, physicians, nurses, occupational therapists and physiotherapists in the Departments of Internal Medicine and Geriatrics were asked to make an individual prognosis assessment regarding patients' need for help, health and dwelling situation at 3 and 12 months after admission to hospital. Results: The prognosis assessments were on average accurate in 68.4% (3 months) and 61.5% (12 months), far better than chance (33.3%). There were no significant differences between staff categories. The accuracy was influenced by a number of patient linked factors, such as activity degree, household situation before admission, and Mini Mental State Examination level and need of help measured 1 week after discharge, and ranged from 22 to 89%, depending on factor combinations. Conclusions: Prognosis assessments based on clinical judgement were on average quite accurate but the accuracy varied markedly with patient linked factors. Feedback of outcome might be one way to further improve the accuracy of prognosis assessment.

  • 243.
    Olai, Lena
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm , Center for Clinical Research Dalarna.
    Omne-Pontén, Marianne
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm , Center for Clinical Research Dalarna.
    Borgquist, Lars
    Svärdsudd, Kurt
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Survival, hazard function for a new event, and healthcare utilization among stroke patents ≥65 Years2009In: Stroke, ISSN 0039-2499, E-ISSN 1524-4628, Vol. 40, no 11, p. 3585-3590Article in journal (Refereed)
    Abstract [en]

    Background and Purpose — The natural history of stroke is still incompletely understood. The aim of this study was to present detailed data on survival, recurrence, and all types of healthcare utilization before and after a stroke event in patients with stroke.

    Methods — Three hundred ninety stroke survivors constituted the study population. Information on survival data during 5 years of follow-up, all hospital admissions since 1971, all outpatient and primary care consultations, and all municipal social service support during the year before and after the index stroke admission and patient interviews 1 week after discharge were obtained.

    Results — The risk of death or a new stroke was high in the early phase after admission but then decreased rapidly during the next few months. Mortality during the first 5 years was influenced by age and functional ability, whereas the risk of stroke recurrence was influenced by number of previous strokes, hypertension diagnosis, and sex. On a day-by-day basis, 35% were dependent on municipal support before and 65% after the stroke. The corresponding proportions in outpatient care were 6% and 10%, and for hospital inpatient care 1% to 2% and 2% to 3%. Of the health care provided, nursing care dominated.

    Conclusions — The risk of dying or having a new stroke event decreased sharply during the early postmorbid phase. Healthcare utilization increased after discharge but was still moderate on a day-by-day basis, except for municipal social service support, which was substantial.

  • 244. Olesen, Hanne Vebert
    et al.
    Pressler, Tacjana
    Hjelte, Lena
    Mared, Lena
    Lindblad, Anders
    Knudsen, Per Kristian
    Laerum, Birger N.
    Johannesson, Marie
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Gender Differences in the Scandinavian Cystic Fibrosis Population2010In: Pediatric Pulmonology, ISSN 8755-6863, E-ISSN 1099-0496, Vol. 45, no 10, p. 959-965Article in journal (Refereed)
    Abstract [en]

    Aims: To explore whether gender differences in the Scandinavian Cystic Fibrosis (CF) patients exist in the areas of key clinical parameters, complications, and medication. Methods: Cross-sectional data on 890 (416 female) pancreatic insufficient CF patients were evaluated regarding chronic infection, body mass index, lung function, medication, and diabetes, as well as data of Pseudomonas infection status, antibiotic treatment and hospitalization from 1-year follow-up. Results: We found no differences in lung function, body mass index, or frequency of diabetes. The adult group consisted of more males than females (208:168). We found no significant difference in prevalence of chronic Pseudomonas aeruginosa infection, but during the follow-up the incidence of new chronic infection was higher in adult females (10/33 vs. 4/56). Females had higher prevalence of Burkholderia infection (21/416 vs. 11/474). Adult females had more days on intravenous antibiotics (median 39 vs. 26 days/year), and days in hospital (median 2 vs. 0 days/year). More adult females received inhaled and oral steroids. In the pediatric cohort, females were treated more often with macrolides as an anti-inflammatory agent. Conclusion: We found no gender difference in key clinical parameters in our CF population. However, our study showed a higher risk of Pseudomonas and Burkholderia infection among the female patients. Additionally, we found that female patients require more intensified treatment regarding antibiotics, macrolides, steroids and days of hospitalization, indicating a true female disadvantage even with modern aggressive treatment. The finding of more males than females in the adult population suggesting a male advantage, warrants a mortality study. Pediatr Pulmonol. 2010; 45:959-965. (C) 2010 Wiley-Liss, Inc.

