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Biomedical subjects

A Isacsson

Publications and source records attributed to A Isacsson.

At least 37 records · Page 2Linked to original sources
PubMed1997

Health, health care utilization and living conditions in foreign-born diabetic patients in southern Sweden.

OBJECTIVES: To compare foreign- and Swedish-born diabetic subjects regarding health care utilization, complications, clinical and socio-economic characteristics. DESIGN: Cross-sectional study. SETTING: All known diabetic patients living in six defined primary health care districts. SUBJECTS: Of 1861 identified subjects aged > 25 years 90.1%. 113 foreign- and 1564 Swedish-born subjects participated. Mean time of residence in Sweden was 32 +/- 1.2 years, 93% > 10 years. MAIN OUTCOME MEASURES: A standardized interview, a physical examination and an evaluation of medical records. RESULTS: No differences were found regarding living conditions or health care utilization, with the exception of higher use of home-care from public authorities in Swedish-born subjects (P < 0.05) despite no difference in dependency on help according to Katz's ADL index. There were no major differences in objective health (glycaemic control and complications related to diabetes) with the exception of lower frequency of sensory neuropathy (P < 0.01) and peripheral vascular disease (P < 0.05) in foreign-born subjects. The prevalence of diabetes was 2.1% (95% CI 1.7-2.5) in the foreign-born and 2.6% (95% CI 2.5-2.7) in Swedes. Foreign-born individuals were five years younger (P < 0.001), were more often diagnosed > or = 30 years (P < 0.05), had a two years' shorter duration of disease (P < 0.001) and were less often treated with insulin (P < 0.01). Treatment with insulin was related to the duration and presence of complications related to diabetes. CONCLUSIONS: There were no major differences in objective health or use of health care in European migrants with diabetes mellitus, mainly Scandinavians, with short cultural distance and long residence in Sweden compared to Swedish-born diabetic patients.

Activities of Daily Living↗
PubMed1997

HIV/AIDS--information and knowledge: a comparative study of Kenyan and Swedish teenagers.

Knowledge of hiv/aids, exposure to hiv/aids information and appreciation of given information was studied, by a questionnaire, among 326 Kenyan and 146 Swedish teenage school students in 1994. The aim of the study was to examine differences and similarities in knowledge in the two populations and to examine which sources of information about hiv and aids the respondents had been exposed to and which were most appreciated. The overall knowledge about hiv/aids was high but in specific items the knowledge and awareness of different risk behaviours for contracting hiv/aids differed for the Kenyan and Swedish teenagers. The dissemination of hard factual information about hiv/aids has thus been successful in reaching out although not in stopping the spread of hiv/aids. This calls for new strategies in disease prevention and health promotion. Those strategies should focus much more on lifestyle changes. The health care system, the school and the existing strong civil and voluntary information structures have an important role to play in that work.

Adolescent↗
PubMed1997

Evaluation of a self-reported questionnaire on hand dermatosis in secondary school children.

The purpose of this study was to investigate the reliability and validity of a self-reported questionnaire for estimating the prevalence of hand eczema and other hand dermatoses. All pupils in grades 1 and 3 from the secondary schools in Växjö, in southern Sweden, were invited to participate in the study, which consisted of two parts, a questionnaire and a clinical examination. Of those invited, 2572 (98.6%) responded to the questionnaire. Of the respondents, 2535 pupils (98.5%) were clinically examined. The kappa value for the questionnaire findings, compared with the diagnosis from the clinical examination, was 0.79, indicating good agreement. The sensitivity of the questionnaire findings was 73% (95% confidence interval [CI]: 0.6425-0.7975), and the specificity was 99% (95% confidence interval [CI]: 0.9860-0.9940). The self-reported questionnaire was suitable for detecting hand dermatosis in a population of secondary school children and may be used as a cost-effective and reliable method of investigating the prevalence of hand dermatosis in epidemiological studies.

Child↗
PubMed1997

Quality of life after gastroplasty is normal: a controlled study.

