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Gunnar Lindberg

Publications and source records attributed to Gunnar Lindberg.

8 recordsLinked to original sources
PubMed2006

Correlation of drug utilisation and morbidity at the municipality level. High use of antibiotics associated with low use of antihypertensives.

OBJECTIVE: The aim of the study was to explore the relationship between Swedish drug sales data per municipality and morbidity per municipality. The morbidity was expressed as "sickness numbers" which are assumed to function as proxy for morbidity. METHODS: Sickness numbers per municipality were correlated to volumes of drug sales per municipality in 2003. In addition, the sales volumes of antibiotics were correlated to the sales volumes of other drugs. RESULTS: We found significant positive correlations between municipality sickness numbers and sales volumes for most drug groups, except for antibiotics where the correlations were negative in all age groups. When the volumes of antibiotics were related to the volumes of other drug groups it was observed that municipalities with volumes of antibiotics above the national average had reduced volumes of cardiovascular drugs, especially of diuretics, beta blockers and calcium antagonists, all primarily used as antihypertensives. For ACE inhibitors and statins, no such relationship was found. CONCLUSION: The findings might suggest a link between infection and hypertension, but a cause-effect relation is not established.

Adult↗
PubMed2005

General practitioners' conceptions about treatment of depression and factors that may influence their practice in this area. A postal survey.

BACKGROUND: The way GPs work does not appear to be adapted to the needs of depressive patients. Therefore we wanted to examine Swedish GPs' conceptions of depressive disorders and their treatment and GPs' ideas of factors that may influence their manner of work with depressive patients. METHODS: A postal questionnaire to a stratified sample of 617 Swedish GPs. RESULTS: Most respondents assumed antidepressive drugs effective and did not assume that psychotherapy can replace drugs in depression treatment though many of them looked at psychotherapy as an essential complement. Nearly all respondents thought that clinical experiences had great importance in decision situations, but patients' own preferences and official clinical guidelines were also regarded as essential. As influences on their work, almost all surveyed GPs regarded experiences from general practice very important, and a majority also emphasised experiences from private life. Courses arranged by pharmaceutical companies were seen as essential sources of knowledge. A majority thought that psychiatrists did not provide sufficient help, while most respondents perceived they were well backed up by colleagues. CONCLUSION: GPs tend to emphasize experiences, both from clinical work and private life, and overlook influences of collegial dealings and ongoing CME as well as the effects of the pharmaceutical companies' marketing activities. Many GPs appear to need more evidence based knowledge about depressive disorders. Interventions to improve depression management have to be supporting and interactive, and should be combined with organisational reforms to improve co-operation with psychiatrists.

Adult↗
PubMed2005

General practitioners' conceptions of depressive disorders in relation to regional sales levels of antidepressive drugs. A study based on a postal survey and ecological data.

OBJECTIVES: To examine how local sales levels of antidepressive agents (ADs) correlated with GPs' conceptions of depressive disorders and of factors that may influence their work with depressed patients. DESIGN: A postal questionnaire survey to GPs requesting their conceptions of depression and their opinions of additional factors that may influence their work with depressed patients. GPs' conceptions and opinions were compared with local sales rates of ADs. SETTINGS: Three selected groups of Swedish municipalities: those with the highest, the average, and the lowest sales rates of ADs. SUBJECTS: All 535 GPs who worked in the selected municipalities. MAIN OUTCOME MEASURES: Spearman rank correlations for responses to the questionnaire with the sales levels of ADs. RESULTS: High sales levels correlated positively with a high evaluation of ADs' effectiveness in depression and panic disorders and were inversely correlated with the degree of appreciation of psychotherapy-based treatments. High sales levels were also associated with a high evaluation of GPs' own clinical and private experience, with a positive appreciation of the work with depressed patients and with a high level of participation in the pharmaceutical companies' activities. The demonstrated statistical correlations were not particularly strong and included less than half of the items. CONCLUSIONS: This ecological study confirms a number of statistical associations between sales levels of ADs and GPs' prevailing conceptions of factors related to depression. However, their explanatory value of the geographical sale variation appears limited. To further clarify this variation, studies employing information on individual GPs' conceptions and prescribing are required.

Adult↗
PubMed2002

Use of calcium channel blockers as antihypertensives in relation to mortality and cancer incidence: a population-based observational study.

PURPOSE: Treatment with blood pressure lowering drugs may reduce morbidity and mortality. However, the efficacy and effectiveness may differ between antihypertensive agents. The current investigation aimed to compare mortality and cancer incidence in hypertensive patients treated with calcium channel blockers (CCB) or with other antihypertensive drugs (AHD). METHODS: All patients in two outpatient clinics treated with AHD who underwent an annual check-up during 1989 or 1990 were selected. Fatal events were identified through 1997 and incident cancers through 1998. RESULTS: Two hundred and fourteen patients on CCB and 1029 on other AHD were identified. Overall mortality and the combined mortality from myocardial infarction and stroke were higher in CCB users; hazard ratios adjusted for sex, age, comorbidity and other and risk factors were 1.84 (95% CI 1.25-2.72) and 2.37 (95% CI 1.27-4.44), respectively. The risk estimates for cancer mortality and for cancer incidence did not differ significantly. CONCLUSIONS: Results from clinical trials as well as observational studies, including the present one, indicate a higher mortality risk and a higher cardiovascular morbidity risk associated with use of CCB. Accordingly, CCB should not be regarded as first line drugs in hypertension.

Antihypertensive Agents↗
PubMed2002

What shapes GPs' work with depressed patients? A qualitative interview study.

BACKGROUND: The ways that GPs treat depressed patients have been criticized in a number of studies. OBJECTIVE: To explore factors that shape how GPs work with depressed patients. METHODS: Seventeen GPs from the county of Orebro, Sweden participated in a qualitative semi-structured interview study. GPs' conceptions of factors shaping their way of working with depressed patients, especially continuing medical education (CME), commercial information, inter-collegial support, collaboration with psychiatrists and GPs' gender were recorded. RESULTS: Private life experiences as well as professional experiences from family medicine were more often stressed as formative factors than university education and training in psychiatry. Groups of GPs discussisng the doctor-patient relationship set out from real cases (Balint groups) and CME groups were regarded as good forms of education. Most GPs considered company-sponsored lectures valuable. Commercial drug information was seen as more powerful than non-commercial information and GPs wished for more non-commercial information. Collaboration with psychiatry consultants was perceived as insufficient, and GPs felt a need for more inter-collegial support. Traditional female qualities were generally seen as advantageous in the work with depressed patients. CONCLUSIONS: Many GPs consider personal qualities and experiences, including those of gender, to be more influential than academic education and professional literature. This reflects a preference for individual 'tacit knowledge'. Although tacit knowledge is indispensable in consultations, the low priority given to theoretical CME may make GPs less inclined to make optimal use of different therapeutic alternatives and also less critical of commercial marketing. CME on depression should start with GPs' individual tacit knowledge and assume a more independent stance from the drug industry.

Adult↗