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Biomedical subjects

Jørund Straand

Publications and source records attributed to Jørund Straand.

16 recordsLinked to original sources
PubMed2006

Antihypertensive and lipid lowering treatment in 70-74 year old individuals--predictors for treatment and blood-pressure control: a population based survey. The Hordaland Health Study (HUSK).

BACKGROUND: In an elderly, community based population we aimed at investigating antihypertensive and lipid lowering medication use in relation to own and familiar cardiovascular morbidity and diabetes mellitus, as well as to lifestyle factors and general health. We also examined levels of blood pressure in untreated and treated residents, to investigate factors correlating with blood pressure control. METHODS: A health survey carried out in 1997-9 in the county of Hordaland, Norway included a self-administered questionnaire mailed to 4,338 persons born in 1925-7. Drug use the day prior to filling in the questionnaire was reported. A health check-up was carried out, where their systolic and diastolic blood pressure (SBP and DBP), body mass index (BMI), and serum-cholesterol level were recorded. RESULTS: One third of respondents used one or more antihypertensive drugs, while 13% of men and women were treated with a statin. Diabetes mellitus, own or relatives'cardiovascular disease, having quit smoking, physical inactivity, and overweight correlated with antihypertensive treatment. Mean blood pressure was lower in respondents not on treatment. Among those on treatment, 38% of men and 29% of women had reached a target BP-level of lower than 140/90 mm Hg. Own cardiovascular disease and a low BMI correlated with good BP-control. CONCLUSION: One third of 70-74 year old individuals living in the community used one or more antihypertensive drugs. Only around one third of those treated had reached a target BP-level of less than 140/90 mm Hg. Own cardiovascular disease and a low BMI correlated with good BP-control.

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PubMed2006

Can antibiotic prescriptions in respiratory tract infections be improved? A cluster-randomized educational intervention in general practice--the Prescription Peer Academic Detailing (Rx-PAD) Study [NCT00272155].

BACKGROUND: More than half of all antibiotic prescriptions in general practice are issued for respiratory tract infections (RTIs), despite convincing evidence that many of these infections are caused by viruses. Frequent misuse of antimicrobial agents is of great global health concern, as we face an emerging worldwide threat of bacterial antibiotic resistance. There is an increasing need to identify determinants and patterns of antibiotic prescribing, in order to identify where clinical practice can be improved. METHODS/DESIGN: Approximately 80 peer continuing medical education (CME) groups in southern Norway will be recruited to a cluster randomized trial. Participating groups will be randomized either to an intervention- or a control group. A multifaceted intervention has been tailored, where key components are educational outreach visits to the CME-groups, work-shops, audit and feedback. Prescription Peer Academic Detailers (Rx-PADs), who are trained GPs, will conduct the educational outreach visits. During these visits, evidence-based recommendations of antibiotic prescriptions for RTIs will be presented and software will be handed out for installation in participants PCs, enabling collection of prescription data. These data will subsequently be linked to corresponding data from the Norwegian Prescription Database (NorPD). Individual feedback reports will be sent all participating GPs during and one year after the intervention. Main outcomes are baseline proportion of inappropriate antibiotic prescriptions for RTIs and change in prescription patterns compared to baseline one year after the initiation of the tailored pedagogic intervention. DISCUSSION: Improvement of prescription patterns in medical practice is a challenging task. A thorough evaluation of guidelines for antibiotic treatment in RTIs may impose important benefits, whereas inappropriate prescribing entails substantial costs, as well as undesirable consequences like development of antibiotic resistance. Our hypothesis is that an educational intervention program will be effective in improving prescription patterns by reducing the total number of antibiotic prescriptions, as well as reducing the amount of broad-spectrum antibiotics, with special emphasis on macrolides.

Anti-Bacterial Agents↗
PubMed2006

A cluster-randomized educational intervention to reduce inappropriate prescription patterns for elderly patients in general practice--The Prescription Peer Academic Detailing (Rx-PAD) study [NCT00281450].