  • 245.
    Oliynyk, Igor
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Cell Biology.
    Varelogianni, Georgia
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Cell Biology.
    Schalling, Martin
    Asplund, Monika Stenkvist
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences.
    Roomans, Godfried M.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Cell Biology.
    Johannesson, Marie
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Azithromycin increases chloride efflux from cystic fibrosis airway epithelial cells2009In: Experimental Lung Research, ISSN 0190-2148, E-ISSN 1521-0499, Vol. 35, no 3, p. 210-221Article in journal (Refereed)
    Abstract [en]

    It was investigated whether azithromycin (AZM) stimulates chloride (Cl-) efflux from cystic fibrosis (CF) and non-CF airway epithelial cells, possibly secondary to up-regulation of the multidrug resistance protein (MDR). CF and non-CF human airway epithelial cell lines (CFBE and 16HBE) were treated with 0.4, 4, and 40 microg/mL AZM for 4 days. Cl- efflux was explored in the presence or absence of specific inhibitors of CFTR and alternative Cl- channels. Six CF patients received AZM (500 mg daily) for 6 months. The percentage of predicted forced vital capacity (FVC%), forced expiratory volume (FEV1%), and the number of acute exacerbations were compared before and after treatment. Nasal biopsies were taken before and after treatment, and mRNA expression of MDR and CFTR was determined by in situ hybridization. A significant dose-dependent increase of Cl- efflux from CFBE cells (but not from 16HBE cells) was observed after AZM treatment. A CFTR inhibitor significantly reduced AZM-stimulated Cl- efflux from CFBE cells. A significant improvement in FEV1%, and fewer exacerbations were observed. AZM treatment did not affect mRNA expression of MDR and CFTR. The stimulation of Cl- efflux could be part of the explanation for the clinical improvement seen among the patients.

  • 246.
    Peterson, Magnus
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Chronic Tennis Elbow: Aspects on Pathogenesis and Treatment in a Soft Tissue Pain Condition2011Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Objectives: To study the treatment practice of chronic tennis elbow (TE) among general practitioners (GPs) and physiotherapists (PTs), the effects of a simple, graded home exercise regime versus expectation, the effects of eccentric versus concentric exercise, and the involvement of the substance P – NK1 receptor system in the peripheral, painful tissue of chronic TE patients by positron emission tomography (PET).

    Materials and methods: A postal survey regarding therapeutic methods used in patients with chronic TE was sent to 129 GPs and 77 PTs, 81 subjects with chronic TE were randomly and blindly assigned to either an exercise group or a wait list group, 120 subjects were randomly assigned to either eccentric or concentric exercise and ten subjects were examined by PET and the NK1 specific radioligand [11C]GR205171.

    Results: High proportions of GPs and PTs used ergonomic counselling and stretching in the treatment of chronic TE. The majority of GPs prescribed passive anti-inflammatory measures such as sick leave and anti-inflammatory medication. Many PTs prescribed dynamic, particularly eccentric, exercise. Graded dynamic exercise according to a simple low-cost protocol, has better effect on pain than a wait-and-see attitude. Adjusted for outcome affecting variables, eccentric graded exercise has quicker effect than concentric graded exercise. During PET scan with the NK1 specific radioligand [11C]GR205171, voxel volume and signal intensity of this volume was significantly higher in the affected than the unaffected arm in subjects with unilateral chronic TE.

    Conclusions: GPs and PTs used many treatments to a similar extent but differed regarding the use of exercise. Chronic TE responds favourably to graded dynamic exercise aimed specifically at the painful tissue. The exercise should stress the eccentric work phase. The substance P – NK1 receptor system seems to play a part in the peripheral, painful tissue of a chronic, soft tissue pain condition such as chronic TE.

