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  • 251. Pettersson, Billie
    et al.
    Ambegaonkar, Baishali
    Sazonov, Vasilisa
    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.
    Wändell, Per
    Prevalence of lipid abnormalities before and after introduction of lipid modifying therapy among Swedish patients with dyslipidemia (PRIMULA)2010In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 10, p. 737-Article in journal (Refereed)
    Abstract [en]

    Background. Data on the prevalence of dyslipidemia and attainment of goal/normal lipid levels in a Swedish population are scarce. The objective of this study is to estimate the prevalence of dyslipidemia and attainment of goal/normal lipid levels in patients treated with lipid modifying therapy (LMT). Methods. This longitudinal retrospective observational study covers time periods before and after treatment. Data were collected from 1994-2007 electronic patient records in public primary healthcare centers in Uppsala County, Sweden. Patients were included if they had been treated with LMT and had at least one lipid abnormality indicating dyslipidemia and if complete lipid profile data were available. Thresholds levels for lipids were defined as per Swedish guidelines. Results. Among 5,424 patients included, at baseline, the prevalence of dyslipidemia (1 lipid abnormality) was by definition 100%, while this figure was 82% at follow-up. At baseline, 60% had elevated low-density lipoprotein (LDL-C) combined with low high-density lipoprotein (HDL-C) and/or elevated triglycerides (TG s), corresponding figure at follow-up was 36%. Low HDL-C and/or elevated TGs at follow-up remained at 69% for patients with type 2 diabetes mellitus (T2DM), 50% among patients with coronary heart disease (CHD) and 66% among patients with 10 year CHD risk >20%. Of the total sample, 40% attained goal levels of LDL-C and 18% attained goal/normal levels on all three lipid parameters. Conclusions. Focusing therapy on LDL-C reduction allows 40% of patients to achieve LDL-C goal and helps reducing triglyceride levels. Almost 60% of patients experience persistent HDL-C and/or triglyceride abnormality independently of LDL-C levels and could be candidates for additional treatments.

  • 252. Pinnock, Hilary
    et al.
    Thomas, Mike
    Tsiligianni, Ioanna
    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.
    Østrem, Anders
    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 Sörmland (CKFD).
    Yusuf, Osman
    Ryan, Dermot
    Buffels, Johan
    Cals, Jochen W L
    Chavannes, Niels H
    Henrichsen, Svein Høegh
    Langhammer, Arnulf
    Latysheva, Elena
    Lionis, Christos
    Litt, John
    van der Molen, Thys
    Zwar, Nick
    Williams, Sian
    The International Primary Care Respiratory Group (IPCRG) Research Needs Statement 20102010In: Primary Care Respiratory Journal, ISSN 1471-4418, E-ISSN 1475-1534, Vol. 19, no Suppl 1, p. S1-S20Article in journal (Refereed)
    Abstract [en]

    AIM: Respiratory diseases are a public health issue throughout the world, with high prevalence and morbidity. This Research Needs Statement from the International Primary Care Respiratory Group (IPCRG) aims to highlight unanswered questions on the management of respiratory diseases that are of importance to practising primary care clinicians. METHODS: An informal but inclusive consultation process was instigated in 2009. Draft statements in asthma, rhinitis, COPD, tobacco dependence, and respiratory infections were circulated widely to IPCRG members, other recognised experts, and representatives from a range of economic and healthcare backgrounds. An iterative process was used to generate, prioritise and refine research questions in each section. RESULTS: Two overarching themes emerged. Firstly, there is a real need for research to be undertaken within primary care, which recruits patients representative of primary care populations, evaluates interventions realistically delivered within primary care, and draws conclusions that will be meaningful to professionals working within primary care. Secondly, international and national guidelines exist, but there is little evidence on the best strategies for implementing recommendations. Disease-specific research questions focus on effective and cost-effective ways to prevent disease, confirm the diagnosis, assess control, manage treatment, and empower selfmanagement. Practical questions about how to deliver this comprehensive agenda in diverse primary care settings are highlighted. CONCLUSIONS: We hope that this Research Needs Statement will be used by clinicians and patients campaigning for answers to relevant questions, by researchers seeking funding to provide answers to these questions, and by funding bodies to enable them to prioritise research agendas.

  • 253. Pinnock, Hilary
    et al.
    Østrem, Anders
    Rodriguez, Miguel Roman
    Ryan, Dermot
    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.
    Thomas, Mike
    Tsiligianni, Ioanna
    Williams, Siân
    Yusuf, Osman
    Prioritising the respiratory research needs of primary care: the International Primary Care Respiratory Group (IPCRG) e-Delphi exercise2012In: Primary Care Respiratory Journal, ISSN 1471-4418, E-ISSN 1475-1534, Vol. 21, no 1, p. 19-27Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:

    Community-based care, underpinned by relevant primary care research, is an important component of the global fight against non-communicable diseases. The International Primary Care Research Group's (IPCRG's) Research Needs Statement identified 145 research questions within five domains (asthma, rhinitis, chronic obstructive pulmonary disease (COPD), smoking, respiratory infections).

    AIMS:

    To use an e-mail Delphi process to prioritise the research questions.

    METHODS:

    An international panel of primary care clinicians scored the clinical importance, feasibility, and international relevance of each question on a scale of 1-5 (5 = most important). In subsequent rounds, informed by the Group's median scores, participants scored overall priority. Consensus was defined as 80% agreement for priority scores 4 or 5.

    RESULTS:

    Twenty-three experts from 21 countries completed all three rounds. Sixty-two questions were prioritised across the five domains. A recurring theme was for 'simple tools' (e.g. questionnaires) enabling diagnosis and assessment in community settings, often with limited access to investigations. Seven questions recorded 100% agreement: these involved pragmatic approaches to the diagnosis of COPD and rhinitis, assessment of asthma and respiratory infections, management of rhinitis, and implementing asthma self-management.

    CONCLUSIONS:

    Evidence to underpin the primary care approach to diagnosis and assessment and broad management strategies were overarching priorities. If primary care is to contribute to the global challenge of managing respiratory non-communicable diseases, policymakers, funders, and researchers need to prioritise these questions.

  • 254. Quilici, S
    et al.
    Chancellor, J
    Maclaine, G
    McGuire, A
    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.
    Chiasson, JL
    Cost-effectiveness of acarbose for the management of impaired glucose tolerance in Sweden.2005In: International journal of clinical practice (Esher), ISSN 1368-5031, E-ISSN 1742-1241, Vol. 59, no 10, p. 1143-1152Article in journal (Refereed)
    Abstract [en]

    We assessed the cost-effectiveness of acarbose in the management of patients with impaired glucose tolerance (IGT) in Sweden, based on progression to type 2 diabetes (T2D) and cardiovascular (CV) events reported in the STOP-NIDDM trial population, including high-risk subgroups. The cost per patient free from T2D was SEK28 000 or SEK1260 per diabetes free month prior to progression to T2D. The cost per patient free from CV events was SEK101 000 or SEK5000 per CV event free month. For the high CV risk subgroups, acarbose treatment dominated placebo (i.e. acarbose was more effective, less costly).

    Acarbose significantly reduces the incidence of diabetes and CV events in IGT patients. We predict this may translate into healthcare cost savings that partially or, in patients at high CV risk, fully offset the cost of acarbose. We conclude that acarbose is likely to be cost-effective in the management of impaired glucose tolerance.

  • 255. Rabe, Klaus F.
    et al.
    Pizzichini, Emilio
    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).
    Romero, Santiago
    Balanzat, Ana M.
    Atienza, Tito
    Lier, Per Arve
    Jorup, Carin
    Budesonide/formoterol in a single inhaler for maintenance and relief in mild-to-moderate asthma: a randomized, double-blind trial2006In: Chest, ISSN 0012-3692, E-ISSN 1931-3543, Vol. 129, no 2, p. 246-256Article in journal (Refereed)
    Abstract [en]

    Study objective: To compare a novel asthma management strategy—budesonide/formoterol in a single inhaler for both maintenance therapy and symptom relief—with a higher dose of budesonide plus as-needed terbutaline.

    Methods: This was a 6-month, randomized, double-blind, parallel-group study in patients with mild-to-moderate asthma (n = 697; mean age, 38 years [range, 11 to 79 years]; mean baseline FEV1, 75% of predicted; mean inhaled corticosteroid [ICS] dosage, 348 μg/d). Following a 2-week run-in period, all patients received two blinded, dry powder inhalers, one containing maintenance medication and one containing medication to be used as needed for the relief of symptoms. Patients were randomized to receive either budesonide/formoterol (80 μg/4.5 μg, two inhalations qd) for maintenance plus additional inhalations as needed for symptom relief, or budesonide (160 μg, two inhalations qd) for maintenance medication plus terbutaline (0.4 mg) as needed. The primary efficacy variable was morning peak expiratory flow (PEF).

    Results: Patients receiving budesonide/formoterol showed greater improvements in morning PEF than patients receiving budesonide (increases of 34.5 L/min vs 9.5 L/min, respectively; p < 0.001). The risk of having a severe exacerbation (hospitalization/emergency department [ED] treatment, oral steroids for asthma, or a ≥ 30% decrease from baseline in morning PEF on 2 consecutive days) was 54% lower with budesonide/formoterol vs budesonide (p = 0.0011). Budesonide/formoterol patients experienced 90% fewer hospitalizations/ED treatments due to asthma than budesonide patients (1 vs 10, respectively; p = 0.026). The increased efficacy with budesonide/formoterol was achieved with less ICS than was used in the budesonide group (mean dose, 240 μg/d vs 320 μg/d, respectively) and with 77% fewer oral steroid treatment days vs budesonide (114 days vs 498 days, respectively). Both treatments were well tolerated.

    Conclusions: Budesonide/formoterol for both maintenance and relief improves asthma control with a lower steroid load compared with a higher dose of budesonide plus terbutaline.

  • 256. Ridderstråle, M
    et al.
    Gudbjörnsdottir, S
    Eliasson, B
    Nilsson, P M
    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.
    Obesity and cardiovascular risk factors in type 2 diabetes: results from the Swedish National Diabetes Register2006In: Journal of Internal Medicine, ISSN 0954-6820, E-ISSN 1365-2796, Vol. 259, no 3, p. 314-322Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: To compare obese with normal and overweight type 2 diabetic patients regarding body mass index (BMI) and cardiovascular risk factors, and to analyse changes in weight versus risk factors. DESIGN AND SETTING: A cross-sectional study of 44 042 type 2 patients, and a 6-year prospective study of 4468 type 2 patients. RESULTS: Obese patients (BMI > or = 30 kg m(-2)), 37% of all patients, had high frequencies of hypertension (88%), hyperlipidaemia (81%) and microalbuminuria (29%). Only 11% had blood pressure <130/80 mmHg. Their ratio of triglycerides to HDL cholesterol was considerably elevated, whilst the mean total and LDL cholesterol were similar as in normal weight subjects. Obese patients had elevated odds ratios for hypertension, hyperlipidaemia and microalbuminuria: 2.1, 1.8 and 1.4 in the cross-sectional study, similarly confirmed in the prospective 6-year study. BMI was an independent predictor of these risk factors (P < 0.001), although only slightly associated with HbA1c and not with total or LDL cholesterol. A change in BMI during the prospective study was related to a change in HbA1c in patients treated with diet and oral hypoglycaemic agents (OHAs) but not with insulin. In all patients, an increase in BMI was related to the development of hypertension, and a change in BMI to change in blood pressure, also mostly confirmed when treated with diet, OHAs or insulin. CONCLUSIONS: The high frequencies of risk factors in obese type 2 patients implies an increased risk of cardiovascular disease and the need for therapeutic measures. The paradox that hypoglycaemic treatment accompanied by weight gain may increase cardiovascular risk factors seems to be verified here concerning hypertension but not concerning microalbuminuria.