BACKGROUND: Age-related alterations in metabolism and excretion of medications increase the risk of adverse drug events in the elderly. Inappropriate polypharmacy and prescription practice entails increased burdens of impaired quality of life and drug related morbidity and mortality. The main objective of this trial is to evaluate effects of a tailored educational intervention towards general practitioners (GPs) aimed at supporting the implementation of a safer drug prescribing practice for elderly patients > or = 70 years. METHODS/DESIGN: Approximately 80 peer continuing medical education (CME) groups (about 600 GPs) in southern Norway will be recruited to a cluster randomized trial. Participating groups will be randomized either to an intervention- or a control group. The control group will not receive any intervention towards prescription patterns in elderly, but will be the target of an educational intervention for prescription of antibiotics for respiratory tract infections. A multifaceted intervention has been tailored, where key components are educational outreach visits to the CME-groups, work-shops, audit and feedback. Prescription Peer Academic Detailers (Rx-PADs), who are trained GPs, will conduct the educational outreach visits. During these visits, a set of quality indicators (QIs), i.e. explicit recommendations for safer prescribing for elderly patients, will be presented and discussed. Software will be handed out for installation in participants' practice computers to enable extraction of pre-defined prescription data. These data will subsequently be linked to corresponding data from the Norwegian Prescription Database (NorPD). Individual feedback reports will be sent all participating GPs during and one year after the intervention. Feedback reports will include QI-scores on individual- and group levels, before and after the intervention. The main outcome of this trial is the change in proportions of inappropriate prescriptions (QIs) for elderly patients > or = 70 years following intervention, compared to baseline levels. DISCUSSION: Improvement of prescription patterns in medical practice is a challenging task. Evidence suggests that a thorough evaluation of diagnostic indications for drug treatment in the elderly and/or a reduction of potentially inappropriate drugs may impose significant clinical benefits. Our hypothesis is that an educational intervention program will be effective in improving prescribing patterns for elderly patients in GP settings.

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PubMed2006

[The withdrawal of Vioxx: how did the patients react?].

BACKGROUND: The withdrawal of rofecoxib (Vioxx) from the global market because of adverse cardiovascular effects affected many patients and created a lot of publicity. MATERIAL AND METHODS: 287 patients from four general practices who had received prescriptions for rofecoxib in 2004 were identified from the medical records of their general practitioner (GP) and mailed a questionnaire addressing their reactions and their expectations of their GP in this respect. RESULTS: 140 out of 287 patients returned the questionnaire. More than half were scared by the media frenzy about the withdrawal. 15% had received information from their GP after the withdrawal, whereas 70% wanted this kind of information. 42% had received prescriptions for rofecoxib, even if the patients could not confirm the presence of the diagnostic criteria. INTERPRETATION: The media frenzy gave rise to concern among patients, who want their GP to be more active in informing them about their use of unsafe medication. Better routines and data tools are needed for GPs to better identify and inform patients when needed.

Attitude to Health↗
PubMed2006

Self-reported drug utilization, health, and lifestyle factors among 70-74 year old community dwelling individuals in Western Norway. The Hordaland Health Study (HUSK).

BACKGROUND: To examine the level and patterns of self-reported medication use (prescription and non-prescription drugs) among 70-74 year old individuals living in the community, and to explore self-reported indications for use, and factors possibly predictive of drug use. METHODS: A health survey carried out in 1997-99 in the county of Hordaland (Western Norway) in the setting of a population study. A self-administered questionnaire was mailed to 4338 persons born in 1925-27, and a health check-up was offered. Drug use the previous day was reported (point prevalence). 3341 (77.0%) persons who responded, comprise the material for the analyses. RESULTS: Between one third (males) and one quarter (females) did not take any drug the previous day. Mean number of drugs among users was 2.8 (men and women). 32% used three or more drugs and 11.5% five or more. Hypertension and other cardiovascular problems were by far the most common reasons for drug use, followed by respiratory, musculoskeletal and mental health problems. Self-reported poor health, a high Body Mass Index (BMI), and being an ex-smoker (but not currently a smoker) correlated with increasing number of drugs taken. CONCLUSION: Among 70-74-year old individuals living in the community no use of medication was more common than major polypharmacy (5+ drugs). Persons who had fallen ill and were put on regular medication, probably tended to quit smoking, while those who remained healthy, continued to smoke.