    List of papers
    1. Treatment practice in chronic epicondylitis: a survey among general practitioners and physiotherapists in Uppsala County, Sweden
    Open this publication in new window or tab >>Treatment practice in chronic epicondylitis: a survey among general practitioners and physiotherapists in Uppsala County, Sweden
    2005 (English)In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 23, no 4, p. 239-41Article in journal (Refereed) Published
    Abstract [en]

    OBJECTIVE: To investigate treatment practice among general practitioners (GPs) and physiotherapists (PTs) in chronic epicondylitis of 3 months' duration or more. DESIGN: Postal survey. SETTING AND SUBJECTS: All 129 GPs and all 77 PTs at 35 primary health care centres in Uppsala County, Sweden, received the questionnaire. MAIN OUTCOME MEASURES: Proportion of responders using various treatments (five specified alternatives + open question). RESULTS: The questionnaire was answered by 70% of the GPs and 61% of the PTs. Ergonomic counselling, stretching, and orthotic devices were common, and used to a similar extent by GPs and PTs. Acupuncture was also common, but less so among GPs than PTs. Transcutaneous electric nerve stimulation was used by relatively few GPs and PTs. The open question revealed that dynamic exercise, particularly eccentric, was used by most PTs but only one GP. A majority of GPs prescribed sick leave and anti-inflammatory treatment with an NSAID or cortisone injections. CONCLUSION: A large number of treatment methods in chronic epicondylitis were reported, none of which is properly evidence-based and some of which are even known to be ineffective. There is a need for randomized controlled studies of potentially effective treatments in this condition.

    Keywords
    Anti-Inflammatory Agents; Non-Steroidal/therapeutic use, Chronic Disease, Family Practice, Humans, Physical Therapy (Specialty), Physical Therapy Modalities/utilization, Physician's Practice Patterns, Questionnaires, Referral and Consultation, Research Support; Non-U.S. Gov't, Sweden, Tennis Elbow/drug therapy/rehabilitation/*therapy
    National Category
    Public Health, Global Health, Social Medicine and Epidemiology
    Identifiers
    urn:nbn:se:uu:diva-75207 (URN)10.1080/02813430510031333 (DOI)16272073 (PubMedID)
    Available from: 2007-03-21 Created: 2007-03-21 Last updated: 2017-12-14Bibliographically approved
    2. A randomized controlled trial of exercise versus wait list in chronic tennis elbow (lateral epicondylosis)
    Open this publication in new window or tab >>A randomized controlled trial of exercise versus wait list in chronic tennis elbow (lateral epicondylosis)
    2011 (English)In: Upsala Journal of Medical Sciences, ISSN 0300-9734, E-ISSN 2000-1967, Vol. 116, no 4, p. 269-279Article in journal (Refereed) Published
    Abstract [en]

    Background.

    Chronic tennis elbow (lateral epicondylosis) is a common disorder. Like other chronic soft tissue pain conditions it is often difficult to treat successfully. The effects of exercise have been discussed but no convincing evidence has been put forward so far, and a simple protocol for exercise is lacking.

    Aims of the study.

    This study is a randomized, controlled, clinical trial of the effect of exercise versus expectation (wait-list) on pain, muscle strength, function, and quality of life in patients with longstanding lateral epicondylosis.

    Methods.

    Eighty-one subjects with tennis elbow lasting for more than three months were randomly allocated to an exercise group (n=40) or a reference group (n=41). The exercise group performed daily exercise, with weekly load increase, for three months. The reference group was wait listed, but otherwise followed in the same way. Outcome measures were pain during maximum voluntary muscle contraction (Cozen´s test) and pain during maximum muscle elongation with a load (modified Empty-can-test), muscle strength measured with a Chatillon MSE 100 hand-held dynamometer, and the Disability of the Arm, Shoulder and Hand (DASH) and the Gothenburg Quality of Life questionnaires.

    Results

    .The exercise group had greater and faster regression of pain, both during muscle contraction and muscle elongation, than the reference group (p=0.0005 and p=0.0016, respectively). There was a non-significant muscle strength difference between the groups, but no differences regarding DASH scores or quality of life measures.

    Conclusions

    .Exercise appears to be superior to expectation in reducing pain in chronic lateral epicondylosis.

