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Biomedical subjects

B Hagander

Publications and source records attributed to B Hagander.

At least 19 recordsLinked to original sources
PubMed2001

Early patient contact in primary care: a new challenge.

BACKGROUND: The Medical School of Lund University, Sweden, has introduced an early patient contact course, including training in communication and examination skills. The course runs parallel with theoretical subjects during the students' first two-and-a-half years. General practitioner (GP) participation is gradually increasing, and in the last half-year of the course GPs in all health centres in the area are involved. Little is known about the GPs' interest, competence and time for this new task. AIM: To describe the GPs' attitudes towards teaching and the rewards and problems they experience. SUBJECTS: 30 GPs teaching third-year medical students. METHOD: Semistructured interview study. Data analysis by a method described by Malterud. RESULTS: The attitude towards teaching was mostly positive and the teachers were confident about teaching examination procedure. Among rewards of teaching, improved quality of clinical practice was the main theme, but imparting knowledge to others, contact with enthusiastic students, and gains in self-esteem were also mentioned. Problems with teaching were mostly due to external factors such as lack of time and space, but concern about a negative effect on patient care was also recognized. Educational objectives of the course were not completely accepted. GPs were not fully aware about what to expect from the students, with subsequent problems concerning how to assess students' performance and how to give effective feedback. CONCLUSIONS: The teaching of junior medical students is maintained by the GPs' enthusiasm for teaching. However, teacher training is required and the crucial issues of time and space have to be considered.

Attitude of Health Personnel↗
PubMed2000

Infantile colic. Follow-up at four years of age: still more "emotional".

This paper presents a follow-up at 4 y of formerly colicky infants and controls, with respect to behaviour, temperament, eating and sleeping habits, psychosomatic complaints, number of hospital stays, growth and "family climate". There were no differences between the two groups in most parameters studied. However, ex-colicky children displayed more negative emotions according to the temperament scale. There were also more negative moods during meals, and more reported stomach-ache. Although relationships regarding crying and mother-infant interaction remain extremely complex, the findings point toward a possible temperamental contribution to the pathogenesis of the infantile colic syndrome.

Age Factors↗
PubMed1996

Infantile colic--less common than previously estimated?

A two-part population-based study investigating the occurrence of infantile colic was undertaken, in which 92% of mothers with newborn healthy infants were reached. In the prospective part 152 mothers ("diary group") registered crying and fussing in their infants during 12 weeks. In the retrospective part 224 mothers ("interview group") were contacted by telephone at an infant age of 5-7 months. The colic occurrence was determined according to four different definitions; the rate varied from 3.3 to 17.1%. The classical "Wessel-type" colic was present in 9.3%. Colic defined as "crying seen as a problem by parent" was present in 12.1% of the "interview group", but in only 3.3% of the "diary group". Some earlier studies may have overestimated colic occurrence. Another possibility is an actual decline. The contributive part of preventive measures is discussed.

Colic↗
PubMed1995

Influence of processing and cooking of carrots in mixed meals on satiety, glucose and hormonal response.

The influence of processing and cooking on the metabolic response to carrots in mixed meals was explored in two consecutive harvest years. The contribution of dietary fibre (4.4 g 1989 and 6.6 g 1990) from carrots was chosen to be different in order to compare effects with varying doses. The meals, composed of carrots, creamed potatoes, meat balls, lingonberry jam, white bread and light beer, were served in the morning after an overnight fast to 10 healthy male volunteers. Carrots were investigated raw, processed (blanched and frozen) and variously cooked (thawed, boiled and microwaved). The amount of dietary fibre from the vegetable, and the content of energy, digestible carbohydrates, fat and protein were similar in the meals compared. Significantly lower glucose, insulin and C-peptide responses and higher satiety scores were elicited with raw carrots than with microwaved ones, harvest year 1989. The next year, with a higher dietary fibre intake from carrots, there were significant effects of processing only on the glucose response. Plasma beta-carotene levels tended to be higher postprandially with raw carrots than with microwaved ones. Hence, ordinary processing and cooking of vegetables can affect the metabolic response to a mixed meal. However, the influence seems to be varying and of minor importance in ordinary meals. Increasing vegetable portions entailing a higher soluble fibre content and a higher viscosity could further reduce the influence of processing.

