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Biomedical subjects

J Holmen

Publications and source records attributed to J Holmen.

At least 55 records · Page 3Linked to original sources
PubMed1995

[What do we know about the frequency of stroke? A review of incidence studies].

In Norway, mortality from stroke has declined during the last 30-40 years. It is unknown whether the frequency of stroke has declined. This article presents studies on incidence and trends in incidence of stroke in different countries, especially Scandinavian countries. Geographical differences in incidence are small, when the rates are compared, adjusted for age and sex. Time trend studies on incidence give conflicting results. Some studies suggest increasing incidence of stroke, others a decrease or even no change of incidence. The age-standardised incidence rate (adjusted to the Norwegian population) from six studies in people aged 55-84 years is estimated to 6-8 per 1,000 per year. Little is known about incidence and time trend in Norway. Factors of importance for primary prevention of stroke (e.g. treatment of hypertension), treatment and rehabilitation of the stroke patient and knowledge about the incidence.

Aged↗
PubMed1995

Prevalence of known and previously unknown diabetes mellitus and impaired glucose tolerance in an adult Norwegian population. Indications of an increasing diabetes prevalence. The Nord-Trøndelag Diabetes Study.

OBJECTIVE: To establish the prevalence of known and undiagnosed diabetes mellitus and impaired glucose tolerance in a representative Norwegian adult population according to the 1980 World Health Organization Expert Committee diagnostic criteria. DESIGN: Screening survey applying questionnaire and non-fasting blood glucose followed by a fasting and an oral glucose tolerance test. SETTING: The county of Nord-Trøndelag, Norway, 1984-86. SUBJECTS: All inhabitants aged > or = 20 years (85,100); 90.3% participated. For previously unknown diabetes: all inhabitants > or = 40 years (53,001)--participation rate 84.7%. MAIN OUTCOME MEASURE: Prevalence. RESULTS: The prevalence of previously known diabetes was 2.6% in men and 3.2% in women. Total diabetes prevalence > or = 40 years was 4.8% in men and 5.6% in women. The prevalence increased continuously with age until 90 years. One patient in five was previously undiagnosed. Impaired glucose tolerance in those with an abnormal non-fasting value was rare; only 0.9% in men and 0.2% in women. The prevalence of known diabetes was three times higher than 20-30 years ago and four times higher than 50 years ago. Except for known diabetes in the very old the prevalence corresponded well with recent Nordic studies. IMPLICATIONS: The present diabetes prevalence was so high that interested general practitioners will get sufficient experience in follow-up of diabetic patients to facilitate a good quality of the care.

Adult↗
PubMed1995

Low blood pressure and mortality in the elderly: a 6-year follow-up of 18,022 Norwegian men and women age 65 years and older.

Several studies have shown that low blood pressure in individuals age 65 years and older is related to increased overall mortality. We hypothesize that this association is secondary to serious underlying illness, which has caused blood pressure reduction and, subsequently, has increased the risk of dying. Our study population was comprised of individuals age 20 years and older in the county of Nord Trøndelag in Norway, who were studied in a general health survey between 1984 and 1986. We had measurements of blood pressure, blood glucose, weight, height, and other information for 9,732 women and 8,290 men age 65 years or older. During approximately 6 years of follow-up, 2,122 women and 2,578 men died. For both genders, low systolic pressure was not associated with increased mortality, and the mortality curve did not display a J-shaped relation, after adjustment for age, marital status, body mass index, blood glucose, self-assessed health, use of antihypertensive medication, and history of diabetes and cardiovascular diseases. For diastolic pressure, however, women in the lowest category (< 75 mmHg) had an adjusted mortality rate ratio of 1.21 (95% confidence limits = 1.05, 1.39), compared with reference women (80-87 mmHg). Among men, the analogous mortality rate ratio was 1.16 (95% confidence limits = 1.02, 1.31). To reduce further the potential confounding between diastolic pressure and underlying illness, we excluded users of antihypertensive medication as well as the 2 first years of follow-up. After these procedures, the J-shaped mortality curve was not present among women, and it was substantially reduced among men. Thus, the results for both men and women indicated that the age-adjusted J-shaped relation between diastolic blood pressure and mortality was confounded with indicators of ill health, and that the often-found association between low diastolic blood pressure and increased mortality is indirect, possibly caused by serious underlying disease.

Aged↗
PubMed1994

[Reduced glucose tolerance as a risk factor of cardiovascular diseases].