  • 257. Ringborg, A.
    et al.
    Lindgren, P.
    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.
    Yin, D. D.
    Schön, S.
    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.
    Prevalence and incidence of Type 2 diabetes and its complications 1996-2003: estimates from a Swedish population-based study2008In: Diabetic Medicine, ISSN 0742-3071, E-ISSN 1464-5491, Vol. 25, no 10, p. 1178-1186Article in journal (Refereed)
    Abstract [en]

    AIMS

    To determine the prevalence and incidence of Type 2 diabetes and its complications in Uppsala county, Sweden between 1996 and 2003.

    METHODS

    Retrospective population-based study of patients with Type 2 diabetes identified in computerized medical records at 26 county primary care centres. Prevalence and incidence of Type 2 diabetes were estimated in the population aged 30-39, 40-49, 50-59, 60-69, 70-79 and > or = 80 years. Mortality, prevalence and incidence of complications in patients with Type 2 diabetes were determined through linkage to national inpatient, uraemia and cause-of-death registers.

    RESULTS

    Crude prevalence of Type 2 diabetes increased from 2.2 to 3.5% between 1996 and 2003. In the population aged > or = 30 years, the age- and sex-adjusted period increase was 53%[odds ratio (OR) 1.53, 95% confidence interval (CI) 1.47-1.58]. Crude population incidence was approximately stable after 1997 (3.7 cases/1000 residents in 1997 compared with 3.8/1000 in 2003). Age- and sex-adjusted mortality rates in Type 2 diabetic patients decreased by 4% per year (OR 0.96, 95% CI 0.94-0.97). Prevalence rates of cardiovascular disease in Type 2 diabetic patients were essentially stable, affecting 13.8% of females and 18.0% of males in 2003. No trend was detected for prevalence of renal failure or incidence of acute myocardial infarction, stroke and amputation.

    CONCLUSIONS

    Prevalence of Type 2 diabetes increased in Uppsala county between 1996 and 2003 as a consequence of approximately stable incidence since 1997 and declining mortality. Rates of diabetes-related complications, notably cardiovascular disease, continued to impose a substantial burden.

  • 258. Ringborg, A.
    et al.
    Lindgren, P.
    Yin, D. D.
    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.
    Time to insulin treatment and factors associated with insulin prescription in Swedish patients with type 2 diabetes2010In: Diabetes & Metabolism, ISSN 1262-3636, E-ISSN 1878-1780, Vol. 36, no 3, p. 198-203Article in journal (Refereed)
    Abstract [en]

    Aims. - The purpose of this study was to investigate the time between the start of OAD treatment and the initiation of insulin therapy and to identify the factors associated with insulin prescription among Swedish patients with type 2 diabetes in Uppsala County. Methods. - Retrospective, population-based, primary-care data gathered within the Swedish RECAP-DM study were used to identify type 2 diabetic patients who initiated OAD treatment. A Kaplan-Meier survival estimate for time to initiation of insulin therapy was generated and factors associated with insulin prescription were tested using a Cox proportional-hazards model. Results. - Within 6 years of starting OAD treatment, an estimated 25% of Swedish patients with type 2 diabetes will be prescribed insulin (95% CI: 0.23-0.26) and, within 10 years, this figure will rise to 42% (95% CI: 0.39-0.45). The probability of insulin prescription was increased in patients aged less than 65 years (HR = 1.24, 95% CI: 1.03-1.50) and in those who initiated OAD treatment with more than one agent (HR = 2.71, 95% CI: 2.15-3.43). HbA(1c) at the time of starting OAD treatment was also related to the probability of insulin prescription (HR = 1.20, 95% CI: 1.146-1.25). Conclusion. - Many type 2 diabetic patients who begin treatment with an OAD will eventually be prescribed insulin. An, disease severity and the type of prior treatment may affect the rate of the transition.

  • 259. Ringborg, A.
    et al.
    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.
    Yin, D. D.
    Lindgren, P.
    Resource use and costs of type 2 diabetes in Sweden: estimates from population-based register data2008In: International journal of clinical practice (Esher), ISSN 1368-5031, E-ISSN 1742-1241, Vol. 62, no 5, p. 708-716Article in journal (Refereed)
    Abstract [en]

    AIMS

    To examine medical resource use of Swedish patients with type 2 diabetes during 2000-2004 and to estimate annual costs of care.

    METHODS

    Retrospective population-based cohort study of patients with type 2 diabetes identified in computerised medical records at 26 primary care centres in Uppsala county, Sweden. Annual quantities of medical resources were determined for prevalent cases during 2000-2004 using register data from outpatient primary care, outpatient hospital care, the National Inpatient Register and a national register for treatment of uraemia. Average costs of care of patients with type 2 diabetes were estimated based on year 2004 resource quantities of 8230 prevalent study cases.

    RESULTS

    Annual quantities of medical resource use were stable in outpatient primary care and outpatient hospital care, with patients making an average of two General Practitioner visits and 3.5 outpatient hospital visits each year. Higher rates of hospitalisation [12% in 2000 (n = 6711) compared with 16% in 2004 (n = 8230)] led to an increase in the mean (SD) number of inpatient days from 2.3 (11.8) to 2.7 (11.9) (p = 0.040) between 2000 and 2004. Mean (SD) total costs of care in 2004 were EUR 3602 (EUR 9537). Inpatient care was the major contributor to costs, accounting for 57% of total costs while drug costs accounted for an average 7%.

    CONCLUSIONS

    Swedish type 2 diabetic patients in this large sample from Uppsala county required steady annual amounts of outpatient care and increasing amounts of inpatient care during 2000-2004. The associated costs in 2004 were substantial, with inpatient care identified as the most important component.

  • 260. Ringborg, Anna
    et al.
    Yin, Donald D
    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.
    Lindgren, Peter
    The impact of acute myocardial infarction and stroke on health care costs in patients with type 2 diabetes in Sweden2009In: European Journal of Cardiovascular Prevention & Rehabilitation, ISSN 1741-8267, E-ISSN 1741-8275, Vol. 16, no 5, p. 576-582Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Estimates of the economic impact of cardiovascular events in patients with type 2 diabetes are scarce. The aim of this study was to determine the health care costs associated with acute myocardial infarction (AMI) and stroke in patients with type 2 diabetes in Sweden. DESIGN: Population-based open cohort study of 9941 patients with type 2 diabetes retrospectively identified in primary care records at 26 centres in Uppsala County. METHODS: Episodes of AMI and stroke suffered by study patients were tracked in the Swedish National Inpatient Register. Annual per patient costs of health care were computed for the years 2000-2004 using register data covering inpatient care, outpatient hospital care, primary care and drugs. Panel data regression was applied to determine the impact of suffering a first or repeat AMI or stroke on health care costs during the year of the event and in subsequent years. RESULTS: Total health care costs of patients suffering a first AMI/stroke increased by 4.1/6.5 during the year of the event [95% confidence interval (CI): 3.1-5.4/4.9-8.5] and by 1.1/1.4 during subsequent years (95% CI: 1.0-1.3/1.2-1.6), controlling for age, sex, the event of amputation and presence of renal failure, heart failure and diabetic eye disease. Total health care costs of patients suffering a first or repeat AMI/stroke increased by 4.1/6.4 during the year of an event (95% CI: 3.2-5.2/5.0-8.1) but were not significantly higher during subsequent years. CONCLUSION: Estimates of the costs related to major cardiovascular complications of type 2 diabetes are critical input to economic evaluations.

  • 261.
    Rodhe, Nils
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Asymptomatic Bacteriuria in the Elderly2008Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    The aim of this thesis was to explore the features of asymptomatic bacteriuria (ASB) in elderly people living in the community, and to seek diagnostic tools to discriminate between ASB and symptomatic urinary tract infection (UTI).

    All men and women aged 80 and over living in an urban district of Falun, Sweden, were invited to participate. Urine samples were obtained together with information on symptoms and on health indicators. The same cohort was surveyed again after 6 and 18 months. Urinary cytokines were analysed in 16 patients with UTI, in 24 subjects with ASB and in 20 negative controls.

    ASB occurred at baseline in 19.0% of women and 9.4% of men, and was found at least once in 36.9% of women and in 20.2% of men. ASB in women was associated with reduced mobility and urge urinary incontinence. Of those with ASB at baseline, 60% still had bacteriuria at 6 and 18 months, but among those with repeated findings of ASB with E. coli, only 40% had the same bacterial strain after 18 months. In women, the risk of developing a UTI within 24 months was higher among those with ASB at baseline than in those without. Urinary levels of cytokines (CXCL1, CXCL8 and IL-6) and leukocyte esterase were higher in patients with UTI than in patients with ASB.

    There is convincing evidence that ASB is harmless and should not be treated with antibiotics. However, such treatment is still often given, thereby unnecessarily contributing to the increased number of bacteria resistant to common antibiotics. This study confirms the high prevalence of ASB in elderly people living in the community. In order not to be misled by a urinary test showing bacteria, it is important to restrict urinary testing for bacteria to patients where there is a suspicion of UTI. In elderly patients with diffuse symptoms or in patients who are unable to communicate their symptoms, further diagnostic help could possibly be obtained by evaluating the urinary levels of leukocyte esterase and/or IL-6.

    List of papers
    1. Asymptomatic bacteriuria in a population of elderly residents living in a community setting: prevalence, characteristics and associated factors
    Open this publication in new window or tab >>Asymptomatic bacteriuria in a population of elderly residents living in a community setting: prevalence, characteristics and associated factors
    2006 (English)In: Family Practice, ISSN 0263-2136, E-ISSN 1460-2229, Vol. 23, no 3, p. 303-7Article in journal (Refereed) Published
    Abstract [en]

    Background. Asymptomatic bacteriuria (ASB) is common among the elderly in institutionalcare, but less is known about its prevalence among the elderly living in community settings.Knowledge of the prevalence of ASB in this population could contribute to a reduction inunnecessary use of antibiotics.Objective. To study the prevalence of ASB and associated health and social factors in apopulation of elderly people, aged 80 and over, in a community setting.Design. A cross-sectional study.Setting. The catchment area of a primary health care centre in a Swedish middle-sized town.Method. All residents, aged 80 and over, except for those in institutional living, were invited. Astructured interview was carried out and urinary culture obtained.Results. ASB was found in 14.8% of the participants, in 19.0% of the women and 5.8% of themen. In women independent associations with ASB were found for urinary incontinence (OR:2.99, CI: 1.60–5.60), reduced mobility (OR: 2.68, CI: 1.42–5.03) and oestrogen treatment (OR: 2.20,CI: 1.09–4.45).Conclusion. Bacteriuria is common among the elderly living in non-institutional communitysettings, especially among women, although not as common as among the elderly in institutionalsettings. A woman over 80, with urinary incontinence, and needing support to walk has arisk of nearly 50% of presenting with ASB, a condition about which there is consensus not totreat with antibiotics. This should be borne in mind when examining patients with diffusesymptomatology and an accidental finding of bacteriuria.