Adult↗
PubMed1995

Satiety effects of spinach in mixed meals: comparison with other vegetables.

The effects of vegetables in mixed meals on satiety were evaluated by varying the dose (portions 150 and 250 g containing 4.3 and 7.2 g of dietary fibre, respectively) and structure (cut and minced) of microwaved spinach. A control meal without spinach and the test meals with spinach were balanced regarding energy (2000 kJ) and digestible carbohydrates (59 g, 51 E%) and with protein and fat as far as possible similar. The meals were served in the morning, after an overnight fast, to ten healthy male volunteers. Satiety was registered and blood glucose as well as plasma insulin and C-peptide were analysed at regular intervals until 3.5 h postprandially. The largest spinach portions augmented satiety and reduced the postprandial glucose response. The total satiety scores seemed to be correlated positively to both the dietary fibre and the water content in the vegetable. Differences in structure had no influence on satiety scores.

Adult↗
PubMed1995

Metabolic responses to starch in oat and wheat products. On the importance of food structure, incomplete gelatinization or presence of viscous dietary fibre.

OBJECTIVE: Evaluate the importance of incomplete gelatinization, food structure and presence of viscous dietary fibre for the postprandial glycaemic and insulinaemic responses to oat and wheat products. DESIGN: Three common breakfast meals were tested, 'raw' rolled oats (muesli), boiled rolled oats (oat porridge) and white wheat bread. Boiled intact oat and wheat kernels (kernel porridges) were also included. For comparison, glycaemic indices (GIs) were calculated both from analysis of capillary and venous blood samples. SETTING: The study was performed at the research laboratory, Dalby Health Sciences Centre (primary care). SUBJECTS: Nine healthy male volunteers between 65 and 70 years of age participated in the study. RESULTS: The rolled oats and oat porridge elicited high metabolic responses. No differences in the glycaemic and insulinaemic indices (IIs) were seen between these products and white wheat bread. In contrast, the kernel porridges produced low glucose and insulin responses. No differences were obtained in GI values whether based on capillary or venous blood. However, with some products capillary blood allowed smaller differences to be detected. CONCLUSIONS: Neither incomplete gelatinization in rolled oats nor naturally occurring viscous dietary fibre in oats affect postprandial glycaemia, whereas enclosure of intact kernels significantly blunt metabolic responses.

Aged↗
PubMed1994

Dyspepsia in general practice: history and symptoms in relation to Helicobacter pylori serum antibodies.

BACKGROUND: This study was designed to explore the relationships between serologic Helicobacter pylori positivity and demographic, behavioural, and symptomatologic factors in patients consulting for dyspeptic symptoms in general practice. METHODS: H. pylori enzyme-linked immunosorbent assay results and checklist data were collected by general practitioners at three community health centers in southern Sweden from consecutive patients aged 18-65 years with upper abdominal pain or discomfort (dyspepsia). RESULTS: Of the 130 available patients with dyspepsia, 127 agreed to participate, 45 (mean age, 41.2 years) being classified as H. pylori-positive and 82 (mean age, 33.5 years) as H. pylori-negative. Manual workers were diagnosed as H. pylori-positive significantly more often than were non-manual workers (p < 0.05). Of those patients examined earlier by gastroscopy or roentgenography, H. pylori-positives reported stomach or duodenal ulcer significantly more often than did H. pylori-negatives (p < 0.01). H. pylori-positives reported stomach/duodenal ulcer in their parents/siblings to a significantly greater extent than did H. pylori-negatives (45.2% versus 10.1%, p < 0.001). H. pylori-negatives reported stress-generated symptoms significantly more often than did H. pylori-positives (82.9% versus 61.5%, p < 0.01). Hierarchical regression analyses showed that, when age and sex were controlled for, the ability of each of these measures to predict the serologic results remained significant. CONCLUSIONS: Higher levels of H. pylori antibodies in dyspeptic patients appear to be associated with a relatively low self-perception of stress, with manual work, with being older, and with the occurrence, both in the patients themselves and in their close relatives, of stomach/duodenal ulcer.