OBJECTIVE: To assess the quality of life of patients 1 1/2-5 1/2 years after vertical banded gastroplasty for morbid obesity. DESIGN: Retrospective study by questionnaire. SETTING: University hospital, Sweden. SUBJECTS: 102 of the 127 patients (80%) operated on for morbid obesity between January 1989 and February 1993 responded to the questionnaire. 74 patients who underwent routine cholecystectomy were matched for age and time of surgery, of whom 55 (74%) responded to the questionnaire and acted as controls. INTERVENTION: Standardised questionnaire of 112 items, 28 of which referred to problems with eating (Gothenburg Quality of Life Scale). MAIN OUTCOME MEASURES: Differences in scores between the groups. RESULTS: Gastroplasty caused profound changes in patients' lives, cholecystectomy did not. This was reflected in self esteem, relations with partners, and social networking for both sexes. There was no difference between groups in overall quality of life, the mean (SEM) scores for women being 5.32 (0.09) compared with 5.33 (0.07) and for men 5.32 (0.17) compared with 5.40 (0.14). CONCLUSION: Vertical banded gastroplasty seems to offer morbidly obese patients not only reduction in weight but also improved quality of life.

Adult↗
PubMed1996

Changes in cardiovascular risk factors by combined pharmacological and nonpharmacological strategies: the main results of the CELL Study.

OBJECTIVE: The objectives of the Cost Effectiveness of Lipid Lowering (CELL) study were twofold: (i) to evaluate the effect on overall cardiovascular risk of two types of health care advice ("usual' and "intensive') given in primary care, with or without pharmacological medication, with the target being to attain a moderate decrease in cholesterol; (ii) to evaluate the ritual of daily medication on compliance with the health care advice. DESIGN: A prospective, double-blind, randomized, controlled trial of 18 months' duration. SETTING: The study was carried out in 32 health centres (out of a total of approximately 850) in Sweden. SUBJECTS: In all, 681 subjects, aged 30-59 years, were randomized. They had at least two cardiovascular risk factors in addition to moderate primary hyperlipidaemia (total cholesterol of at least 6.50 mmol L-1 on three occasions measured by Reflotron triglycerides less than 4.0 mmol L-1 and an LDL:HDL cholesterol ratio of more than 4.0). Most (87%) of the subjects were males; 626 subjects (92%) completed the 18-month follow-up. INTERVENTION: Half the subjects were randomized to 'intensive advice' given in group sessions led by doctors and nurses in primary care. The other half received 'usual advice'. In each of the two advice groups, one-third received an active lipid-lowering drug (pravastatin), one-third placebo, and one-third no drug at all. The tablets were titrated to achieve a 15% reduction in cholesterol. MAIN OUTCOME MEASURES: Changes in the overall Framingham risk score, and the development of adverse events in each group. RESULTS: The change in Framingham risk score was significantly reduced only in subjects taking lipid-lowering medication (together with intensive advice -0.13; 95% CI-0.20, -0.06, and together with usual advice -0.16; 95% CI -0.23, -0.09). The other subjects receiving intensive advice tended to fare better than those on usual advice. Lifestyle was not influenced significantly over the study period. The ritual of daily medication did not affect the outcome. CONCLUSION: As expected, lipid-lowering medication reduced serum cholesterol as well as overall cardiovascular risk in subjects with several risk factors for cardiovascular disease. There was no additive effect of intensive advice to these subjects. However, there was a meagre but significant effect of intensive advice in subjects not receiving active lipid-lowering drugs. One explanation for this difference may be that those on active lipid-lowering medication who had substantial drops in cholesterol might have felt less inclined to change their lifestyle compared with those on other treatment regimens who had less successful drops in cholesterol. There was no benefit from the ritual of taking daily medication.

Adult↗
PubMed1996

Foreign- and Swedish-born diabetic patients--a population-based study of prevalence, glycaemic control and social position.

In this study foreign- and Swedish-born individuals with diabetes mellitus were compared regarding prevalence and characteristics. In a Swedish county 1,568 patients aged 20-64 years were identified, of whom 97.4% were included (143 foreign- and 1,384 Swedish-born) in the study of medical records. There was no difference in prevalence of diabetes (1.4% (95% CI 1.2-1.7%) vs 1.5% (95% CI 1.4-1.6%) but diagnosis at or after the age of 30 years was more common in foreign-born patients (p < 0.001). They were also less often treated with insulin (p < 0.001), had shorter duration of diabetes (p < 0.001), were more often classified as having a low social position in Sweden (p < 0.001) and less often controlled in specialized diabetes care departments (p < 0.001, 18% vs 43%). There was a higher occurrence of albuminuria among foreign-born women (p < 0.05). No differences were found in glycaemic control, but low social position was related to poor glycaemic control independent of being foreign- or Swedish-born, and it seems to be more important than place of birth.