    Keywords
    Aged, bacteriuria, epidemiology, incontinence, urinary
    National Category
    Public Health, Global Health, Social Medicine and Epidemiology
    Identifiers
    urn:nbn:se:uu:diva-83621 (URN)10.1093/fampra/cml007 (DOI)16595541 (PubMedID)
    Available from: 2007-03-21 Created: 2007-03-21 Last updated: 2017-12-14Bibliographically approved
    2. Bacteriuria is associated with urge urinary incontinence in older women
    Open this publication in new window or tab >>Bacteriuria is associated with urge urinary incontinence in older women
    2008 (English)In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 26, no 1, p. 35-39Article in journal (Refereed) Published
    Abstract [en]

    OBJECTIVE: To investigate the association between bacteriuria and frequency and type of urinary incontinence in elderly people living in the community. Bacteriuria and urinary incontinence are common conditions and often coexisting in this population; the authors have previously reported the prevalence of bacteriuria to be 22.4% in women and 9.4% in men. DESIGN: Cross-sectional study. SETTING: The catchment area of a primary healthcare centre in a Swedish middle-sized town. SUBJECTS: Residents, except for those in nursing homes, aged 80 and over. Participation rate: 80.3% (431/537). MAIN OUTCOME MEASURES: Urinary cultures and questionnaire data on urinary incontinence. RESULTS: In women the OR for having bacteriuria increased with increasing frequency of urinary incontinence; the OR was 2.83 (95% CI 1.35-5.94) for women who were incontinent daily as compared with continent women. Reporting urge urinary incontinence increased the risk of having bacteriuria: 3.36 (95% CI 1.49-7.58) in comparison with continent women while there was no significant association between stress urinary incontinence and bacteriuria. The prevalence of bacteriuria among men was too low to make any meaningful calculations about the association between bacteriuria and frequency and type of incontinence. CONCLUSION: Bacteriuria is associated with more frequent leakage and predominantly with urge urinary incontinence. The causes of this association and their clinical implications remain unclear. There might be some individuals who would benefit from antibiotic treatment, but further studies are warranted.

    Keywords
    Bacteriuria, elderly, family practice, stress urinary incontinence, urge urinary incontinence
    National Category
    Public Health, Global Health, Social Medicine and Epidemiology
    Identifiers
    urn:nbn:se:uu:diva-97548 (URN)10.1080/02813430701878250 (DOI)000253514300008 ()
    Available from: 2008-10-02 Created: 2008-10-02 Last updated: 2017-12-14Bibliographically approved
    3. Asymptomatic bacteriuria in the elderly: High prevalence and high turnover of strains
    Open this publication in new window or tab >>Asymptomatic bacteriuria in the elderly: High prevalence and high turnover of strains
    Show others...
    2008 (English)In: Scandinavian Journal of Infectious Diseases, ISSN 0036-5548, E-ISSN 1651-1980, Vol. 40, no 10, p. 804-810Article in journal (Refereed) Published
    Abstract [en]

    Asymptomatic bacteriuria (ASB) was followed in repeated prevalence surveys in a cohort of non-institutionalized residents (n=330), aged80 y. Urine samples were collected at baseline, and at 6, and at 18 months. Phenotyping (PhenePlate) was performed on isolates of Escherichia coli to evaluate strain relatedness. ASB occurred in 19.0, 19.4, and 19.9% in women, and in 9.4, 9.6 and 7.9% in men, at baseline and at the 6- and 18-months follow-up, respectively, and ASB was found at least once in 37% of women and in 20% of men. Of those with ASB at baseline, 60% also had ASB in the 2 subsequent surveys. Among those with persisting E. coli bacteriuria, 76% and 40%, respectively, carried the same strain at the 6- and 18-months follow-ups. In women, we found that the risk of developing a symptomatic urinary tract infection within 24 months was higher among those with ASB at baseline than in those without bacteriuria (p=0.019). ASB is common and often persistent, but we found a high turnover of strains, indicating a high rate of recolonization.

    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:uu:diva-97549 (URN)10.1080/00365540802195242 (DOI)000259239700006 ()
    Available from: 2008-10-02 Created: 2008-10-02 Last updated: 2017-12-14Bibliographically approved
    4. Cytokines in urine in elderly subjects with symptomatic and asymptomatic urinary tract infections
    Open this publication in new window or tab >>Cytokines in urine in elderly subjects with symptomatic and asymptomatic urinary tract infections
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    Article in journal (Refereed) Submitted
    Identifiers
    urn:nbn:se:uu:diva-97550 (URN)
    Available from: 2008-10-02 Created: 2008-10-02Bibliographically approved
  • 262.
    Rodhe, Nils
    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, Faculty of Medicine, Department of Public Health and Caring Sciences.
    André, M
    Urinvägsinfektion och asymtomatisk bakteriuri hos äldre2006Other (Other academic)
  • 263.
    Rodhe, Nils
    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.
    Englund, Lars
    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.
    Mölstad, Sigvard
    Samuelsson, Eva
    Bacteriuria is associated with urge urinary incontinence in older women2008In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 26, no 1, p. 35-39Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To investigate the association between bacteriuria and frequency and type of urinary incontinence in elderly people living in the community. Bacteriuria and urinary incontinence are common conditions and often coexisting in this population; the authors have previously reported the prevalence of bacteriuria to be 22.4% in women and 9.4% in men. DESIGN: Cross-sectional study. SETTING: The catchment area of a primary healthcare centre in a Swedish middle-sized town. SUBJECTS: Residents, except for those in nursing homes, aged 80 and over. Participation rate: 80.3% (431/537). MAIN OUTCOME MEASURES: Urinary cultures and questionnaire data on urinary incontinence. RESULTS: In women the OR for having bacteriuria increased with increasing frequency of urinary incontinence; the OR was 2.83 (95% CI 1.35-5.94) for women who were incontinent daily as compared with continent women. Reporting urge urinary incontinence increased the risk of having bacteriuria: 3.36 (95% CI 1.49-7.58) in comparison with continent women while there was no significant association between stress urinary incontinence and bacteriuria. The prevalence of bacteriuria among men was too low to make any meaningful calculations about the association between bacteriuria and frequency and type of incontinence. CONCLUSION: Bacteriuria is associated with more frequent leakage and predominantly with urge urinary incontinence. The causes of this association and their clinical implications remain unclear. There might be some individuals who would benefit from antibiotic treatment, but further studies are warranted.

  • 264.
    Rodhe, Nils
    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.
    Löfgren, Sture
    Matussek, Andreas
    André, Malin
    Englund, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Kuhn, Inger
    Mölstad, Sigvard
    Asymptomatic bacteriuria in the elderly: High prevalence and high turnover of strains2008In: Scandinavian Journal of Infectious Diseases, ISSN 0036-5548, E-ISSN 1651-1980, Vol. 40, no 10, p. 804-810Article in journal (Refereed)
    Abstract [en]

    Asymptomatic bacteriuria (ASB) was followed in repeated prevalence surveys in a cohort of non-institutionalized residents (n=330), aged80 y. Urine samples were collected at baseline, and at 6, and at 18 months. Phenotyping (PhenePlate) was performed on isolates of Escherichia coli to evaluate strain relatedness. ASB occurred in 19.0, 19.4, and 19.9% in women, and in 9.4, 9.6 and 7.9% in men, at baseline and at the 6- and 18-months follow-up, respectively, and ASB was found at least once in 37% of women and in 20% of men. Of those with ASB at baseline, 60% also had ASB in the 2 subsequent surveys. Among those with persisting E. coli bacteriuria, 76% and 40%, respectively, carried the same strain at the 6- and 18-months follow-ups. In women, we found that the risk of developing a symptomatic urinary tract infection within 24 months was higher among those with ASB at baseline than in those without bacteriuria (p=0.019). ASB is common and often persistent, but we found a high turnover of strains, indicating a high rate of recolonization.

  • 265.
    Rodhe, Nils
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm , Center for Clinical Research Dalarna.
    Mölstad, Sigvard
    Englund, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm , Center for Clinical Research Dalarna.
    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.
    Asymptomatic bacteriuria in a population of elderly residents living in a community setting: prevalence, characteristics and associated factors2006In: Family Practice, ISSN 0263-2136, E-ISSN 1460-2229, Vol. 23, no 3, p. 303-7Article in journal (Refereed)
    Abstract [en]

    Background. Asymptomatic bacteriuria (ASB) is common among the elderly in institutionalcare, but less is known about its prevalence among the elderly living in community settings.Knowledge of the prevalence of ASB in this population could contribute to a reduction inunnecessary use of antibiotics.Objective. To study the prevalence of ASB and associated health and social factors in apopulation of elderly people, aged 80 and over, in a community setting.Design. A cross-sectional study.Setting. The catchment area of a primary health care centre in a Swedish middle-sized town.Method. All residents, aged 80 and over, except for those in institutional living, were invited. Astructured interview was carried out and urinary culture obtained.Results. ASB was found in 14.8% of the participants, in 19.0% of the women and 5.8% of themen. In women independent associations with ASB were found for urinary incontinence (OR:2.99, CI: 1.60–5.60), reduced mobility (OR: 2.68, CI: 1.42–5.03) and oestrogen treatment (OR: 2.20,CI: 1.09–4.45).Conclusion. Bacteriuria is common among the elderly living in non-institutional communitysettings, especially among women, although not as common as among the elderly in institutionalsettings. A woman over 80, with urinary incontinence, and needing support to walk has arisk of nearly 50% of presenting with ASB, a condition about which there is consensus not totreat with antibiotics. This should be borne in mind when examining patients with diffusesymptomatology and an accidental finding of bacteriuria.

  • 266. Rodríguez, Luis Alberto García
    et al.
    Ruigómez, 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
    Acid-suppressive drugs and community-acquired pneumonia2009In: Epidemiology, ISSN 1044-3983, E-ISSN 1531-5487, Vol. 20, no 6, p. 800-806Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Acid suppression may increase the risk of community-acquired pneumonia. We investigated this association in the United Kingdom primary care system taking account of the potential for confounding by indication. METHODS: We identified patients aged 20-79 years in The Health Improvement Network database with a new diagnosis of pneumonia between 2000 and 2005 (n = 7297). Cases were validated by manual review and compared with age- and sex-matched controls (n = 9993). Using unconditional logistic regression, we estimated the relative risk (RR) of pneumonia associated with current use of acid-suppressive drugs compared to nonuse. RESULTS: Newly diagnosed community-acquired pneumonia was increased with current use of proton pump inhibitors (RR = 1.16 [95% confidence interval 1.03-1.31]) but not H2-receptor antagonists (0.98 [0.80-1.20]). An increased risk of pneumonia was evident only in the first 12 months of treatment with proton pump inhibitors. There was some evidence of a dose response. Among patients taking proton pump inhibitors for less than 1 year, the risk of community-acquired pneumonia was stronger when current use was for dyspepsia or peptic ulcer (1.73 [1.29-2.34]) than for gastroesophageal reflux disease or prevention of upper gastrointestinal injury associated with aspirin or nonsteroidal anti-inflammatory drugs (1.22 [0.97-1.52]). CONCLUSIONS: We observed a small increase in the risk of community-acquired pneumonia associated with current proton pump inhibitor use, particularly during the first 12 months of treatment and at higher doses. This may be due in part to the underlying indication.

  • 267.
    Ronquist, Gunnar
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Chemistry.
    García Rodríguez, LA
    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.
    Frithz, G
    Svärdsudd, K
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Association between captopril, other antihypertensive drugs and risk of prostate cancer2004In: The Prostate, ISSN 0270-4137, E-ISSN 1097-0045, Vol. 58, no 1, p. 50-56Article in journal (Refereed)
    Abstract [en]

    BACKGROUND

    There has been some debate on the existence of an association between hypertension, antihypertensive medications and cancer risk.