The term reduced glucose tolerance is often used to describe an intermediate phase between normal glucose metabolism and diabetes, and WHO discriminates between type 2 diabetes and reduced glucose tolerance. However, biologically there is no clear distinction between the two groups. As a biological phenomenon reduced glucose tolerance is important because it is a risk factor for cardiovascular disease. The article describes reduced glucose tolerance as a part of the metabolic cardiovascular syndrome, and several models which might help to explain some of the mechanisms. The distribution of musculoskeletal fibres, the impact of physical activity, and the relation between insulin and blood pressure, lipids and the disposition for thrombosis, are discussed. Genetic disposition is also an important factor. The research in this field is rapidly increasing, and a survey can only be a snapshot. However, greater understanding of the mechanisms linking reduced glucose tolerance and the metabolic cardiovascular syndrome is a strong argument to focussing the total risk profile, and not only, single risk factors, in preventive cardiovascular medicine.

Cardiovascular Diseases↗
PubMed1994

[What attitude do physicians have towards risk?].

Results of medical research provide physicians with knowledge on how to reduce risk, and are probably the main source of such knowledge. The results are usually presented in terms of relative risk reduction. However, when treating the individual patient, the most important question will be how beneficial the treatment is for this particular patient, that is to say, the absolute reduction of risk. 91 Norwegian general practitioners who participated in a symposium on hypertension were presented with results from a recent study of treatment of this condition. Most of the doctors placed a different interpretation when the same information was presented in two different ways, i.e.: as relative reduction and absolute reduction of risk. They evaluated the results stated in terms of relative risk reduction as far better than the same results when stated as absolute risk reduction. This may influence the degree of treatment of hypertension in general practice.

Attitude of Health Personnel↗
PubMed1994

[Variation in the number of clinical chemical analyses requested by primary health care].

The number of clinical chemical tests requested by the primary health care sector in one year was registered in ten municipalities. Considerable inter-municipality variation was found. Some variation in test requesting could be explained by differences in number of inhabitants per general practitioner. The request for tests increased with decreasing number of inhabitants per general practitioner. No statistically significant correlation was found between number of tests and morbidity in the case of two conditions where the use of tests is well defined. Most of the variation was unexplained, indicating a problem of quality connected to the use of clinical chemical tests.

Chemistry, Clinical↗
PubMed1994

[Physical inactivity of adults with functional disabilities and diseases].

This article describes physical inactivity among adults in Nord-Trøndelag who suffer from or have suffered from heart infarction, angina pectoris, stroke, impaired motor ability, impaired vision, impaired hearing or impairment because of psychological complications. Information was collected by questionnaire during the Nord-Trøndelag Health Survey 1984-86. Younger men and younger women with previous heart infarction reported less inactivity than persons with no history of infarction. In contrast, young men and women suffering from impaired hearing were more inactive than people not suffering from impaired hearing. Among the disabled or sick, more women reported physical inactivity than men. This also held good when the results were controlled for age. Among healthy persons, the highest share of physically inactive was found in the oldest age groups, regardless of gender. This survey indicates that, to some degree, physical activity has become an accepted means of improving health after heart infarction in younger men and women. Physical activity has unexploited potential as a means of treating other disabilities and illness.

Adult↗
PubMed1994

[Drug risk intervention--a care technology in crisis?].

Drug treatment in patients who feel well but have an elevated risk of disease and premature death is steadily increasing. This kind of treatment is qualitatively different from the ordinary practice where patients visit a doctor because of symptoms or complaints. In recent decades, great confidence has evolved in this kind of risk intervention. Antihypertensive treatment is one example and risk intervention with drugs is also used in cases of hypercholesterolemia, type 2 diabetes and osteoporosis. The effect of this effort on public health has not been as great as expected. This kind of treatment has emerged gradually and without debating the principles. The author wants to start a debate about what kind of treatment we are experiencing. Is it quasi-treatment based on the premises of the technology? Should we think again about this kind of practice? The author suggests subjects for further debate, including the use of precise language, better co-operation with the persons at risk and further research.

Antihypertensive Agents↗
PubMed1994

Interaction between current smoking, leanness, and physical inactivity in the prediction of hip fracture.

To study the association between smoking habits and the incidence of hip fracture, adjusted for leanness and physical inactivity, a cohort study with 3 years follow-up was conducted. Subjects were 34,856 adults aged 50 years or older who attended a health screening in Nord-Trøndelag County in Norway in 1984-1986 (91% of eligible subjects in 1986, n = 38,356). Of these, 421 suffered a hip fracture during the years 1986-1989. Using Cox regression models, the relative risk (with 95% confidence interval) of suffering a hip fracture for female smokers versus nonsmokers was 1.5 (1.0-2.4). These results refer to females when the female body mass index (BMI) was set at 25 kg/m2 in the female model (the mean BMI for the smoking female population in this study). Among thinner females, however, smoking had a much stronger effect. For instance, if the female BMI was set at 20 kg/m2, the relative risk was 3.0 (1.8-5.0). The relative risk of hip fracture for male smokers versus nonsmokers was 1.8 (1.2-2.9) irrespective of BMI. Smoking is associated with incidence of hip fracture in both sexes and also after adjusting for body mass index and physical inactivity (the effect of physical inactivity was adjusted for self-reported ill health because ill health was included in the model). For lean females, the association with current smoking was large, as large as if they added 10 years to their age.