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PubMed2005

[The role of the general practitioner in the health center].

BACKGROUND: With the introduction of the list patient system, it has been suggested that routine examination of children should be transferred to the general practitioners (GPs). The aim of this study was to find out how the users of the public child health centres view the relationship between the child health centre and the GPs, and to find out whether parents would like their GPs to perform the routine examinations. MATERIAL AND METHODS: A questionnaire was given to parents in a small Norwegian town who attended the child health centre during spring and summer 2003 and to the town's GPs. Replies were received from 189 parents and from 14 out of 18 GPs. RESULTS: 29% of the parents would prefer to have their GP perform the routine examinations, 48% preferred not to and 23% did not express an opinion. Among the GPs, the corresponding figures were 57%, 29% and 14%. 93% of the GPs felt the need for closer cooperation between GP and child health centre. INTERPRETATION: The parents thought that having their GPs perform the routine examinations was less important than the contact with the health visitor and other parents. The GPs wanted closer cooperation between child health centre and GP. We recommend local trials in which the GPs perform the routine examinations of children on their list, at the child health centre.

Child↗
PubMed2005

Depressive symptoms in adolescent pupils are heavily influenced by the school they go to. A study of 10th grade pupils in Oslo, Norway.

BACKGROUND: A school is generally acknowledged to be a key setting for promoting pupils' health and well-being. METHODS: Data from a cross-sectional questionnaire study conducted with all 10th grade pupils in 46 public schools. Depressive symptoms was defined by a positive score on Hopkin's Symptom Check List-10 (HSCL-10). Two composite variables expressing risk were established: (i) presence of negative factors (PNF), consisting of self-reported pressure to succeed, sexual violation, and exposure to bullying and violence; and (ii) absence of positive factors (APF), comprising respondents' self-reported physical activity, educational aspirations, and family's valuing their opinions. RESULTS: Out of 7505 pupils, complete data were obtained for 6207. The prevalence of symptoms of depression varied greatly among different schools (boys, from 0 to 19%; girls, from 3.3 to 39%). The PNF varied from 12.3 to 45.5% for boys, and from 4.2 to 38.8% for girls. Corresponding figures for APF were 2.4-23.1% for boys and 4.3-37.5% for girls. Among boys, we found significant associations between PNF and symptoms of depression, odds ratio (95% CI) 4.5 (3.5-5.8), and between APF and depressive symptoms, 3.1 (2.3-4.1). For girls, corresponding odds ratios were 3.5 (2.9-4.2) and 2.1 (1.7-2.6), respectively. CONCLUSIONS: The proportion of pupils with depressive symptoms varies greatly among Oslo public schools. This variation is associated with features of the pupils' social context.

Adolescent↗
PubMed2005

[Antipsychotics against anxiety in dementia: medical treatment or chemical restraints?].

BACKGROUND: Antipsychotic drugs are widely used for behavioural and psychological symptoms of dementia. We discuss the evidence for this treatment and implications for clinical practice. METHOD: Literature search on Medline was supplemented by clinical guidelines and drug reports. RESULTS AND INTERPRETATION: Treatment with antipsychotic drugs for behavioural symptoms has limited effectiveness; the documentation is generally weaker for older than for newer drugs. Conventional antipsychotics give important risks of adverse events, while the newer antipsychotics imply increased risk of cerebrovascular events; hence, monitoring of effect and adverse events is imperative. Standardised methods for assessing behavioural symptoms, e.g. the Neuropsychiatric Inventory, are suitable for follow up. Controlled trials indicate that withdrawal is a feasible method for assessing actual drug effect and the need for continued treatment. Withdrawal attempts should therefore be conducted regularly for all patients taking antipsychotics for behavioural and psychological symptoms of dementia.

Aged↗
PubMed2004

[Do general practitioners know what medication community nurses give their shared patients?].