    METHODS

    We performed a nested case-control study to assess the association between the risk of prostate cancer and the use of the angiotensin converting enzyme (ACE)-inhibitor captopril, and other antihypertensive drugs. We used data from the General Practice Research Database in UK.

    RESULTS

    We found an incidence rate of prostate cancer of 1.61 per 1,000 person-years among male patients aged 50–79 years old. Patients with a history of benign prostatic hyperplasia and/or prostatism carried a two-fold greater risk of prostate cancer than those without such antecedents. None of the other studied co-morbidities were associated with prostate cancer. We found that users of captopril had a relative risk of 0.7 (95% CI: 0.4–1.2) to develope prostate cancer. None of the other studied individual ACE-inhibitors shared a similar effect with the one observed for captopril.

    CONCLUSIONS

    No clear association was apparent between the use of antihypertensive drugs and prostate cancer. However, specific focus on users of captopril showed a lower risk of subsequent prostate cancer. Further research is needed to explore this association.

  • 268. Rosengren, A
    et al.
    Eriksson, H
    Hansson, P O
    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.
    Wilhelmsen, L
    Johansson, S
    Welin, C
    Welin, L
    Obesity and trends in cardiovascular risk factors over 40 years in Swedish men aged 502009In: Journal of Internal Medicine, ISSN 0954-6820, E-ISSN 1365-2796, Vol. 266, no 3, p. 268-276Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To study trends over 40 years in cardiovascular risk factors in normal weight, overweight and obese men, all aged 50 when examined. Design. Cross-sectional studies of five successive cohorts of men aged 50. SETTING: City of Göteborg, Sweden. SUBJECTS: Random population samples of altogether 3251 urban Swedish men born in 1913, 1923, 1933, 1943 and 1953. MAIN OUTCOME MEASURES: Anthropometry, cardiovascular risk factors, rates of nonsmoking, normotension and serum cholesterol <5 mmol L(-1) over four decades. RESULTS: Over 40 years, there was a net increase in body mass index (BMI) from 24.8 (SD = 3.2) to 26.4 (3.7) kg m(-2) (P < 0.0001), with an increase in the prevalence of obesity (BMI >or= 30 kg m(-2)) from 6.0% in 1963 to 13.8% in 2003. Favourable trends with respect to smoking, blood pressure and serum cholesterol were observed similarly amongst normal weight, overweight and obese men. In 1963, 24% of obese men were normotensive compared to 45% in 2003, and 6% had serum cholesterol <5 mmol L(-1) compared to 34% in 2003. Compared with obese men in 1963, men who were obese in 2003 had an odds ratio (OR) of 3.39 being a nonsmoker [95% confidence interval (CI): 1.56 to 7.36], 2.67 of being normotensive (1.23 to 5.83) and having serum cholesterol <5 mmol L(-1) of 8.30 (2.37 to 29.0). However, optimal risk factor status - no smoking, normotension and total serum cholesterol <5 mmol L(-1)- was still present in less than one in six men in 2003, similar across BMI categories. CONCLUSIONS: Obese Swedish men who are now in their fifties have much lower levels of other risk factors compared with obese men 40 years ago. This could contribute to explain why coronary heart disease death rates still are falling despite increasing rates of obesity.

  • 269. Ruigomez, A
    et al.
    Garcia Rodriguez, LA
    Cattaruzzi, C
    Grazia Troncon, M
    Agostinis, L
    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
    Use of cimetidine, omeprazole and ranitidine in pregnant women and pregnancy outcomes1999In: American Journal of Epidemiology, ISSN 0002-9262, E-ISSN 1476-6256, Vol. 150, no 5, p. 476-481Article in journal (Refereed)
    Abstract [en]

    Evidence documenting the safety of acid-suppressing drugs in pregnancy is very limited. The authors assessed the prevalence of congenital malformations in first trimester-exposed pregnancies to cimetidine, omeprazole, and ranitidine and compared it with nonexposed pregnancies between 1991 and 1996. Two different sources were used, the United Kingdom General Practice Research Database and the Italian Friuli-Venezia Giulia Health Database. The final study cohort included 1, 179 pregnancies from the United Kingdom and 1, 057 from Italy. Abortions or ectopic pregnancies were not included. There were 20 stillbirths and 2, 261 live-born babies in both cohorts combined, with 100 offspring identified with a malformation. The overall malformation rate was 4.4%. The relative risks for nongenetic congenital malformations associated with the use of cimetidine, omeprazole, and ranitidine were 1.2 (95% confidence interval (CI): 0.6, 2.3), 0.9 (95% CI: 0.3, 2.2), and 1.4 (95% CI: 0.8, 2.4), respectively, compared with the nonexposed. No specific grouping in the distribution of malformations was observed in any of the three exposed groups. Moreover, no relation was found between drug exposure and preterm delivery or growth retardation. These findings suggest that the use of acid-suppressing drugs during the first trimester of pregnancy is not associated with a major teratogenic risk.

  • 270. Ruigomez, A
    et al.
    Garcia Rodriguez, LA
    Hasselgren, G
    Johansson, S
    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.
    Overall mortality among patients surviving an episode of peptic ulcer bleeding2000In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 54, p. 130-133Article in journal (Refereed)
    Abstract [en]

    STUDY OBJECTIVE: The authors investigated whether patients who have survived an acute episode of peptic ulcer bleeding (PUB) have an excess long term all cause mortality compared with the general population free of PUB.

    DESIGN: Follow up study of previously identified cohort of patients with a PUB episode and a general population cohort.

    SETTING: The source population included all people aged 30 to 89 years, registered with general practitioners in the United Kingdom.

    PATIENTS: All patients alive one month after the PUB episode constituted the cohort of PUB patients (n = 978). A control group of 5000 people was randomly sampled from the source population. The same eligibility criteria as for patients with PUB were applied to the control series. Also, controls had to be free of PUB before start date.

    MAIN RESULTS: Relative risk of mortality among PUB patients was 2.1, 95% CI: 1.7, 2.6) compared with the general population. This increased mortality risk occurred mainly in the patients less than 60 years old. No difference was observed between men and women. The excess mortality was not only circumscribed to deaths attributable to recurrent gastrointestinal bleed, but also cardiovascular, cancer and other causes.

    CONCLUSIONS: People who have survived an acute episode of PUB have a reduced long term survival compared with the general population. This reduction was stronger among middle age patients than in the elderly.

  • 271. Ruigomez, A
    et al.
    Garcia Rodriguez, LA
    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.
    Is hormone replacement therapy associated with an increased risk of irritable bowel syndrome?2003In: Maturitas, ISSN 0378-5122, E-ISSN 1873-4111, Vol. 44, no 2, p. 133-140Article in journal (Refereed)
    Abstract [en]

    Objective: Hormonal status could be involved in the occurrence of irritable bowel syndrome (IBS). The authors examined the risk of developing IBS in women using hormone replacement therapy (HRT). Methods: Women 50–69 years old with at least one prescription for HRT during 1994–1999 were identified from the General Practice Research Database in the UK (n=40, 119). An aged-matched cohort of 50 000 women who never used HRT was sampled from the source population where the HRT cohort was ascertained. Women in the two cohorts were followed to assess the risk of development of IBS. Authors performed a nested case-control analysis to assess the role of duration, route and regimen of HRT use and other risk factors for IBS. The IBS diagnosis was validated by means of a questionnaire sent to the general practitioners (n=660). Results: The incidence rate of IBS per 1000 person-years was 1.7 in the cohort of never HRT users and 3.8 among HRT users, respectively. Both current and past users of HRT presented an increased risk of IBS compared to non-users, after adjusting for co-morbidity and consultation patterns. This increased risk was observed irrespective of treatment duration, regimen or route of administration of HRT. Conclusion: The result suggests that HRT use is associated with an increased risk of IBS similar to the one observed among younger premenopausal women with endogenous oestrogenic activity.

  • 272. Ruigomez, A
    et al.
    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.
    Garcia Rodriguez, LA
    Gender and drug treatment as determinants of mortality in a cohort of heart failure patients2001In: European Journal of Epidemiology, ISSN 0393-2990, E-ISSN 1573-7284, Vol. 17, no 4, p. 329-335Article in journal (Refereed)
    Abstract [en]

    Aim: We assessed gender differences in the risk of mortality in heart failure (HF) patients and evaluated the association between HF drug treatment and mortality. Methods and Results: We identified a cohort of 820 patients with newly diagnosed HF in 1996 in UK general practices. The diagnosis of HF was confirmed by the general practitioner. Fifty per cent were females and 27% were less than 70 years old. During a mean follow-up of 2 years, 172 patients died. We used computerized records to assess risk factors and drugs prescribed as treatment. The information on severity was assessed through a questionnaire. We performed a nested case–control analysis, and observed that men had twice the risk of dying than females, however the effect of age on mortality was stronger in females than males. We found a similar interaction between HF severity and sex. Data on use of some cardiovascular drugs such as diuretics, beta-blockers ACE-inhibitors and calcium channel blockers were suggestive of a reduced mortality risk. Current use of nitrates and glycosides carried an increased risk. Conclusion: Older age, male sex and severity of HF were the main predictors of mortality among HF patients. Long-term use of beta-blockers was associated with a significantly reduced risk of mortality.

  • 273. Ruigomez, A
    et al.
    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.
    Garcia Rodriguez, LA
    Risk of mortality in a cohort of patients newly diagnosed with chronic atrial fibrillation2002In: BMC Cardiovascular Disorders, ISSN 1471-2261, E-ISSN 1471-2261, Vol. 2, no 5Article in journal (Refereed)
    Abstract [en]

    Objective

    To estimate the mortality rate of patients newly diagnosed with chronic atrial fibrillation (AF) and compare it with the one in the general population. To evaluate the role of co-morbidity and other factors on the risk of dying among AF patients.

    Methods

    We used the General Practice Research Database in the UK to perform a retrospective cohort study. We followed a cohort of chronic AF patiens (N = 1,035) and an age and sex matched cohort of 5,000 subjects sampled from the general population. We used all deceased AF patients as cases (n = 234) and the remaining AF patients as controls to perform a nested case-control analysis. We estimated mortality risk associated with AF using Cox regression. We computed mortality relative risks using logistic regression among AF patients.

    Results

    During a mean follow-up of two years, 393 patients died in the general population cohort and 234 in the AF cohort. Adjusted relative risk of death in the cohort of AF was 2.5 (95%CI 2.1 – 3.0) compared to the general population. Among AF patients, mortality risk increased remarkably with advancing age. Smokers carried a relative risk of dying close to threefold. Ischaemic heart disease was the strongest clinical predictor of mortality with a RR of 3.0 (95% CI; 2.1–4.1). Current use of calcium channel blockers, warfarin and aspirin was associated with a decreased risk of mortality.

    Conclusions

    Chronic AF is an important determinant of increased mortality. Major risk factors for mortality in the AF cohort were age, smoking and cardiovascular co-morbidity, in particular ischaemic heart disease.