    Keywords
    exercise, chronic, pain, tennis elbow, epicondylitis, RCT, epicondylosis, tendinosis, tendinitis
    National Category
    Medical and Health Sciences
    Research subject
    Medicine
    Identifiers
    urn:nbn:se:uu:diva-159954 (URN)10.3109/03009734.2011.600476 (DOI)000296794100008 ()
    Available from: 2011-10-13 Created: 2011-10-12 Last updated: 2017-12-08Bibliographically approved
    3. A randomized controlled trial of eccentric versus concentric exercise in chornic tennis elbow (lateral epicondylosis)
    Open this publication in new window or tab >>A randomized controlled trial of eccentric versus concentric exercise in chornic tennis elbow (lateral epicondylosis)
    2011 (English)In: European Journal of Pain, ISSN 1090-3801, E-ISSN 1532-2149Article in journal (Refereed) Submitted
    Abstract [en]

    Chronic tennis elbow was used in this paper as a model for chronic soft tissue pain, which is a common problem, often difficult to treat. Exercise has been shown to have positive effects in chronic pain, but whether eccentric or concentric exercise should be used is controversial. The aim of this study was to test the effects of eccentric versus concentric exercise on pain, strength, function and quality of life in chronic tennis elbow. One hundred and twenty subjects with tennis elbow lasting for more than three months were randomly allocated to eccentric exercise (n=60) or to concentric exercise (n=60), performed at home daily for three months with increasing load. The subjects were seen at baseline and after one, two, three, six, and twelve months of follow up, where the outcome measures pain during maximum voluntary muscle contraction (Cozen’s test), pain during maximum muscle elongation (modified Empty can test), and muscle strength were measured. Function was measured with the Disability of the Arm, Shoulder and Hand questionnaire (DASH) and quality of life with the Gothenburg Quality of Life questionnaire at baseline and after three, six, and twelve months. The eccentric exercise group had faster regression of pain, both during muscle contraction and elongation, as well as greater increase of muscle strength than the concentric group (p<0.0001, p=0.006, and p<0.02, respectively). The differences persisted throughout the follow-up period. There were no significant differences between the groups regarding DASH scores or quality of life measures.

    Keywords
    eccentric, exercise, concentric, RCT, tennis elbow, epicondylosis, tendinosis, tendinitis, chronic, pain
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:uu:diva-160038 (URN)
    Available from: 2011-10-13 Created: 2011-10-13 Last updated: 2017-12-08Bibliographically approved
    4. PET-scan shows peripherally increased neurokinin 1 receptor availability in chronic tennis elbow: a picture of neurogenic inflammation?
    Open this publication in new window or tab >>PET-scan shows peripherally increased neurokinin 1 receptor availability in chronic tennis elbow: a picture of neurogenic inflammation?
    Show others...
    2011 (English)In: Pain, ISSN 0304-3959, E-ISSN 1872-6623Article in journal (Refereed) Submitted
    Abstract [en]

    In response to pain, neurokinin 1 (NK1) receptor availability in the central nervous system is altered in the dorsal horn of the spinal cord as well as in the brain. But the NK1 receptor and its primary agonist, substance P, also play a crucial role in peripheral tissue in response to pain, as part of neurogenic inflammation. However, little is known about alterations in NK1 receptor availability in peripheral tissue in chronic pain conditions and very few studies have been performed on human beings. We therefore performed positron emission tomography (PET) with the NK1 specific radioligand [11C]GR205171 in ten subjects with chronic tennis elbow. We demonstrated increased NK1 receptor availability in the affected arm as compared with the unaffected arm, measured as differences between the arms in number and volume of pixels > 2.5 SD above reference as well as signal intensity of this volume. We conclude that in addition to alteration of the NK1 receptor in the CNS, there is also activation, or up-regulation of the NK1 receptor in the peripheral, painful tissue in a chronic pain condition. We interpret this increased NK1 receptor availability as part of ongoing neurogenic inflammation and suggest that this is part of the cause of chronic tennis elbow.

    Keywords
    PET, chronic, pain, substance P, neurokinin 1, tennis elbow, epicondylitis, epicondylosis
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:uu:diva-160048 (URN)
    Available from: 2011-10-13 Created: 2011-10-13 Last updated: 2017-12-08Bibliographically approved
  • 247.
    Peterson, Magnus
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Butler, Stephen
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    Eriksson, Margaretha
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Svardsudd, Kurt
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    A randomized controlled trial of eccentric versus concentric exercise in chornic tennis elbow (lateral epicondylosis)2011In: European Journal of Pain, ISSN 1090-3801, E-ISSN 1532-2149Article in journal (Refereed)
    Abstract [en]