Adult↗
PubMed1995

Ability of a trained primary healthcare nurse to discriminate dementia from other psychogeriatric disorders.

The aim of this study was to evaluate the ability of a trained primary health care (PHC) nurse to discriminate dementia, by systematic assessments, from other psychogeriatric diseases. The reported study emanates from a dementia prevalence survey in an elderly (65+) population (n = 851). Forty-two frail elderly people (mean age 77.8 years) referred to a psychogeriatric hospital for further clinical investigation were tested. Dementia rating scales were used by the trained nurse, who noted her clinical observations systematically as well. The instrument results of the testing procedures, evaluated in combination with the clinical picture of the patients, were correlated to the DSM-III-R criteria of dementia. Thereafter, the nurse's judgements were compared with the clinical diagnoses based on thorough geropsychiatric investigations. The nurse's diagnoses of moderate and severe dementia had a sensitivity of 80% and a specificity of 82%. The predictive value of a positive test for moderate and severe dementia was 87%. When the mildly demented patients were included, sensitivity was 93%, specificity was 75%, positive predictive value was 90%, and kappa value was .70.

Aged↗
PubMed1995

Social network, social support and the prevalence of neck and low back pain after retirement. A population study of men born in 1914 in Malmö, Sweden.

In this study we investigated the importance of social network and social support systems outside the workplace and workload and psychological job strain in former work for the prevalence of daily neck and low back pain. The study population (n = 621) comprised a random half of all male residents in Malmö, Sweden, born in 1914, of whom 500 (80.5%) participated. Two of the social network and social support indices (social anchorage and availability of material and informational support) were independent of life-style factors (leisure time physical activity, smoking and alcohol consumption) related to daily neck and back pain after retirement (OR = 2.0, 95% CI 1.2-3.4 and OR = 1.7, 95% CI 1.0-2.7, respectively), while the psycho-social and physical factors in former work were not. As no conclusion about the direction of the association can be drawn, prospective studies are needed to further explore these findings.

Aged↗
PubMed1995

Migration and health. A study of Latin American refugees, their exile in Sweden and repatriation.

OBJECTIVE: To analyse and elucidate the migration process in order to identify psycho-social themes which might act as stressors with influence on health. DESIGN: Qualitative in-depth interviews with eleven strategically selected Latin American refugees. SETTING: Latin American refugees living in Lund, a university town, and those who were repatriated to Santiago, Chile. PARTICIPANTS: 11 Latin Americans of whom 4 were repatriated to Chile. RESULTS: The migration process was divided into four courses of events: cultural background and everyday life; organized violence; the exile; the repatriation. "Themes" such as cultural and working identity and high control were extracted from the dialogues as central buffering factors against microbiological or physicochemical disease agents harboured by the individual. CONCLUSIONS: During the exile the cultural barrier, social degradation, guilt, social passivity, and ideological alienation cause a changed identity and low control which increase the vulnerability to psychological distress and physical disease.

Adaptation, Psychological↗
PubMed1994

Caring for demented elderly in rural primary health care.

In 1988, the demented in an elderly rural population (n = 851) were traced and assessed with the GBS geriatric rating scale. The aim of the study was to investigate the level of impairments of demented persons primary cared for and to relate their impairments to form of housing; to compare the distribution of care between not-demented and demented in an elderly population, and to establish the primary caregiver/patient ratio. The majority of the demented (44/50) were cared for in the studied primary health care area, despite the scarcity of staff. All received formal care. They consumed more formal care than the not-demented in the population. In relation to amount of elderly persons helped, the home-help personnel ratio was 0.30, in district care the ratio was 0.02, whereas the ratio of general practitioners was 0.002, estimated from the number of contacts and staff.