  • 274. Ruigomez, A
    et al.
    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.
    Rodriguez, LA
    Incidence of chronic atrial fibrillation in general practice and its treatment pattern2002In: Journal of Clinical Epidemiology, ISSN 0895-4356, E-ISSN 1878-5921, Vol. 55, no 4, p. 358-363Article in journal (Refereed)
    Abstract [en]

    The object of this article was to estimate the incidence rate of chronic atrial fibrillation (AF) in a general practice setting, to identify factors predisposing to its occurrence, and to describe treatment patterns in the year following the diagnosis. The method used was a population-based cohort study using the General Practice Research Database (GPRD) in the UK. We identified patients aged 40-89 years with a first ever recorded diagnosis of AF. The diagnosis was validated through a questionnaire sent to the general practitioners. A nested case-control analysis was performed to assess risk factors for AF using 1,035 confirmed incident cases of chronic AF and a random sample of 5,000 controls from the original source population. The incidence rate of chronic AF was 1.7 per 1,000 person-years, and increased markedly with age. The age adjusted rate ratio among males was 1.4 (95% CI 1.2-1.6). The major risk factors were age, high BMI, excessive alcohol consumption, and prior cardiovascular comorbidity, in particular, valvular heart disease and heart failure. Digoxin was used in close to 70% of the patients, and close to 15% did not receive any antiarrhythmic treatment. Close to 40% did not receive either warfarin or aspirin in the 3 months period after the diagnosis. Among the potential candidates for anticoagulation only 22% of those aged 70 years or older were prescribed warfarin in comparison to 49% among patients aged 40-69 years. Chronic AF is a disease of the elderly, with women presenting a lower incidence rate than men specially in young age. Age, weight, excessive alcohol consumption, and cardiovascular morbidity were the main independent risk factors for AF. Less than half of patients with chronic AF and no contraindications for anticoagulation received warfarin within the first trimester after the diagnosis.

  • 275. Ruigomez, A
    et al.
    Rodriguez Garcia, 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
    Dent, J
    Endoscopic findings in a cohort of newly diagnosed gastroesophageal reflux disease patients registered in a UK primary care database2007In: Diseases of the esophagus, ISSN 1120-8694, E-ISSN 1442-2050, Vol. 20, no 6, p. 504-509Article in journal (Refereed)
    Abstract [en]

    Gastroesophageal reflux disease (GERD) may be accompanied by erosive complications that are diagnosed by endoscopy. This study aimed to describe the characteristics of patients newly diagnosed with GERD who are referred for endoscopy, and the factors associated with esophageal endoscopic findings. The study included patients aged 2-79 years with a first recorded diagnosis of GERD in 1996, as identified in a previous cohort study in the UK General Practice Research database. The rate and results of endoscopy were recorded. Unconditional logistic regression analysis was used to estimate the odds ratios and 95% confidence intervals for the relationship between a range of factors and endoscopy and its findings. Of the 7159 patients with a new GERD diagnosis, 805 (11%) underwent endoscopy close to the time of first consultation for GERD. Endoscopic findings indicative of esophageal damage were recorded in 73% of these patients. Esophageal endoscopic findings were significantly more likely in males, older patients, and individuals with a history of peptic ulcer disease or gastrointestinal bleeding. Use of acid-suppressive drugs, particularly proton pump inhibitors, was inversely associated with erosive endoscopic findings. Patients with erosive endoscopic findings were more likely to start a new course of treatment with a proton pump inhibitor. In conclusion, relatively few patients are referred for endoscopy close to the first consultation for GERD and the majority of these individuals have esophageal findings. Male gender, increasing age and a history of bleeding were risk factors for esophageal complications.

  • 276. Ruigomez, A
    et al.
    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
    Rodriguez, G
    One-year follow-up of newly diagnosed irritable bowel syndrome patients1999In: Alimentary Pharmacology and Therapeutics, ISSN 0269-2813, E-ISSN 1365-2036, Vol. 13, no 8, p. 1097-1102Article in journal (Refereed)
    Abstract [en]

    Background: Irritable bowel syndrome is the most common functional gastrointestinal disorder seen by general physicians.

    Methods: We followed up a population-based cohort of newly diagnosed irritable bowel syndrome patients aged 20–79 years, to examine patterns of treatment, comorbidity and healthcare utilization. We used the UK General Practice Research Database as the source population. Individuals with other gastrointestinal diseases, cancer and pregnant women were not included. There were 2956 patients in our final cohort.

    Results: Irritable bowel syndrome patients were mainly young and middle-aged; only 12% were 60 years or older. The majority of patients were women (74%). There were no marked differences in terms of use of healthcare services or comorbidity status in the year before irritable bowel syndrome diagnosis as compared to the year after. Fourteen per cent of irritable bowel syndrome patients received no drug treatment at all. Among those treated, the first choice was an antispasmodic. Elderly patients (> 60 years old) were more likely to receive drug treatment. Females had a slightly higher probability of being treated than men, except for the category of anti-diarrhoeal drugs.

    Conclusion: This study has shown that irritable bowel syndrome patients are mainly young and female. We also found that treatment pattern varied according to age and gender. Elderly patients and females were at a higher risk of receiving drug treatment.

  • 277. Ruigomez, A
    et al.
    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.
    Lundborg, P
    Johansson, Saga
    Garcia Rodriguez, LA
    Gastroesophageal reflux disease in children and adolescents in primary care2010In: Scandinavian Journal of Gastroenterology, ISSN 0036-5521, E-ISSN 1502-7708, Vol. 45, no 2, p. 139-146Article in journal (Refereed)
    Abstract [en]

    Objectives. To determine the prevalence and incidence of a diagnosis of gastroesophageal reflux disease (GERD) in children and adolescents in UK primary care, and to assess comorbidities that are associated with a diagnosis of GERD. Material and methods. Incident GERD cases during 2000-05 were identified from The Health Improvement Network (THIN) UK primary care database via a computer search for diagnostic codes for GERD, followed by manual review of the patient records. Results. We identified 1700 children with a first diagnosis of GERD during 2000-05. The incidence of GERD was 0.84 per 1000 person-years. The incidence decreased with age from 1.48 per 1000 person-years among 1-year-old children until the age of 12 years, whereupon it increased to a maximum at 16-17 years of 2.26 per 1000 person-years for girls and 1.75 per 1000 person-years for boys. Pregnant adolescents were not included in the study. In addition to typical GERD symptoms (epigastric pain, heartburn, reflux, regurgitation), 21.2% of children reported nausea or vomiting. Children with neurological disorders were at increased risk of a GERD diagnosis. Hiatus hernia and congenital esophageal disorders were also associated with a diagnosis of GERD. Children and adolescents using antiepileptics, oral/inhaled steroids, beta-agonists and paracetamol had an increased risk of a GERD diagnosis. Conclusions. The incidence of a GERD diagnosis was age-dependent and was highest among very young children and older female adolescents. Children with neurological impairments and other comorbidities were at increased risk of a GERD diagnosis.

  • 278. Ruigomez, Ana
    et al.
    Lundborg, Per
    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.
    Garcia Rodriguez, Luis A.
    Follow-up of a cohort of children and adolescents with gastro-esophageal reflux disease who were free of reflux esophagitis at initial diagnosis2010In: Scandinavian Journal of Gastroenterology, ISSN 0036-5521, E-ISSN 1502-7708, Vol. 45, no 7-8, p. 814-821Article in journal (Refereed)
    Abstract [en]

    Objective. Few studies have examined the incidence of complications from gastro-esophageal reflux disease (GERD) in children and adolescents in primary care. Here we aimed to describe the natural history of GERD in a pediatric population with no reflux esophagitis at initial diagnosis, assessing diagnoses of new esophageal complications and extra-esophageal conditions. Material and methods. We used The Health Improvement Network UK primary care database (which includes data on more than 2 million patients) to identify individuals aged 1-17 years with a first diagnosis of gastro-esophageal reflux or heartburn in the period 2000-2005, via a computerized search followed by a manual review of the patient records. This search identified 1242 individuals with an incident diagnosis of GERD but no record of esophagitis. This cohort was followed-up to detect new diagnoses of esophageal complications and extra-esophageal conditions. Results. During a mean follow-up period of almost 4 years, 40 children and adolescents had a confirmed new diagnosis of reflux esophagitis (incidence: 10.9 per 1000 person-years). No cases of Barrett's esophagus, esophageal stricture or esophageal ulcer were reported. Individuals with GERD had double the risk of an extra-esophageal condition such as asthma, pneumonia, cough or chest pain compared with children and adolescents with no diagnosis of GERD. Conclusions. Children and adolescents with GERD may be at risk of developing reflux esophagitis and a range of other extra-esophageal conditions, but more severe esophageal complications are rare.

  • 279. Ruigómez, A
    et al.
    García Rodríguez, 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
    Dent, J
    Comparison of gastro-oesophageal reflux disease and heartburn diagnoses in UK primary care2006In: Current Medical Research and Opinion, ISSN 0300-7995, E-ISSN 1473-4877, Vol. 22, no 9, p. 1661-1668Article in journal (Refereed)
    Abstract [en]

    Objective: It is unclear how gastro-oesophageal reflux disease (GORD) is diagnosed in primary care. The aim of this study is to compare patients given a diagnosis of GORD with those diagnosed with heartburn.

    Research design and methods: Data from the UK General Practice Research Database were extracted for patients newly diagnosed with heartburn (n = 1841) or GORD (n = 5318) in 1996.

    Main outcome measures., Patient characteristics, morbidity, healthcare use and prescribed treatments were compared using unconditional logistic regression analysis.

    Results: GORD was diagnosed more frequently than heartburn (3.2 vs. 1.1 per 1000 patient-years). A diagnosis of GORD was less likely among females (odds ratio (OR): 0.8; confidence interval (Cl): 0.7-0.9), smokers (OR: 0.8; Cl: 0.7-0.9) and patients who consulted their physician frequently (OR: 0.8; Cl: 0.7-0.9). There was a wide distribution in the ratio of GORD-to-heartburn diagnoses between primary care practices (mean 2.9; range 0-infinity). GORD patients were more likely to receive proton pump inhibitors (OR: 2.9; Cl: 2.6-3.4), but 24% of GORD patients and 40% of heartburn patients received no acid-suppressive treatment in the month after diagnosis.

    Conclusions: Several factors influenced the diagnosis of gastro-oesophageal reflux symptoms by primary care physicians. Further research is needed to aid the diagnosis of GORD in primary care.

  • 280. Ruigómez, A
    et al.
    García Rodrí­guez, 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
    Eklund, S
    Esophageal stricture: incidence, treatment patterns, and recurrence rate2006In: American Journal of Gastroenterology, ISSN 0002-9270, E-ISSN 1572-0241, Vol. 101, no 12, p. 2685-2692Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: We aimed to determine the incidence, natural history, and recurrence rate of esophageal stricture diagnosed in primary care. METHODS: From the U.K. General Practice Research Database, we identified patients with a stricture diagnosis recorded between 1994 and 2000. Diagnoses were confirmed by general practitioner-completed questionnaires. Patients with stricture were compared to an age- and sex-matched sample of controls from the original source population. We estimated the incidence of stricture, potential risk factors, and comorbidities, and relative risk (RR) for subsequent stricture recurrence and mortality. RESULTS: The incidence of esophageal stricture was 1.1 per 10,000 person-years and increased markedly with age. Incidence of stricture decreased from 1994 to 2000, concomitant with a substantial increase in proton pump inhibitor (PPI) use. The majority of stricture cases (68%) were peptic. Prior dysphagia, gastroesophageal reflux disease (GERD), hiatus hernia, peptic ulcer disease, and heavy alcohol use were associated with an increased risk of stricture. The rate of stricture recurrence was 11.1 per 100 person-years. Risk of recurrence associated with long-term PPI use adjusting for other factors was 0.6 (95% CI 0.3-1.1). Mortality in patients with peptic stricture was similar to that in the control population. CONCLUSIONS: Esophageal stricture is a rare event, and most cases in primary care are peptic strictures. Prior GERD, hiatus hernia, and peptic ulcer are associated with an increased risk of peptic stricture. Incidence of stricture decreased from 1994 to 2000.