    Chronic tennis elbow was used in this paper as a model for chronic soft tissue pain, which is a common problem, often difficult to treat. Exercise has been shown to have positive effects in chronic pain, but whether eccentric or concentric exercise should be used is controversial. The aim of this study was to test the effects of eccentric versus concentric exercise on pain, strength, function and quality of life in chronic tennis elbow. One hundred and twenty subjects with tennis elbow lasting for more than three months were randomly allocated to eccentric exercise (n=60) or to concentric exercise (n=60), performed at home daily for three months with increasing load. The subjects were seen at baseline and after one, two, three, six, and twelve months of follow up, where the outcome measures pain during maximum voluntary muscle contraction (Cozen’s test), pain during maximum muscle elongation (modified Empty can test), and muscle strength were measured. Function was measured with the Disability of the Arm, Shoulder and Hand questionnaire (DASH) and quality of life with the Gothenburg Quality of Life questionnaire at baseline and after three, six, and twelve months. The eccentric exercise group had faster regression of pain, both during muscle contraction and elongation, as well as greater increase of muscle strength than the concentric group (p<0.0001, p=0.006, and p<0.02, respectively). The differences persisted throughout the follow-up period. There were no significant differences between the groups regarding DASH scores or quality of life measures.

  • 248.
    Peterson, Magnus
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Elmfeldt, Dag
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Svärdsudd, Kurt
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Treatment practice in chronic epicondylitis: a survey among general practitioners and physiotherapists in Uppsala County, Sweden2005In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 23, no 4, p. 239-41Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To investigate treatment practice among general practitioners (GPs) and physiotherapists (PTs) in chronic epicondylitis of 3 months' duration or more. DESIGN: Postal survey. SETTING AND SUBJECTS: All 129 GPs and all 77 PTs at 35 primary health care centres in Uppsala County, Sweden, received the questionnaire. MAIN OUTCOME MEASURES: Proportion of responders using various treatments (five specified alternatives + open question). RESULTS: The questionnaire was answered by 70% of the GPs and 61% of the PTs. Ergonomic counselling, stretching, and orthotic devices were common, and used to a similar extent by GPs and PTs. Acupuncture was also common, but less so among GPs than PTs. Transcutaneous electric nerve stimulation was used by relatively few GPs and PTs. The open question revealed that dynamic exercise, particularly eccentric, was used by most PTs but only one GP. A majority of GPs prescribed sick leave and anti-inflammatory treatment with an NSAID or cortisone injections. CONCLUSION: A large number of treatment methods in chronic epicondylitis were reported, none of which is properly evidence-based and some of which are even known to be ineffective. There is a need for randomized controlled studies of potentially effective treatments in this condition.

  • 249.
    Peterson, Stefan
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Eriksson, Margaretha
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Tibblin, Gösta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Practice variation in Swedish primary care1997In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 15, no 2, p. 68-75Article in journal (Refereed)
    Abstract [en]

    Objective - To study individual practice patterns of physicians working in primary health care for standardized simulated cases on their first visit, and relate them to resource consumption for diagnostic tests, drugs and sick leave from a combined perspective of the health care and social security systems. 

    Design - Postal questionnaire presenting six hypothetical working-age cases with symptoms of ailments common in primary care asking physicians to order diagnostic tests and procedures, drugs, follow-up appointments and sick pay.

    Setting - Swedish primary health care centres.

    Subjects - Two hundred randomly selected physicians.

    Main outcome measures - Activities taken by the physician - diagnostic and laboratory tests ordered, drugs prescribed, length of sick leave and the cost of these actions.

    Results - Practice patterns varied considerably, corresponding to a six-fold difference in total cost between the “cheapest” and “most expensive” physician. The largest share was loss of production as estimated by the cost of prescribed sick leave. Physicians who practised further away from hospitals and those who had worked more years tended to prescribe more measures. However, this only explained a small portion of the observed variation, which may be due to different physician attitudes to taking risks.

    Conclusion - ‘Paper’ cases of common medical ailments presented to primary care physicians revealed considerable differences in practice style, resulting in six-fold differences in cost of measures prescribed at first visits.

  • 250. Pettersson, B.
    et al.
    Lindgren, P.
    Ringborg, A.
    Martinell, Mats
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Stålhammar, Jan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    RESOURCE CONSUMPTION AND COSTS OF CARE THE YEAR BEFORE AND AFTER INITIATION OF INSULIN THERAPY IN SWEDISH PATIENTS WITH TYPE 2 DIABETES2010In: Value in Health, ISSN 1098-3015, E-ISSN 1524-4733, Vol. 13, no 3, p. A58-A58Article in journal (Other academic)
2345678 201 - 250 of 356
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