BACKGROUND: Frail elderly outpatients often receive medicines from community nurses. There is little knowledge of how general practitioners (GPs) and nurses update and coordinate their medication lists for their shared patients. MATERIAL AND METHODS: Lists of regular medication for 90 randomly selected shared patients from GPs as well as community nurses were assessed with respect to agreement. An agreement score was calculated for number of medicines and for each drug: total daily dosage and dose regimen. Routines for updating medication lists were addressed in a questionnaire to GPs and community nurses. RESULTS: For three out of four patients, discrepancies were found between physicians' and nurses' lists of regular medication. 52% of the discrepancies were in relation to cardiovascular drugs and psychotropic drugs. Only 41% of the GPs reported explicit routines for updating their medication lists. INTERPRETATION: The GPs' lack of knowledge of what their patients actually receive may contribute to medication errors and adverse drug reactions.

Aged↗
PubMed2004

[337 home calls during daytime from the emergency medical center in Oslo].

BACKGROUND: Few studies have addressed physicians' home calls in Norway. The aim of this study is to analyse home calls during daytime in Oslo in relation to patients (age, sex, district), diagnoses, request procedures, and clinical outcome. METHODS AND MATERIAL: General practitioners in the City of Oslo emergency medical centre recorded their home calls during three months using a standardised form. RESULTS: Calls to 337 patients (mean age 70, median 77 years; two thirds females; seven to children below two years of age) were recorded. The home calls were requested by relatives (36%), the patients themselves (32%), community care nurses (11%), and nursing homes (7%). The assessments made by the operators of the medical emergency telephone were generally correct. Physicians reported 77% full and 20% partial match between reported and found medical problem. The physicians assessed that 22% of the patients would have been able to go and see a doctor. 39% of all patients were admitted to hospital, 34 % needed ambulance transportation. The admitting GPs received hospital reports only after 27% of admissions. INTERPRETATION: Access to acute home calls by a physician during daytime is a necessary function in an urban public health service.

Adolescent↗
PubMed2004

Not less but different: psychotropic drug utilization trends in Norwegian nursing homes during a 12-year period. The Bergen District Nursing Home (BEDNURS) Study.

BACKGROUND AND AIMS: The use of psychotropic drugs in nursing homes is generally considered to be inappropriately high. The aim of the present survey was to compare psychotropic drug use in nursing homes (NHs) in 1985 relative to 1996/97, and to explore predictors for this drug use. METHODS: Cross-sectional study. Mental capacity was assessed by means of the Clinical Dementia Rating scale (CDR), and behavior registered by trained nurses. Scheduled, daily use of psychotropic drugs among long-term care residents in 1985 (N=1247) and 1996/97 (N=1035) was recorded. Bivariate analyses and logistic regression analyses were applied to establish predictors for psychoactive drug use. RESULTS: From 1985 to 1996/97, the proportion of residents using any psychotropic drug increased from 52 to 57%. Antipsychotic drug use decreased from 33 to 22%, while anxiolytics increased from 11 to 16%, hypnotics from 11 to 14%, and antidepressants from 12 to 31%. Psychotropic drug use was predominantly associated with behavioral symptoms and not with mental impairment. Concurrent use of two or more psychotropic drugs increased from 23 to 32% of all psychotropic users. CONCLUSIONS: During the study period, a substantial decline in the use of antipsychotics was observed, but a generally increased overall use of psychotropic drugs, particularly antidepressants. Psychotropic drug treatment was mainly associated with behavioral symptoms.

Aged↗
PubMed2004

Effect of antipsychotic withdrawal on behavior and sleep/wake activity in nursing home residents with dementia: a randomized, placebo-controlled, double-blinded study. The Bergen District Nursing Home Study.