  • 281. Ruigómez, A
    et al.
    García Rodríguez, 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
    Graffner, H
    Dent, J
    Natural history of gastro-oesophageal reflux disease diagnosed in general practice2004In: Alimentary Pharmacology and Therapeutics, ISSN 0269-2813, E-ISSN 1365-2036, ISSN 0269-2813, Vol. 20, no 7, p. 751-760Article in journal (Refereed)
    Abstract [en]

    Background : Cross-sectional studies indicate that gastro-oesophageal reflux disease symptoms have a prevalence of 10–20% in Western countries and are associated with obesity, smoking, oesophagitis, chest pain and respiratory disease.

    Aim : To determine the natural history of gastro-oesophageal reflux disease presenting in primary care in the UK.

    Methods : Patients with a first diagnosis of gastro-oesophageal reflux disease during 1996 were identified in the UK General Practice Research Database and compared with age- and sex-matched controls. We investigated the incidence of gastro-oesophageal reflux disease, potential risk factors and comorbidities, and relative risk for subsequent oesophageal complications and mortality.

    Results : The incidence of a gastro-oesophageal reflux disease diagnosis was 4.5 per 1000 person-years (95% confidence interval: 4.4–4.7). Prior use of non-steroidal anti-inflammatory drugs, smoking, excess body weight and gastrointestinal and cardiac conditions were associated with an increased risk of gastro-oesophageal reflux disease diagnosis. Subjects with gastro-oesophageal reflux disease had an increased risk of respiratory problems, chest pain and angina in the year after diagnosis, and had a relative risk of 11.5 (95% confidence interval: 5.9–22.3) of being diagnosed with an oesophageal complication. There was an increase in mortality in the gastro-oesophageal reflux disease cohort only in the year following the diagnosis.

    Conclusions : Gastro-oesophageal reflux disease is a disease associated with a range of potentially serious oesophageal complications and extra-oesophageal diseases.

  • 282. Ruigómez, A
    et al.
    García Rodrí­guez, 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
    Jones, R
    Chest pain in general practice: incidence, comorbidity and mortality2006In: Family Practice, ISSN 0263-2136, E-ISSN 1460-2229, Vol. 23, no 2, p. 167-174Article in journal (Refereed)
    Abstract [en]

    Background. Chest pain is a common symptom that presents the primary care physician with a complex diagnostic and therapeutic challenge. Aims. To evaluate the natural history and management of patients diagnosed with chest pain of unspecified type or origin in primary care. Design. Population-based case-control study. Methods. The study included 13 740 patients with a first diagnosis of unspecified chest pain and 20 000 age- and sex-matched controls identified from the UK General Practice Research Database. Odds ratios (ORs) and 95% confidence intervals (CIs) were computed using unconditional logistic regression. Risk estimates were adjusted for age, sex and number of physician visits. Results. The incidence of a new diagnosis of chest pain was 15.5 per 1000 person-years and increased with age, particularly in men. The risk of a chest pain diagnosis was greatest in patients with prior diagnoses of coronary heart disease (OR: 7.1; 95% CI: 6.1-8.2) and gastroesophageal reflux disease (OR: 2.0; 95% CI: 1.7-2.3). In the year after diagnosis, chest pain patients were more likely than controls to be newly diagnosed with coronary heart disease (OR: 14.9; 95% CI: 12.7-17.4) and heart failure (OR: 4.7; 95% CI: 3.6-6.1). A new diagnosis of chest pain was associated with an increased risk of death in the following year (RR: 2.3; 95% CI: 1.9-2.8). Conclusions. Some causes of chest pain are underdiagnosed in primary care. This is of particular consequence for the minority of chest pain patients with cardiac disease.

  • 283. Ruigómez, A
    et al.
    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.
    Edvardsson, N
    García Rodríguez, LA
    Risk of cardiovascular and cerebrovascular events after atrial fibrillation diagnosis2009In: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 136, no 2, p. 186-192Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Atrial fibrillation (AF) is associated with subsequent cardiovascular events including ischemic stroke, transient ischemic events, and coronary events. This study aimed to evaluate the risk of ischemic cerebrovascular events (ICVE), coronary events (CE) or heart failure (HF) following a diagnosis of AF. METHODS: Patients were selected from the UK General Practice Research Database. The incidence of ICVE, CE and HF was determined during a 6-year follow-up period for patients with a first diagnosis of AF (n=831) and a control group without AF (n=8226). Relative risk of developing a cardiovascular event associated with prior AF and other potential risk factors was estimated using Cox regression analysis. RESULTS: A first diagnosis of ICVE, CE or HF was made in 261 patients in the AF group and 622 in the control group. The relative risks associated with AF were 2.1 for CE (95% CI: 1.6-2.9), 3.0 for ICVE (95% CI: 2.3-4.0) and 6.4 for HF (95% CI: 5.0-8.3). The risks of CE, HF and ICVE were higher in patients with chronic AF than paroxysmal AF (odds ratio: 1.5, 95% CI: 1.0-2.2) and in patients aged at least 60 years or with diabetes. Lifestyle factors did not significantly affect the risk of cardiovascular events in patients with AF. CONCLUSIONS: After a first episode of AF there is an increased risk of ICVE, CE and HF. Patients initially diagnosed with chronic AF have a higher risk than those with paroxysmal AF.

  • 284. Ruigómez, A
    et al.
    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 Rodríguez, LA
    Predictors and prognosis of paroxysmal atrial fibrillation in general practice in the UK2005In: BMC Cardiovascular Disorders, ISSN 1471-2261, E-ISSN 1471-2261, Vol. 5, p. 20-Article in journal (Refereed)
    Abstract [en]

    Background: Natural history of paroxysmal atrial fibrillation (AF) is not very well documented. Clinical experience suggests that paroxysmal AF could progress to chronic AF with estimates ranging between 15 and 30% over a period of 1–3 years. We performed an epidemiologic study to elucidate the natural history of paroxysmal AF, this study estimated its incidence in a general practice setting, identified associated factors and analyzed the progression into chronic AF as well as the mortality rate.

    Methods: Using the UK General Practice Research Database (GPRD), we identified patients aged 40–89 years with a first-recorded episode of paroxysmal AF during 1996. Risk factors were assessed using 525 incident paroxysmal AF cases confirmed by the general practitioner (GP) and a random sample of controls. We follow-up paroxysmal AF patients and estimated their mortality rate and progression to chronic AF.

    Results: The incidence of paroxysmal AF was 1.0 per 1,000 person-years. Major risk factors for paroxysmal AF were age and prior valvular heart disease, ischaemic heart disease, heart failure and hyperthyroidism. During a mean follow-up of 2.7 years, 70 of 418 paroxysmal AF patients with complete information progressed to chronic AF. Risk factors associated with progression were valvular heart disease (OR 2.7, 95% CI 1.2–6.0) and moderate to high alcohol consumption (OR 3.0, 95% CI 1.1–8.0). Paroxysmal AF patients did not carry an increased risk of mortality, compared to an age and sex matched sample of the general population. There was a suggestion of a small increased risk among patients progressing to chronic AF (RR 1.5, 96% CI 0.8–2.9).

    Conclusion: Paroxysmal AF is a common arrhythmia in the general practice setting, increasing with age and commonly associated with other heart diseases. It sometimes is the initial presentation and then progress to chronic AF. A history of valvular heart disease and alcohol consumption are associated with this progression.

  • 285. Ruigómez, A
    et al.
    Rodríguez, LAG
    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
    Dent, J
    Endoscopic findings in a cohort of newly diagnosed gastroesophageal reflux disease patients registered in a UK primary care database2008In: Diseases of the esophagus, ISSN 1120-8694, E-ISSN 1442-2050, Vol. 21, no 3, p. 251-256Article in journal (Refereed)
    Abstract [en]

    Gastroesophageal reflux disease (GERD) may be accompanied by erosive complications that are diagnosed by endoscopy. This study aimed to describe the characteristics of patients newly diagnosed with GERD who are referred for endoscopy, and the factors associated with esophageal endoscopic findings. This study included patients aged 2-79 years with a first recorded diagnosis of GERD in 1996, as identified in a previous cohort study in the UK General Practice Research Database. The rate and results of endoscopy were recorded. Unconditional logistic regression analysis was used to estimate the odds ratios and 95% confidence intervals for the relationship between a range of factors and endoscopy and its findings. Of the 7159 patients with a new GERD diagnosis, 805 (11%) underwent endoscopy close to the time of first consultation for GERD. Endoscopic findings indicative of esophageal damage were recorded in 73% of these patients. Esophageal endoscopic findings were significantly more likely in males, older patients, and individuals with a history of peptic ulcer disease or gastrointestinal bleeding. Use of acid-suppressive drugs, particularly proton pump inhibitors, was inversely associated with erosive endoscopic findings. Patients with erosive endoscopic findings were more likely to start a new course of treatment with a proton pump inhibitor. In conclusion, relatively few patients are referred for endoscopy close to the first consultation for GERD, and the majority of these individuals have esophageal findings. Male gender, increasing age and a history of bleeding were risk factors for esophageal complications.

  • 286. Ruigómez, Ana
    et al.
    García Rodríguez, Luis Alberto
    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.
    Edvardsson, Nils
    Risk of cerebrovascular accident after a first diagnosis of atrial fibrillation2007In: Clinical Cardiology, ISSN 0160-9289, E-ISSN 1932-8737, Vol. 30, no 12, p. 624-628Article in journal (Refereed)
    Abstract [en]

    BACKGROUND

    Atrial fibrillation is the most common cardiac arrhythmia and a major risk factor for cerebrovascular accident, including ischemic stroke and transient ischemic attack.

    HYPOTHESIS

    Ischemic cerebrovascular accident is associated with increasing age and cardiovascular and cerebrovascular disease in primary care patients with atrial fibrillation.

    METHODS

    Using the U.K. General Practice Research Database, we identified patients with chronic atrial fibrillation who were alive 1 month after initial diagnosis (n = 906). Potential cases of cerebrovascular accident were identified and confirmed by the primary care physician. The incidence of cerebrovascular accident was calculated. A nested case-control analysis was performed to identify factors associated with cerebrovascular accident among patients with chronic atrial fibrillation.

    RESULTS

    During a mean follow-up period of 1.8 years (range: 0-3.9 years), 60 patients with atrial fibrillation were diagnosed with a new cerebrovascular accident (22 cases with transient ischemic attack and 38 with ischemic stroke). The incidence of new cerebrovascular accident was 3.6 per 100 patient-years (95% confidence interval [CI]: 2.8-4.6). Increased age (odds ratios [OR] compared with age 40-69 years: 3.5 [95% CI: 1.2-10.5] for age 70-79 years and 4.9 [95% CI: 1.6-15.0] for age > or = 80 years), prior cerebrovascular event (OR: 3.4; 95% CI: 1.9-6.1) and diabetes (OR: 2.2; 95% CI: 1.0-4.9) were identified as risk factors for a new cerebrovascular accident.

    CONCLUSIONS

    Among patients with atrial fibrillation, risk factors for a new ischemic cerebrovascular accident include previous ischemic stroke or transient ischemic attack, comorbid diabetes, and increasing age.

