PubMed Health⌕ Search

Biomedical subjects

K Bingefors

Publications and source records attributed to K Bingefors.

15 recordsLinked to original sources
PubMed2002

Attitudes towards drugs--a survey in the general population.

BACKGROUND: Studies have shown that many drugs have a lower effectiveness in clinical practice than would be expected from results reported in randomised controlled clinical trials. Many factors influence the use of drugs. Personal factors such as knowledge, attitudes, motivation, expectations are considered to be of particular consequence. The aim of the study was to analyse attitudes towards drugs from an epidemiological perspective. DESIGN: Cross-sectional survey SETTING: The county of Uppsala, Sweden, 1995. RESULTS: 5,404 completed the questionnaire (response rate = 68%). A majority either considered drugs as something positive, a help (60%), or as something necessary but evil (38%). A small proportion--around 2%--considered drugs as a danger. There were differences in attitudes according to education and income, self-care orientation, medication knowledge, and state of health. We also found differences in attitudes between users and non-users of certain types of drugs. Users of hypertensive drugs more often considered drugs as necessary but evil than did non-users of these drugs, while users of psychotropic drugs more often viewed drugs as something positive than did patients who did not use psychotropic drugs. CONCLUSION: A better understanding of the general attitudes towards drugs is important when giving both written and oral information to patients and to the public at large. It is also important to be aware of differences in attitudes between various patient groups and that certain patients, e.g., patients prescribed hypertensive drugs, could require more attention from health care professionals.

Adult↗
PubMed2002

Self-reported dermatological problems and use of prescribed topical drugs correlate with decreased quality of life: an epidemiological survey.

BACKGROUND: Skin problems are common in the population. Although a substantial fraction of the population suffers from skin conditions, we still have little information on how this affects the everyday life of the individuals concerned. OBJECTIVES: To evaluate the impact of skin disease on health-related quality of life (HRQOL) measured with the Short Form-36 (SF-36), a multidimensional generic HRQOL instrument, from an epidemiological perspective. A further aim was to study differences in HRQOL by use of non-prescription and prescription dermatological drugs. METHODS: The survey was carried out in the county of Uppland, Sweden in a random sample of 8000 individuals aged 20-84 years, of whom 5404 (68%) answered the questionnaire. RESULTS: A large part of the population (20.5%) reported dermatological problems and/or use of topical dermatological drugs, with a higher frequency among women (23.3%) than men (17.3%). Persons reporting dermatological problems scored lower on all eight dimensions of the SF-36. This pattern, although weaker, persisted after adjusting for comorbid somatic as well as psychiatric diseases and complaints. Those using topical dermatological drugs on prescription generally scored lower than the other groups with skin problems: in particular, they evaluated personal health as poorer (general health perceptions), perceived more limitations in daily activities (role limitation because of emotional health problems) and felt more tired and worn out (vitality). CONCLUSIONS: The study shows that skin disorders constitute a substantial problem in the population and cause a significant decrease in HRQOL. Furthermore, the results of this population survey point out the need for further population-based studies more specifically aimed at dermatological problems and HRQOL.

Administration, Topical↗
PubMed2002

Epidemiology of analgesic use: a gender perspective.

BACKGROUND AND OBJECTIVE: Women consistently report significantly more frequent analgesic use in epidemiological studies. The aim of this study was to analyse the influence of medical and non-medical factors on the difference in use of analgesics between women and men from a population perspective. METHODS: Cross-sectional survey. Postal questionnaires were sent to a random sample of the general population in the country of Uppland, Sweden (5404 answered the questionnaire, response rate: 68%). RESULTS: 34.8% of the women and 21.4% of the men had used analgesics during the two week recall period (Odds Ratio = 1.96). Social structure, social status, marital status, educational level, economic situation, lifestyle, attitudes toward drugs, medication knowledge and self-care orientation were of minor importance for the difference in use between women and men. Difference in prevalence of various types of pain and ache and the degree of pain experienced were the most influential factors affecting the difference in use. However, when all factors were analysed there remained a substantial difference in use between women and men (OR = 1.39, CI (95%) 1.20 to 1.60). CONCLUSIONS: In the population, women use analgesics much more frequently than men. Consequently women may be at greater risk for adverse effects and dependency. Some of the gender difference is explained by the greater frequency of pain conditions among women, but a significant difference in use still remains to be explained.