Aged↗
PubMed1994

Types of diabetes treatment in a total, Norwegian, adult population. The Nord-Trøndelag Diabetes Study.

OBJECTIVES: To describe types of diabetes treatment in a total, adult population, including those on no antidiabetic medication, and to evaluate use of the defined daily doses in estimation of diabetes prevalence. DESIGN: Cross-sectional epidemiologic survey applying patient-based questionnaires and clinical examinations approaching all inhabitants of > or = 20 years (85,100). SETTING: Nord-Trøndelag county in the middle part of Norway. SUBJECTS: All known diabetic patients in the county (2242) amongst all participants of > or = 20 years (76,855), registered in 1984-86. INTERVENTIONS: Questionnaire data on type of diabetes treatment including drug doses, measurement of height and weight. MAIN OUTCOME MEASURES: Distribution of types of treatment and of mean drug doses. RESULTS: Of the diabetic patients of > or = 20 years of age, 20% used insulin, 39% oral hypoglycaemic agents and 41% no antidiabetic medication. Corresponding prevalence figures were 0.6%, 1.1% and 1.2%. Mean daily insulin dose per kg body weight was significantly higher in women than in men. Women with no antidiabetic medication stated a more restricted diet than men. The mean prescribed insulin dose was 14% higher than the defined daily dose, but the corresponding oral agent dose was lower than the defined daily dose. CONCLUSIONS: Sales figures is a bad estimate of total diabetes prevalence due to the high proportion of diabetic patients using no antidiabetic medication. Correction is also necessary when the defined daily dose system is used to estimate the prevalence of medically treated diabetes.

Adult↗
PubMed1993

Age-specific genetic effects for blood pressure.

Correlations between relatives were determined for systolic and diastolic blood pressure. The correlations decrease as age differences between relatives increase in a Norwegian sample with 43,751 parent-offspring pairs, 19,140 pairs of siblings, and 169 pairs of twins. A simple biometric model specifying only age-specific genetic additive effects and environmental effects fitted well to correlations between cotwins, pairs of siblings, and parent-offspring dyads in subsets of relatives grouped by age differences. None of the environmental effects appeared to be due to environmental factors that are shared by family members. Models that excluded a parameter for the age-specific genetic influence did not fit the data. The results may partly explain what seems to be a discrepancy between relatively low parent-offspring correlations from previous nuclear family studies and high correlations from twin studies, especially in identical twins.

Adult↗
PubMed1992

[The child with bronchial obstruction in general practice. Need for better follow-up].

Early diagnosis and adequate follow-up routines are important in giving children with bronchial asthma good care and treatment. The aim of this study was to evaluate how children with bronchial obstruction and possible asthma were detected and treated in general practice. Children with bronchial obstruction (78) were registered in two municipalities in Nord-Trøndelag county, Norway. The data were supplemented by data from children with asthma (392) describing the situation before they received the diagnosis. In regard to frequency of symptoms and symptoms without infection, too few reported having bronchial asthma. Most children with repeated contacts because of bronchial obstruction had been examined by different doctors, and only seldom was a follow-up appointment made. Not all children with bronchial asthma had been referred to a paediatrician. The study shows that follow-up routines for children with bronchial obstruction are inadequate.

Adolescent↗
PubMed1992

[Does diagnosed hypertension change quality of life? Results from a medical population study in Nord-Trøndelag].

The authors report results from medical screening for hypertension carried out on the entire adult population (aged greater than 20 years) of the county of Nord-Trøndelag, Norway. Previously undiagnosed hypertensives in need of medical treatment (n = 173), false positives (n = 233) and patients in need of continued blood pressure monitoring (n = 474) were followed up 10 to 36 months after the screening. This group was compared with a random population sample of known hypertensives (n = 206), patients previously treated for hypertension (n = 118) and normotensives (n = 2,326). No significant differences in changes in quality of life (subjective well-being) were observed between the two groups from screening to follow-up. However, negative events in life and chronic stresses other than the fact of becoming sick induced a deterioration of quality of life. Positive events induced an improvement in quality of life.

Adult↗
PubMed1992

[The diagnosis of hypertension--psychosocial consequences. A literature review of blood pressure examinations].

Several studies have shown higher rates of absenteeism from work among hypertensives who are aware of their condition than among hypertensives who have no such knowledge or among normotensives. This seems to be the result of labelling rather than of the hypertension itself. The results of studies of the effect of labelling and awareness on quality of life are ambiguous. Follow-up by health professionals in terms of reassurance and support often seems to alleviate adverse psychosocial effects of labelling.

Humans↗