OBJECTIVES: To explore the effect on sleep/wake activity and on behavioral and psychological symptoms of the withdrawal of antipsychotic medications from nursing home (NH) patients with dementia. DESIGN: Randomized, placebo-controlled, double-blind trial. SETTING: NHs in Bergen, Norway. PARTICIPANTS: Thirty patients (mean age 83.5) taking haloperidol, risperidone, or olanzapine for nonpsychotic symptoms. INTERVENTION: Study participants were randomly assigned to withdrawal (intervention group) or continued treatment with antipsychotic medications (reference group) for 4 consecutive weeks. MEASUREMENTS: Behavioral rating using the Neuropsychiatric Inventory Questionnaire (NPI-Q) and actigraphy. RESULTS: After antipsychotic withdrawal, behavioral scores remained stable or improved in 11 of 15 patients, whereas four had worsening scores. Actigraphy revealed decreased sleep efficiency after drug discontinuation and increased 24-hour and night activity in both groups. Actigraphy records of nighttime and daytime activity indicated sleep problems and restlessness, in terms of the NPI-Q. One patient was restarted on antipsychotics. CONCLUSION: Antipsychotic drug withdrawal affected activity and sleep efficiency over the short term. Increases in total activity and impaired sleep quality after drug discontinuation should be monitored, because the long-term effect of these changes is not known. The NPI-Q and actigraphy are feasible tools that disclose relevant changes occurring during antipsychotic withdrawal in NH patients with dementia. Their use in clinical practice should be substantiated by larger studies.

Aged↗
PubMed2003

[Improved medicine lists with multi-dose packaging?].

BACKGROUND: In a part of Oslo, Norway, the community care services use multi-dose packed medicines for some of their clients. We wanted to investigate whether this improved quality as compared to manually dispensed medicines. MATERIAL AND METHODS: We included 20 patients who received multi-dose packaged medicines, and 33 patients in two other districts who received manually dispensed medicines, and recorded disagreements between what daily medicines the general practitioner had prescribed and those that were dispensed by the community care service or the multi-dose packager. RESULTS: The 53 patients received a total of 324 daily medicines. Disagreements were found in 23% of all daily medicines, involving 58% of patients. In addition, deficiencies in the information on medication were found in 6% of all daily doses. For patients who received multi-dose packaged medicines, disagreements were found in relation to 21 % of the drugs. For patients who received manually dispensed medicines, disagreements were found in 17% and 33% of the medicines lists in the two districts. INTERPRETATION: The disagreements found between the medication prescribed by doctors and what was dispensed were unacceptable regardless of dispensing method (manual or automatic). It is important to clarify who should be responsible for maintaining accurate records for patients who receive community care.

Aged↗
PubMed2003

Nursing-home residents and their drug use: a comparison between mentally intact and mentally impaired residents. The Bergen district nursing home (BEDNURS) study.

AIMS: To investigate drug use relative to mental functioning and to explore the use of inappropriate drugs and potentially harmful drug combinations in nursing home residents. METHODS: Cross-sectional study in 15 nursing homes (1042 long-term care residents) in Bergen, Norway. Information on individual patients' scheduled drug use was obtained from drug dispensing cards. Mental functioning was assessed by means of the Clinical Dementia Rating scale. Drug use was considered inappropriate according to approved expert consensus criteria. Drug-drug interactions were considered relevant according to the national standard. Classification of interactions was based on pharmacokinetic and pharmacodynamic principles. RESULTS: Mentally intact residents used significantly more scheduled drugs than the mentally impaired (mean 6.2 vs 4.8, P<0.001). The mentally intact used generally more of all types of drugs, in particular hypnotics, cardiovascular and pain-relieving drugs. Of all drug users, 25.3% received inappropriate medications, comprising 6.2% of all drugs issued. Fewer mentally impaired residents received inappropriate drugs (21.6% vs 44.2%, P<0.001). Of the residents, 95 received 101 potentially harmful two-by-two drug combinations (1.9% of all prescriptions). The number of drugs used was weakly associated with inappropriate drugs (r=0.33, P<0.001) and with potentially harmful two-by-two drug combinations (r=0.27, P<0.001). CONCLUSION: The study shows considerable differences in drug use between mentally impaired and mentally intact nursing-home residents that may only partly be explained by a diagnostic selection effect. Mentally impaired residents are at greater risk of not receiving appropriate treatment for their complaints, but they are also less liable to suffer from hazards caused by inappropriate drugs.

Aged↗