Activities of Daily Living↗
PubMed1994

Quality by selection and purchasing of urinary incontinence aids-- perceptions of nurses and administrators.

In a qualitative-quantitative study, differences in the perceptions of nurses and administrators (admin's) dealing with the purchasing of urinary incontinence (UI) aids were studied by means of interviews with a cognitive and emotional approach. Various aspects of purchasing were concentrated on: cooperation, strategy, competence, costs, measures, and decisions, as well as quality in the selection of aids in order to improve quality of care and achieve better economy. The findings show a continued need for centrally coordinated purchasing (CCP), not least related to the European Community, and also problems of integration. Due to the decentralization process, the nurses perceived a need for more education in overall business strategies in order to underline more constructively their caring and patient-oriented opinions. The admin's experienced uncertainty in their purchasing activities caused by the absence of purchasing policies and lack of knowledge of new demands and routines.

Administrative Personnel↗
PubMed1994

Urinary incontinence in primary health care. 1. Perceived knowledge and training among various categories of nursing personnel and care units.

OBJECTIVES: To investigate perceived knowledge, skills and education of urinary incontinence (UI), focusing on UI facts, product assessment, and quality of care. DESIGN: A quantitative-qualitative questionnaire study. SETTING: Three different care units; a health care centre, a nursing home, and a geriatric clinic in Sweden. SUBJECTS: 254 nurses, nursing assistants, and auxiliary nurses. MAIN OUTCOME MEASURES: Responses to questionnaire. RESULTS: The study shows fragmentary knowledge about UI facts, aid products, and costs, and a lack of holistic view. The differences in knowledge between the groups were small but registered nurses generally showed better results, probably due to their longer vocational training. The health care centre had the best total knowledge as regards facts about UI. CONCLUSION: All categories of nursing personnel wanted more knowledge about UI care and aids, which indicates that improvements in quality of care could be achieved by increasing product awareness.

Adult↗
PubMed1994

Urinary incontinence in primary health care. 2. Care routines and consequences--perception of various categories of nursing personnel and care units.

OBJECTIVE: To find out whether the nursing personnel's perceptions of urine incontinence (UI) care routines and patient observations were in agreement with quality of care, and to analyse differences between nursing personnel categories and care units. DESIGN: A quantitative-qualitative questionnaire study. SETTING: Three different care units; a health care centre, a nursing home, and a geriatric clinic in a county in Sweden. SUBJECTS: 254 nurses, nursing assistants, and auxiliary nurses. MAIN OUTCOME MEASURES: Responses to questionnaire. RESULTS: Faulty perception of UI, diagnosis and treatment possibilities. Care routines about hygiene and integrity, and knowledge about volume frequency chart, selection and changing of pads seemed to be indulgent. Registered nurses showed slightly better results than the other groups, even if the differences were small. There were no significant differences between the care units, but the health care centre had the best total result as regards patient observations. CONCLUSION: The study confirmed that the nurses used faulty procedures to achieve quality of care. The study especially highlighted the role of nurses in primary health care, but since UI is a multidisciplinary symptom it demands interest and UI qualification of all personnel groups in the primary health care team.

Analysis of Variance↗
PubMed1993

Mortality rates in a cardiovascular 'low-risk' population in rural Crete.

A research project in primary health care has been in progress since 1988 in an agricultural area of Crete, with the aim of surveying the cardiovascular risk profile and following the incidence of cardiovascular disease in the population over time. In the present paper we have investigated the mortality rates and the causes of death in 1989 and 1990 of the population of the Agios Vassilios county (n = 7758). Furthermore, whenever possible, we have checked the accuracy of the certified causes of death against the case record system introduced in 1988 in the health centre. During 1989 and 1990, 267 subjects died in the research area, 234 of whom were > 65 years old. Diseases of the circulatory system (mostly congestive heart failure) accounted for 46% of all deaths. The corresponding figure for neoplasms was 18%. The standardized mortality from ischaemic heart disease was found to be very low in both men and women, 37.9 and 41.9 per 100,000 per year, respectively, in comparison with that of Greece as a whole in 1989, 140.0 and 59.5, respectively. These figures were considerably lower than those reported in 1988 from for example Sweden, 303.6 and 153.3, respectively. The standardized mortality from cerebrovascular disease in Agios Vassilios county was found to be somewhat lower than the national figures in 1989, 118.1 and 107.0 in males and females versus 135.7 and 142.1, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1993

Electrocardiographic signs of coronary heart disease in a "low risk" population in rural Crete.