Abdominal Pain↗
PubMed1994

Dose-response effects of boiled carrots and effects of carrots in lactic acid in mixed meals on glycaemic response and satiety.

OBJECTIVE: To evaluate the effect of dosage on the metabolic response to vegetables added to a mixed lunch meal, and to relate the amounts to the tripartite plate model. Carrots were chosen as an example, and the carrots were blanched, frozen and boiled to include possible effects of processing and cooking. The effects of carrots steeped in lactic acid, as produced at fermentation, were also studied. DESIGN: The test meals with carrots, and the control meal without vegetables, were balanced regarding energy (2000 kJ) and digestible carbohydrates (60 g) and similar in fat (17 g) and protein (16-19 g) content. The carrot portions of 100, 200 and 300 g contained 2.9, 5.8 and 8.7 g dietary fibre respectively. The meals were served in the morning after an overnight fast and in random order. Blood samples for the analysis of blood glucose, plasma insulin and C-peptide were collected and satiety was graded until 210 min postprandially. SETTING: The study was performed at the research laboratory, Dalby Health Sciences Centre (primary care). SUBJECTS: The 10 healthy, male volunteers, around 40 years of age, were recruited at random from the district's population list. None dropped out. RESULTS: The larger the carrot portion the lower were the glucose and insulin/C-peptide responses and the higher the satiety scores. The minimum amount causing significant effects was 200 g. According to the plate model, 200 g of boiled carrots was the most that could be included on half the plate. Addition of lactic acid to 200 g carrots augmented the effects on satiety scores and hormonal response. CONCLUSIONS: The addition of generous amounts of vegetables to a mixed meal improves the metabolic response.

Adult↗
PubMed1993

Effects of different vegetables in mixed meals on glucose homeostasis and satiety.

Different vegetables--carrots, peas, Brussels sprouts and spinach--were added to a typical Swedish lunch test meal in portions of 96-164 g. The test and the control meals without vegetables were balanced with respect to digestible carbohydrates (59.7 g) and energy (2000 kJ, 475 kcal), and as far as possible also concerning protein and fat. The added vegetables contained 4.4 g dietary fibre. The meals were prepared by microwave heating and served in the morning after an overnight fast to 10 healthy, male volunteers. Postprandial blood glucose, plasma insulin and C-peptide levels were measured at regular intervals until 210 min. The satiety was graded on a simple scale of 1-10. The meal with spinach elicited significantly lower insulin and C-peptide responses than the control meal, but no significant differences in glucose response or satiety were observed. The other vegetables tested showed no significant effects either on glucose and hormonal responses or on satiety.

Adult↗
PubMed1991

Antenatal care in southern Sweden. A population-based prospective study describing the diagnostic panorama of pregnancy.

All pregnant women from the catchment areas of three health centres in southern Sweden, registered for antenatal care during the calendar year 1986, were included in the study population. Four hundred and nine women could be prospectively followed throughout pregnancy. By 15 completed weeks, 95% of the women were registered at an antenatal clinic. Only 2 women had no antenatal care at all. During the course of pregnancy the 409 women made altogether 6,058 (mean 14.8) visits to the health and medical services, most of them (95%) were to an antenatal clinic. Common obstetrical problems were vaginitis, symphysiolysis, threat of preterm labour, and vaginal bleeding; and common non-obstetrical problems were low back pain and respiratory tract infections. During pregnancy 42% of the women were prescribed some sort of medication, and 53% were sicklisted on one or more occasions. The outcome of pregnancy was comparable to figures for all Sweden.

Adult↗
PubMed1991

On the importance of processing conditions, product thickness and egg addition for the glycaemic and hormonal responses to pasta: a comparison with bread made from 'pasta ingredients'.