  • 287. Ruigómez, Ana
    et al.
    Massó-González, Elvira L
    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-Rodríguez, Luis A
    Chest pain without established ischaemic heart disease in primary care patients: associated comorbidities and mortality2009In: British Journal of General Practice, ISSN 0960-1643, E-ISSN 1478-5242, Vol. 59, no 560, p. 198-205Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Ischaemic heart disease (IHD) can be excluded in the majority of patients with unspecific chest pain. The remainder have what is generally referred to as non-cardiac chest pain, which has been associated with gastrointestinal, neuromusculoskeletal, pulmonary, and psychiatric causes. AIM: To assess morbidity and mortality following a new diagnosis of non-specific chest pain in patients without established IHD. DESIGN OF STUDY: Population-based cohort study with nested case-control analysis. SETTING: UK primary care practices contributing to the General Practice Research Database. METHOD: Patients aged 20-79 years with chest pain who had had no chest pain consultation before 2000 and no IHD diagnosis before 2000 or within 2 weeks after the index date were selected from the General Practice Research Database. The selected 3028 patients and matched controls were followed-up for 1 year. RESULTS: The incidence of chest pain in patients without established IHD was 12.7 per 1000 person-years. In the year following the index date, patients who had chest pain but did not have established IHD were more likely than controls to receive a first IHD diagnosis (hazard ratio [HR] = 18.2, 95% confidence interval [CI] = 11.6 to 28.6) or to die (HR = 2.3, 95% CI = 1.3 to 4.1). Patients with chest pain commonly had a history of gastro-oesophageal reflux disease (GORD; odds ratio [OR] = 2.0, 95% CI = 1.5 to 2.7) or went on to be diagnosed with GORD (risk ratio 4.5, 95% CI = 3.1 to 6.4). CONCLUSION: Patients with chest pain but without established IHD were found to have an increased risk of being diagnosed with IHD. Chest pain in patients without established IHD was also commonly associated with GORD.

  • 288.
    Sandblom, Maria
    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.
    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.
    Rezapour, Masoumeh
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Vårdprogram för inkontinens nådde inte sitt syfte: Antalet remisser ökade och utredningar görs fortsatt på för hög sjukvårdsnivå2006In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 103, no 49, p. 3941-3945Article in journal (Refereed)
    Abstract [en]

    To evaluate the impact of a new guideline on management of urinary incontinence, we scrutinised all the referred letters to the specialist setting at the university hospital in Uppsala, 18 months before and 18 months after the introduction of the recommended guideline. The results showed that the number of cases referred to the specialist, from the general practitioner and private gynaecologist were increased after the introduction. A low rate of performed medical history and symptoms assessment, such as frequency volume chart and estimation of post void residual urine were observed both before and after the introduction of the new guideline. Pelvic floor exercise were used as the first line treatment at the primary settings, twice as often after the introduction of the recommended guideline (20% after / 11% before). However, it seems that the new guideline did not change the primary management of urinary incontinence significantly.

  • 289.
    Schwan, Anna
    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.
    Eriksson, Britt-Marie
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Infectious Diseases.
    Carlson, Ulla
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Petterson, Eva
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Sandblom, Maria
    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.
    Colonization with potentially pathogenic respiratory tract bacteria: a household study1989In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 7, no 4, p. 203-209Article in journal (Refereed)
    Abstract [en]

    A group of 235 persons (180 adults and 55 children 0-15 years old) recorded symptoms of upper respiratory tract infection daily during two three-month periods (autumn 1986 and spring 1987). Samples for culture were taken from the nasopharynx and throat once during each period. Fifteen per cent of asymptomatic subjects harboured respiratory pathogens in the nasopharynx, as did 28% of those subjects with minor respiratory tract infections and 46% of those with more severe respiratory tract infections. Of children up to seven years of age, 58% were colonized with potential respiratory pathogens, which is important to keep in mind when evaluating culture reports from young children. Adults living with young children were colonized significantly more often than other adults. Branhamella catarrhalis was the most common pathogen.

  • 290. Shirazi, M.
    et al.
    Zeinaloo, A.A.
    Parikh, S. V.
    Sadeghi, M.
    Taghva, A.
    Arbabi, M.
    Kashani, A. Sabouri
    Alaeddini, F.
    Lonka, K.
    Wahlström, Rolf
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Effects on readiness to change of an educational intervention on depressive disorders for general physicians in primary care based on a modified Prochaska model: a randomized controlled study2008In: Family Practice, ISSN 0263-2136, E-ISSN 1460-2229, Vol. 25, no 2, p. 98-104Article in journal (Refereed)
    Abstract [en]

    Background: The Prochaska model of readiness to change has been proposed to be used in educational interventions to improve medical care. Objective: To evaluate the impact on readiness to change of an educational intervention on management of depressive disorders based on a modified version of the Prochaska model in comparison with a standard programme of continuing medical education (CME). Methods: This is a randomized controlled trial within primary care practices in southern Tehran, Iran. The participants included 192 general physicians working in primary care (GPs) were recruited after random selection and randomized to intervention (96) and control (96). Intervention consisted of interactive, learner-centred educational methods in large and small group settings depending on the GPs' stages of readiness to change. Change in stage of readiness to change measured by the modified version of the Prochaska questionnaire was the main outcome measure. Results The final number of participants was 78 (81%) in the intervention arm and 81 (84%) in the control arm. Significantly (P < 0.01), more GPs (57/96 = 59% versus 12/96 = 12%) in the intervention group changed to higher stages of readiness to change. The intervention effect was 46% points (P < 0.001) and 50% points (P < 0.001) in the large and small group setting, respectively. Conclusions: Educational formats that suit different stages of learning can support primary care doctors to reach higher stages of behavioural change in the topic of depressive disorders. Our findings have practical implications for conducting CME programmes in Iran and are possibly also applicable in other parts of the world.

  • 291. Stapleton, D B
    et al.
    MacLennan, A H
    Kristiansson, Per
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    The prevalence of recalled back pain during pregnancy: a South Australian population survey2002In: Australian and New Zealand journal of obstetrics and gynaecology, ISSN 0004-8666, E-ISSN 1479-828X, Vol. 42, no 5, p. 482-485Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE:

    To determine the prevalence of low back pain during pregnancy (LBPP) in an Australian population.

    DESIGN:

    A representative population-based survey of women aged 15 years and older.

    SETTING AND SAMPLE:

    Four thousand four hundred randomly selected South Australian households were visited by trained surveyors who interviewed 1531 women (69.7% response rate) using pre-tested questions.

    METHODS:

    The South Australian Health Omnibus survey was utilised.

    MAIN OUTCOME MEASURES:

    Demographic data were collected along with details of previous pregnancies, and degree of back pain during pregnancy treatment regimens, and persistence of back pain.

    RESULTS:

    Thirty-five and a half per cent of women recall having at least moderately severe back pain during pregnancy. Women who reported such back pain were younger, were more likely to report ill health and be unemployed. Increasing parity was not associated with current back pain. The most commonly used treatments were bed rest, pain killing medication, physiotherapy, and chiropractic treatment. Half of those with symptoms were untreated. Sixty-eight per cent of women who experienced moderate or worse low back pain during pregnancy continued to experience recurring low back pain with a self reported reduction in their health.

    CONCLUSIONS:

    Chronic low back pain is commonly associated with an onset in pregnancy subjectively contributing to long-term morbidity The high prevalence may be an underestimate in view of the potential for recall bias in older women.

  • 292. Stjärne, Pär
    et al.
    Odebäck, Peter
    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.
    Lundberg, Johan
    Olsson, Petter
    High costs and burden of illness in acute rhinosinusitis: real-life treatment patterns and outcomes in Swedish primary care2012In: Primary Care Respiratory Journal, ISSN 1471-4418, E-ISSN 1475-1534, Vol. 21, no 2, p. 174-179Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Few studies have investigated the impact of acute rhinosinusitis on disease-specific quality of life, and disease costs have not been studied previously in Scandinavia. AIMS: To study symptoms, treatment patterns, quality of life and costs in adults with acute rhinosinusitis. METHODS: This was an observational study in primary care. Patients aged 18–80 years seeking care for acute rhinosinusitis were evaluated using the Major Symptom Score (MSS) on days 0 and 15. Recommended and used treatments, quality of life and costs were assessed by questionnaires including EQ-5D™ and a visual analogue scale (VAS) on the same days. RESULTS: 150 patients were enrolled; 143 provided follow-up data. The proportion of MSS responders was 91%. Mean MSS decreased from 8.4 on day 0 (N=150) to 1.9 on day 15 (N=143). Patients reporting pain/discomfort and problems with usual activities decreased from 88.4% to 31.5% and from 43.2% to 1.4%, respectively, and mean VAS increased from 58.7 to 79.5. Intranasal corticosteroids were the most recommended and/or prescribed drugs. Total cost for an episode was 10,260 SEK (€1,102), of which 75% were indirect costs. CONCLUSIONS: With treatment dominated by intranasal corticosteroids, a high proportion of responders and good symptom relief were seen. Acute rhinosinusitis seems to cause a high burden on quality of life and also a high cost for society.

  • 293.
    Ställberg, B
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    ABC vid spirometri i primärvården2007In: Allmänmedicin, ISSN 0281-3513, Vol. 6, p. 5-7Article in journal (Refereed)
  • 294.
    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).
    Asthma in Primary Care: Severity, Treatment and Level of Control2008Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Aims. The overall aim was to examine the severity, treatment and level of control in patients with asthma in primary care in Sweden. The specific aims were to assess what matters to asthma patients, evaluate symptoms, medication and identify factors related to asthma severity, compare the extent of asthma control in 2001 and 2005, and investigate the development of asthma and degree of asthma control in adolescents and young adults who had reported asthma six years earlier.

    Methods. The first study was a telephone interview of a representative sample of Swedish asthmatics. In the second study a random sample of 1,136 patients answered two questionnaires. A classification of the asthma severity similar to that in the GINA guidelines was made. In the third study two surveys were performed, in 2001 and in 2005, with a random sample of 1,012 and 224 asthma patients, respectively, and a classification of asthma control similar to the recent GINA guidelines was made. In the fourth study 71 individuals who reported physician-diagnosed asthma in a population-based survey in 1997 and were defined as current asthmatics, were reinvestigated in 2003 with a skin prick test, methacholine challenge test, eucapnic voluntary hyperventilation test and measurement of exhaled nitric oxide.

    Results. Common situations causing symptoms of asthma were physical exertion and contact with pets. Nocturnal symptoms were frequent. In primary care 35% of the women and 24% of the men were classified as having severe asthma. Female sex, increasing age, not filling the asthma prescription owing to cost, daily smoking, and pollen allergy increased the odds of having severe asthma. In 2001, 37% had achieved asthma control, as compared with 40% in 2005. Uncontrolled asthma was more common in women and smokers. In the 2003 study of adolescents and young adults with asthma six years earlier, the definition of current asthma was fulfilled by 50 of the 71 subjects and one third had achieved asthma control.

    Conclusions. The majority of the asthmatics reported a large number of symptoms and limitations in their daily living. Many asthma patients in primary care have insufficient asthma control. One reason for lack of control might be undertreatment with inhaled corticosteroids.