Adult↗
PubMed2000

Patient compliance with drug therapy in schizophrenia. Economic and clinical issues.

The effectiveness of drug treatment in clinical practice is considerably lower than the efficacy shown in controlled studies. The lower effectiveness in practice presumably leads to lower cost effectiveness of drug treatment in real-life situations compared with that demonstrated by studies based on results from controlled trials. Improved cost effectiveness in routine clinical practice would be a significant advantage in the treatment of schizophrenia, one of the most costly diseases in society. The aetiology of schizophrenia is unknown, and there is no cure. The main aims of therapy with antipsychotic medication include the effective relief of symptoms without the introduction of adverse effects or serious adverse events, improved quality of life, cost effectiveness and a positive long term outcome. The older classical antipsychotic drugs do not always meet these requirements because of their well-known limitations, such as a lack of response in a subgroup of individuals with schizophrenia and intolerable adverse effects. There has long been a need for new antipsychotics that can ameliorate more symptoms and have no or few adverse effects. Some of the recently introduced antipsychotics have been shown to be more effective in certain clinical situations and to have a more favourable adverse effect profile than the classical antipsychotics. A major factor contributing to the lower effectiveness of drug treatment is noncompliance, which may be very high in schizophrenia. There are several factors influencing compliance, including drug type and formulation, patient, disease status, physician, health care system, community care and family. There have been very few studies of compliance improvement strategies in schizophrenia or, indeed, in medicine in general. Current methods are relatively complex and there are differing opinions on their effectiveness. There are several ways to increase compliance in schizophrenia--the evidence is strongest for psychoeducative methods, changing to a new drug or using a depot formulation. However, considerably more research is needed in the field of compliance strategies.

Antipsychotic Agents↗
PubMed1999

Oral contraceptives and compliance: reaction to cardiovascular alarm among users.

The effectiveness of oral contraceptives (OC) is dependent on correct daily intake as well as continuous use. The latest cardiovascular alarm in 1995 led to discontinuations, presumably due to concerns about the long-term safety of OCs. The aim of this study was to investigate women's experiences and concerns about OCs in general as well as after the latest cardiovascular alarm. In 1993 and 1996, questionnaires were offered to 645 and 644 consecutive women visiting a midwife or a gynecologist at eleven family planning clinics in order to get their first prescription of oral contraceptives or to renew their prescription. The study was carried out in Uppsala, a city in Sweden with 180000 inhabitants. In 1993, 95%, answered the questionnaire and in 1996 the corresponding figure was 92%. Change of brand was common and increased from 38% in 1993 to 44% in 1996. Mild side-effects were reported by about 25%. Concerns about oral contraceptives increased from 36% to 41% (p < 0.01), particularly regarding the risk for thrombosis. Fewer than 1% expressed this concern in 1993 but 29% did so in 1996. Negative media coverage leads to increased concerns and declining confidence among users of oral contraceptives and has to be met by adequate oral and written information by the counsellor.

Adolescent↗
PubMed1998

Use of calcium channel blockers and risk of suicide: ecological findings confirmed in population based cohort study.

OBJECTIVE: To investigate possible associations between use of cardiovascular drugs and suicide. DESIGN: Cross sectional ecological study based on rates of use of eight cardiovascular drug groups by outpatients. A population based cohort study including users of drugs to control hypertension. SUBJECTS: The ecological study included 152 of Sweden's 284 municipalities. The cohort study included all inhabitants of one Swedish municipality who during 1988 or 1989 had purchased cardiovascular agents from pharmacies within the municipality. Six hundred and seventeen subjects (18.2%) were classified as users of calcium channel blockers and 2780 (81.8%) as non-users. MAIN OUTCOME MEASURES: Partial correlations (least squares method) between rates of use of cardiovascular drugs and age standardised mortality from suicide in Swedish municipalities. Hazard ratios for risk of suicide with adjustments for difference in age and sex in users of calcium channel blockers compared with users of other hypertensive drugs. RESULTS: Among the Swedish municipalities the use of each cardiovascular drug group except angiotensin converting enzyme inhibitors correlated significantly and positively with suicide rates. After adjustment for the use of other cardiovascular drug groups, as a substitute for the prevalence of cardiovascular morbidity, only the correlation with calcium channel blockers remained significant (r = 0.29, P < 0.001). In the cohort study, five users and four non-users of calcium channel blockers committed suicide during the follow up until the end of 1994. The absolute risk associated with use of calcium channel blockers was 1.1 suicides per 1000 person years. The relative risk, adjusted for differences in age and sex, among users versus non-users was 5.4 (95% confidence interval 1.4 to 20.5). CONCLUSIONS: Use of calcium channel blockers may increase the risk of suicide.