The importance of processing conditions, product thickness and effect of egg addition for the glycaemic and hormonal responses to pasta was studied. Healthy subjects were given test meals with an equivalent amount of available carbohydrate from extruded high-temperature dried spaghetti and three varieties of fresh roll-sheeted linguine (thick, thin, thin with egg) made from the same ingredients (durum wheat, water and monoglycerides). As a reference bread was baked from the same ingredients as in the pasta products. Glucose, insulin and C-peptide levels were measured over a 3 h period. Glycaemic, insulin and C-peptide indexes (GI, II, CI) were calculated using 120 min areas under the curves. Glycaemic index was also calculated using the 90 min area. Also studied were the rates of in vitro starch digestion. The four pasta products produced significantly lower peak values (glucose, insulin, C-peptide) and lower GI (90 min), II (120 min) and CI (120 min) than the corresponding bread. The rate of in vitro starch digestion in pasta was also slower than in bread. In contrast to the pasta products, bread resulted in a prominent hypoglycaemia in the late phase, that is a drop below fasting blood glucose level. Minor differences in metabolic responses also appeared in the pasta products. In particular, the insulin and C-peptide response to the thin linguine was accentuated in the phase around 120 min.

Blood Glucose↗
PubMed1989

The effect of various thermal processes on the glycemic response to whole grain wheat products in humans and rats.

The effects of different thermal processes used to produce ready-to-eat cereals on the glycemic response to whole grain wheat were investigated in rats. The metabolic response to drum dried flour, which constitutes the major component in instant gruel and porridge, was also studied in healthy human subjects. Boiled flour was used for comparison. The degree of starch gelatinization and rate of starch hydrolysis in vitro were also measured. Incompletely gelatinized steam flaked and dry autoclaved products were digested more slowly in vitro and elicited lower glucose responses in rats compared with completely gelatinized drum dried, extrusion cooked or boiled samples. The initial glycemic response in rats was closely related to the rate of starch hydrolysis in the pepsin/alpha-amylase assay (r = 0.91, P less than 0.04). When pepsin was omitted, no significant correlation was obtained. The peak glucose, insulin and C-peptide responses in humans after breakfast meals of porridge prepared from drum dried flour and from boiled flour were similar, whereas the rate of depression of the glucose curve was more rapid after consuming drum dried porridge. It is concluded that the glycemic response to wheat products is affected by the processing conditions used. The more severe the processing conditions, the more rapid the digestion of starch.

Adult↗
PubMed1989

Dietary fibre enrichment, blood pressure, lipoprotein profile and gut hormones in NIDDM patients.

The influence of a beet-fibre enriched diet (mean 40 g FibrexR, 27 g dietary fibre per day) on blood pressure, plasma lipoproteins and glycaemic control was studied in 12 non-insulin-dependent diabetic (NIDD) patients. The effect on gastrointestinal hormones was also investigated. Beet-fibre and control diets were given in randomized order for 8 weeks each. During the beet-fibre diet the systolic blood pressure decreased (P less than 0.05) and the HDL-cholesterol levels increased (P less than 0.05) compared to values before the study. There was a tendency for systolic blood pressure to be lower also in the control period, but this was not statistically significant. After both diet periods the total plasma cholesterol and triglyceride levels decreased, as well as the LDL/HDL ratio. Blood glucose levels--fasting or postprandial--and glycosylated haemoglobin were not affected during the two different diet periods. In obese NIDD patients, however, the postprandial insulin levels were lower after the beet-fibre diet compared to the control diet. This subgroup also showed lower fasting values of pancreatic polypeptide and motilin were recorded for the obese patients after the fibre-rich period compared to before the study. Further, increases in postprandial motilin levels, 60-180 min, were found after the fibre-rich period. Investigations with reference to an entero-hormonal mechanism by measuring neurotensin and peptide YY did not show any variations between the diet periods.

Adult↗
PubMed1988

Dietary fiber decreases fasting blood glucose levels and plasma LDL concentration in noninsulin-dependent diabetes mellitus patients.