    List of papers
    1. Living with asthma in Sweden: the ALMA Study
    Open this publication in new window or tab >>Living with asthma in Sweden: the ALMA Study
    Show others...
    2003 (English)In: Respiratory Medicine, ISSN 0954-6111, E-ISSN 1532-3064, Vol. 97, no 7, p. 835-843Article in journal (Refereed) Published
    Abstract [en]

    Background: Recently performed studies have found a number of limitations in the daily lives of asthmatics, and a large disparity between the perception of the sufferers and what health care professionals believe matters to asthmatics. Aim: What matters to Swedish asthma patients, what medicines do they use, and are they compliant with given prescriptions? A further aim was to compare perceptions about asthma and asthma management in asthmatics and among Swedish general practitioners (GP). Design: A structured telephone interview of a representative sample of Swedish asthmatics, and a mailed questionnaire survey among GPs from different parts of Sweden. Methods: Screening by telephone of a random sample of 10,350 subjects aged 18–45. Of those, 240 were subsequently selected for a detailed structured telephone interview about their asthma. A mailed structured questionnaire containing similar questions to those asked of the asthmatics was sent to 600 GPs, and 139 returned completed answers. Results: 16% of the asthmatics reported (asthma) symptoms occurring every day during the previous month. Nocturnal symptoms at least twice per week were reported by 19%. Both these were reported by considerably higher proportions of the asthmatics than the GPs had expected. A large majority classified their disease as mild or very mild, although great majority reported frequent symptoms. Activities or situations which caused symptoms of asthma often or “now and then” were physical exertion, 67%; bad weather, 59%; contact with animals/pets, 58%; and visits to cafés or restaurants, 36%; and several asthmatics avoided these activities due to their asthma. Conclusion: A great majority of asthmatics report a large number of symptoms and limitations in their daily living in proportions which were roughly expected by the GPs.

    Keywords
    Asthma; Living restrictions; Symptoms; Medicines; Epidemiology
    National Category
    Respiratory Medicine and Allergy
    Identifiers
    urn:nbn:se:uu:diva-97664 (URN)10.1016/S0954-6111(03)00040-4 (DOI)000183882000012 ()12854635 (PubMedID)
    Available from: 2008-10-30 Created: 2008-10-30 Last updated: 2017-12-14Bibliographically approved
    2. Factors related to the level of severity of asthma in primary care
    Open this publication in new window or tab >>Factors related to the level of severity of asthma in primary care
    Show others...
    2007 (English)In: Respiratory Medicine, ISSN 0954-6111, E-ISSN 1532-3064, Vol. 101, no 10, p. 2076-2083Article in journal (Refereed) Published
    Abstract [en]

    BACKGROUND: The severity of asthma varies in patients in primary care. The aim of this study was to identify factors related to asthma severity in a primary care setting. METHODS: In this cross-sectional asthma study a random sample of 1477 patients, aged 15-45 years, from 42 primary health care centres received two questionnaires: one disease oriented and one quality of life oriented, MiniAQLQ. A classification of the asthma severity similar to the GINA guidelines was made with the information obtained from the questionnaire. The classification was based on current treatment, use of rescue medication, night symptoms, emergency consultations and use of oral steroids for treatment of exacerbations. RESULTS: Thirty-five per cent of the women and 24% of the men were classified as having severe asthma. Women used more inhaled corticosteroids, more often took long acting beta-2 agonists or a leukotrien antagonist in addition to corticosteroids, experienced more frequent night awakenings and were more often smokers than men. In a multivariable analysis, female sex increased the odds of having severe asthma by 60% as compared with male sex, age by 3% per year, not having the asthma prescription filled owing to cost by 59%, daily smoking by 66% and pollen allergy by 85%. CONCLUSIONS: Female sex, age, pollen and pet allergy, not having the asthma prescription filled owing to cost, and daily smoking were all independently associated with asthma severity.

    Keywords
    Asthma, primary care, asthma severity, sex
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:uu:diva-13900 (URN)10.1016/j.rmed.2007.05.016 (DOI)000249652000006 ()17628463 (PubMedID)
    Available from: 2008-01-28 Created: 2008-01-28 Last updated: 2017-12-11Bibliographically approved
    3. Asthma control in primary care in Sweden: a comparison between 2001 and 2005
    Open this publication in new window or tab >>Asthma control in primary care in Sweden: a comparison between 2001 and 2005
    Show others...
    2009 (English)In: Primary Care Respiratory Journal, ISSN 1471-4418, E-ISSN 1475-1534, Vol. 18, no 4, p. 279-286Article in journal (Refereed) Published
    Abstract [en]

    AIM: To compare the degree of asthma control in 2001 and 2005 in a primary care setting in Sweden. METHOD: Two similar questionnaire surveys were performed in 2001 and 2005 with 1,012 and 224 asthma patients aged 18-45 randomly selected from 42 and 56 primary health care centres, respectively. A classification of asthma control similar to the GINA guidelines was made using information obtained from the questionnaire. RESULTS: In 2001, 36.6% had achieved asthma control, 23.8% were partly controlled and 39.6% uncontrolled. In 2005, the corresponding figures were 40.2%, 26.8% and 33.0%, respectively, with no difference between the two surveys (p=0.114). Uncontrolled asthma was more common in women (p<0.001 in the first and p<0.05 in the second survey) and smokers (p<0.01 in the first and p<0.01 in the second survey). The use of combination corticosteroid/long-acting bronchodilator inhalers had increased - 34.2% and 48.2%, respectively (p<0.001) - and many patients used their inhaled corticosteroids periodically. CONCLUSION: In spite of treatment guidelines many patients in Swedish primary care still have insufficient asthma control.

    Keywords
    Asthma, primary care, asthma control, GINA guideline, Sweden, questionnaire surveys
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:uu:diva-97666 (URN)10.4104/pcrj.2009.00024 (DOI)19455269 (PubMedID)
    Available from: 2008-10-30 Created: 2008-10-30 Last updated: 2017-12-14Bibliographically approved
    4. A follow up of adolescents and young adults with asthma:  airway hyperresponsiveness and asthma control.
    Open this publication in new window or tab >>A follow up of adolescents and young adults with asthma:  airway hyperresponsiveness and asthma control.
    (English)Article in journal (Refereed) Submitted
    Identifiers
    urn:nbn:se:uu:diva-97667 (URN)
    Available from: 2008-10-30 Created: 2008-10-30 Last updated: 2012-01-09Bibliographically approved
  • 295.
    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.
    Hur mår och hur behandlas patienter med astma i primärvården: [Halvtidskontroll]2006Report (Other academic)
  • 296.
    Ställberg, Björn
    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 , Centrum för klinisk forskning i D län (CKFD).
    Ekström, T
    Neij, F
    Olsson, P
    Skoogh, B-E
    Wennergren, G
    Löfdahl, C-G
    A real-life cost-effectiveness evaluation of budesonide/formoterol maintenance and reliever therapy in asthma2008In: Respiratory Medicine, ISSN 0954-6111, E-ISSN 1532-3064, Vol. 102, no 10, p. 1360-1370Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE

    To evaluate direct asthma-related costs in Swedish primary care in a real-life setting. DESIGN: 12-month open-label study.

    SETTING

    Swedish primary care in a real-life setting.

    PARTICIPANTS

    1776 patients with persistent asthma.

    INTERVENTIONS

    Patients with persistent asthma were randomised to one of three treatments: a free adjustable combination of budesonide (100-400 microg/inhalation) and formoterol (4.5 or 9 microg/inhalation) via separate inhalers plus terbutaline as needed; budesonide/formoterol (160/4.5 microg or 80/4.5 microg, two inhalations twice daily) plus terbutaline as needed; budesonide/formoterol (160/4.5 microg or 80/4.5 microg, one inhalation twice daily or two inhalations once daily), for maintenance plus additional inhalations as needed. Doses depended on previous inhaled corticosteroid dose. Patients attended the clinic at 0, 1.5, and 12 months. Telephone interviews were conducted at 4, 6, 8, and 10 months.

    MAIN OUTCOME MEASURES

    The primary endpoint was direct asthma-related healthcare costs.

    RESULTS

    Statistically significant reductions in annual direct costs per patient were observed with budesonide/formoterol maintenance and reliever therapy compared with the free adjustable combination of budesonide and formoterol (-13%, P<0.001) and fixed-dose budesonide/formoterol plus terbutaline (-20%, P<0.001). Time to first severe exacerbation did not differ significantly across treatment groups, with a mean reduction of 28% versus the free adjustable combination of budesonide and formoterol (P=0.076). Patients receiving budesonide/formoterol maintenance and reliever therapy used a significantly lower daily dose of budesonide compared with the conventional (P<0.001).

    CONCLUSIONS

    This study reports direct cost savings with budesonide/formoterol maintenance and reliever therapy compared with conventional treatment regimens with at least equivalent efficacy.

  • 297.
    Ställberg, Björn
    et al.
    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, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm , Centrum för klinisk forskning i D län (CKFD).
    Hedenström, Hans
    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.
    A follow up of adolescents and young adults with asthma:  airway hyperresponsiveness and asthma control.Article in journal (Refereed)
  • 298.
    Ställberg, Björn
    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.
    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.
    Bergentz, S
    Nilholm, L
    Steinholtz, L
    Westring, L
    Jansson, C
    KOL-exacerbationer i Uppsala-Örebroregionen: resultat från Praxisstudien2006Conference paper (Other academic)
  • 299.
    Ställberg, Björn
    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 , Centrum för klinisk forskning i D län (CKFD).
    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.
    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.
    Janson, Christer
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology.
    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.
    Asthma control in primary care in Sweden: a comparison between 2001 and 20052009In: Primary Care Respiratory Journal, ISSN 1471-4418, E-ISSN 1475-1534, Vol. 18, no 4, p. 279-286Article in journal (Refereed)
    Abstract [en]

    AIM: To compare the degree of asthma control in 2001 and 2005 in a primary care setting in Sweden. METHOD: Two similar questionnaire surveys were performed in 2001 and 2005 with 1,012 and 224 asthma patients aged 18-45 randomly selected from 42 and 56 primary health care centres, respectively. A classification of asthma control similar to the GINA guidelines was made using information obtained from the questionnaire. RESULTS: In 2001, 36.6% had achieved asthma control, 23.8% were partly controlled and 39.6% uncontrolled. In 2005, the corresponding figures were 40.2%, 26.8% and 33.0%, respectively, with no difference between the two surveys (p=0.114). Uncontrolled asthma was more common in women (p<0.001 in the first and p<0.05 in the second survey) and smokers (p<0.01 in the first and p<0.01 in the second survey). The use of combination corticosteroid/long-acting bronchodilator inhalers had increased - 34.2% and 48.2%, respectively (p<0.001) - and many patients used their inhaled corticosteroids periodically. CONCLUSION: In spite of treatment guidelines many patients in Swedish primary care still have insufficient asthma control.

  • 300.
    Ställberg, Björn
    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 , Centrum för klinisk forskning i D län (CKFD).
    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.
    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.
    Factors related to the level of severity of asthma in primary care2007In: Respiratory Medicine, ISSN 0954-6111, E-ISSN 1532-3064, Vol. 101, no 10, p. 2076-2083Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The severity of asthma varies in patients in primary care. The aim of this study was to identify factors related to asthma severity in a primary care setting. METHODS: In this cross-sectional asthma study a random sample of 1477 patients, aged 15-45 years, from 42 primary health care centres received two questionnaires: one disease oriented and one quality of life oriented, MiniAQLQ. A classification of the asthma severity similar to the GINA guidelines was made with the information obtained from the questionnaire. The classification was based on current treatment, use of rescue medication, night symptoms, emergency consultations and use of oral steroids for treatment of exacerbations. RESULTS: Thirty-five per cent of the women and 24% of the men were classified as having severe asthma. Women used more inhaled corticosteroids, more often took long acting beta-2 agonists or a leukotrien antagonist in addition to corticosteroids, experienced more frequent night awakenings and were more often smokers than men. In a multivariable analysis, female sex increased the odds of having severe asthma by 60% as compared with male sex, age by 3% per year, not having the asthma prescription filled owing to cost by 59%, daily smoking by 66% and pollen allergy by 85%. CONCLUSIONS: Female sex, age, pollen and pet allergy, not having the asthma prescription filled owing to cost, and daily smoking were all independently associated with asthma severity.

345678 251 - 300 of 356
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