BACKGROUND: Ischemic heart disease (IHD) has been shown to be very uncommon in the population of Crete. Therefore, we established a research project in a rural part of Crete to survey the cardiovascular risk profile and follow the incidence of cardiovascular disease over time. This study investigated the prevalence of ECG abnormalities in the population of five villages and compared the prevalence of hypertension, obesity, diabetes, and hypercholesterolemia in those with and without ECG signs of IHD. METHODS: A cross-sectional study was conducted in a group from 15 to 79 years of age (n = 1218); overall attendance was 926 (76%). Studies included case history, clinical status, laboratory variables, and 12-lead ECG. Technically acceptable ECGs were read and coded blindly for 895 subjects (97%). RESULTS: Minnesota codes suggesting "Probable IHD" were recorded in 3.3% of the women and 3.5% of the men from 45 to 79 years of age. Hypertension was more common in subjects with than in those without "Probable IHD." This also tended to be the case for diabetes. Cholesterol and body mass index were relatively high in both groups. CONCLUSIONS: The present prevalence of "Probable IHD" in Cretans appears to be very similar to that observed in other population surveys. Also, the contemporary cardiovascular risk factor profile in the population was quite unfavorable, with a relatively high prevalence of smoking, dyslipidemia, hypertension, and diabetes. The prevalence of "Probable IHD" was lowest in the village where the health center was situated (1% vs 4.5%), and this difference was also reflected in differences among the villages of some important risk factors for IHD as well as in the way patients with hypertension and other diseases were cared for. Thus, it seems IHD is becoming more prevalent in the "low risk" population of Crete. This may very well be a result of a more unfavorable lifestyle and a higher rate of risk factors than before.

Adolescent↗
PubMed1993

Basic accessibility in modern housing--a key to the problems of care in the domestic setting.

The purpose of this study was to investigate public grants for housing adaptation in modern housing and to explore attitudes to accessibility problems. Grants for housing adaptation in apartments in blocks of flats built during the 1980s in a Swedish urban district were investigated over a 3-year period. Twenty-nine apartments had been adapted, in most cases by making a few simple alterations. Interviews with key persons in the building process stated that the most common measures would have cost less if they had been planned as 'basic accessibility'. The most important reasons why accessibility problems still persisted were building traditions, lack of knowledge about disability, and technical problems. Occupational therapists have a wide knowledge of housing adaptation. Adding their competence to the planning process would most likely increase activity and improve quality of life for disabled individuals. This study indicates that positive effects on the public economy could be achieved by putting 'basic accessibility' into practice.

Aged↗
PubMed1993

Differences in the diagnose panorama in primary health care in Dalby, Sweden and Spili, Crete.

We have compared the use of primary health care and the diagnoses at visits to doctors in the Spili Health Centre (SHC) in Crete and the Dalby Health Centre (DHC) in Sweden. In DHC more patients per 1000 population visited the doctors than in SHC. This was so regardless of age-group and sex, in fact more or less regardless of diagnosis. Other differences between the populations were: The diagnosis acute otitis media was more frequent in the Dalby children than in the Spili ones. The opposite was true of "head injuries" which were more frequent in the Spili boys. Visits to doctors for bronchitis was more frequent in the Spili men, maybe because of the extensive smoking habits of Cretan men. Visits for diseases of the musculoskeletal system were more frequent in DHC than in SHC. A hypothesis worth testing is that this was influenced by differences in the health insurance and sick benefit systems. Angina pectoris was fairly frequent in both areas but cardiosclerosis (including healed myocardial infarction) was more common in DHC than in SHC. Use of primary health care may be influenced by the need for health care in the population, the accessibility of the health care facilities, the costs for the patients, the quality of care as perceived by the patients and by other sociocultural factors. Comparative studies, even though fairly uncommon today, may be of use in generating hypotheses about the impact of different factors on the use of health care.

Adolescent↗