Realistic high-fiber and regular low-fiber diets were given for 8 wk each to noninsulin-dependent diabetes mellitus (NIDDM) patients whose diabetes was being controlled satisfactorily by diet alone. The purpose of the study was to evaluate the metabolic effects of dietary fiber without changing energy intake or proportions of protein, fat, and carbohydrates. The high-fiber diet induced lower fasting blood glucose levels (p less than 0.01) and decreased the ratio of low-density lipoproteins to high-density lipoproteins (p less than 0.025); no difference was found in HbA1c between the two diet periods. Continuous glucose monitoring also showed a difference in fasting glucose levels that remained after identical low-fiber test meals. The incremental glucose responses did not differ. The fasting and incremental postprandial levels of insulin, C-peptide, glucagon, and somatostatin did not change, whereas the mean triglyceride concentrations were lower after the high-fiber diet. The results suggest a beneficial effect of dietary fiber in the metabolic control of NIDDM.

Aged↗
PubMed1987

Pediatric gastroenteritis in primary care and in hospitalized patients.

One-hundred and fifty-seven consecutive children below seven years of age (primary care n = 48, hospitalized patients n = 109) with acute gastroenteritis of assumed infectious origin were studied. Rotavirus was demonstrated by electron microscopy of faeces in 44% of all patients. The occurrence of rotavirus among patients in primary care, 15%, was significantly lower than among hospitalized patients, 57% (p less than 0.01). Adenovirus was isolated in six per cent and enterovirus in two per cent of the patients with no differences between the two groups. Yersinia enterocolitica and Campylobacter jejuni were demonstrated in each three per cent. Salmonella and Shigella spp. or Giardia lamblia were not found in any cases. Thus the cause of gastroenteritis was established in 58% of the patients. This figure was lower among patients in primary care (27%) than among hospitalized patients (72%), a difference mainly due to the high occurrence of rotavirus in the latter group. Clostridium difficile was recovered in 20 cases (12%), eight of which harboured one more enteropathogenic agent. Cultures from the nose and throat revealed Streptococcus pneumoniae, Haemophilus influenzae, Branhamella catarrhalis or group A, C and G streptococci in 58% of the patients with no differences regarding the occurrence of rotavirus in faeces. Neither Clostridium difficile nor respiratory tract pathogens were found to play a role in causation of gastroenteritis in the children investigated.

Acute Disease↗
PubMed1987

Fibre and the diabetic diet. An evaluation of the metabolic response to standardized meals.

Dietary fibre has a beneficial influence on glucose homeostasis, varying for different fibre sources. Fruit, wheat, rye and beet fibre were studied in isoenergetic meals for NIDD patients and healthy volunteers. The effects of extrusion cooking and flaking were also evaluated. The metabolic response was followed by continuous glucose monitoring and by analyses of pancreatic and gastrointestinal hormones as well as plasma lipid concentrations, For NIDD patients the effects, reflected in the area and the shape of the glucose curve, were greater for the more soluble fibre types, but the insulin and C-peptide responses were largely unaffected by dietary fibre. Beet fibre gave increased somatostatin concentrations also in age-matched healthy controls. They showed, however, unchanged plasma glucose responses and markedly decreased insulin and C-peptide levels. These changes were associated with less pronounced postprandial glycerol reduction, but otherwise none of the fibre preparations affected the postprandial lipemia. Extruded bread, based on wholegrain wheat flour, with high availability of in vitro starch, elicited a greater glucose response than wholegrain wheat bread, associated with a modest increase of GIP and insulin and with a stimulated early glucagon secretion. Flaked rye seemed to contain both faster and slower carbohydrates than the corresponding rye bread of similar fibre content. Analyses of the glucose curves suggested that the effect of fibre might be mediated by an effect on glucose absorption and parallel experiments in rat indicated that a delayed rate of gastric emptying might contribute. Further, the liver glycogen content was higher in rats given a slowly absorbed gastric load. A realistic increase in fibre content, given in long-term treatment, improved the metabolic control in NIDD patients, by decreasing the fasting blood glucose and LDL-cholesterol levels, as well as the LDL/HDL ratio. Hypothetically, slower absorption achieved with dietary fibre increases the proportion of glycogen in the liver. This postprandial improvement may cause the long-term trend to normalization of the fasting blood glucose level.

Aged↗