Calcium Channel Blockers↗
PubMed1998

Concomitant prescribing of tranquilizers and hypnotics among patients receiving antidepressant prescriptions.

OBJECTIVE: To evaluate concomitant prescribing of tranquilizers and hypnotics in antidepressant treatment with particular focus on the relationship to drug class in patients prescribed antidepressant treatment for depressive disorders. DESIGN AND METHODS: Repeated cross-sectional surveys of Swedish physicians in ambulatory care from 1991 to 1996, including specialty practices. The participation rate was 65-70%. RESULTS: Tranquilizers and hypnotics were prescribed in 36.1% of the visits in which the intention was to treat depression. Concomitant prescribing increased with the patient's age for all antidepressant drug classes. Women received more concomitant prescriptions than men when treated with nonselective monoamine-reuptake inhibitors (NSMRI), mainly tricyclic compounds. Psychiatrists prescribed more concomitant tranquilizers and hypnotics than other physicians, and general practitioners fewer, when treating depression with selective serotonin-reuptake inhibitors (SSRIs), mainly citalopram. A logistic regression model showed that the risk for concomitant prescribing was higher when an NSMRI was prescribed than with other antidepressants. CONCLUSIONS: Concomitant prescribing of tranquilizers and hypnotics was common among antidepressant-treated patients. The most plausible reasons for the high rate of concomitant prescribing were the symptoms of the depression itself and/or the common comorbidity with anxiety disorders seen in this group of patients. The results of this study indicate that the concern about increased tranquilizer and hypnotic use among patients treated with SSRIs suggested in other studies seems to be unfounded in Sweden.

Adult↗
PubMed1997

Medicated hypertensive patients' views and experience of information and communication concerning antihypertensive drugs.

Semi-structured interviews with mostly open-ended questions were conducted with 21 medicated hypertensive patients regarding their views and experience of information and communication with respect to antihypertensive medicines. The results showed that the physician was the person from whom the patients preferred to receive information about medicines. Pharmacy personnel were not regarded as an information resource and few patients had ever talked to them about drugs. The interviewees expressed a desire to receive information at the beginning of the pharmaceutical treatment, especially concerning possible side-effects. Except for this, information concerning the medicine itself was thought to be relatively unimportant, although patients expressed a desire to know whether the drug after a period of time could accumulate in the body or if the internal organs could be affected.

Aged↗
PubMed1997

Antidepressant dose patterns in Swedish clinical practice.

The Swedish Diagnosis and Therapy Survey was used to analyse the prescribing of antidepressants from 1991 to 1996. There were considerable differences in doses prescribed depending on diagnosis. Adequate dosage is an important factor in antidepressant treatment, and this study showed that tricyclic antidepressants are often prescribed at lower than recommended doses for the treatment of depression. Significantly higher doses were prescribed in continued treatment, as opposed to in new treatment, indicating dose titration when using tricyclic antidepressants and the most common selective serotonin reuptake inhibitors in depression. The findings from the present study suggest that the optimal dosage for some of the new antidepressants in clinical practice has not yet been determined and that costs of treatment in a natural setting might be considerably higher than costs calculated from dose recommendations.

Antidepressive Agents↗
PubMed1996

Antidepressant-treated patients in ambulatory care long-term use of non-psychotropic and psychotropic drugs.

BACKGROUND: Despite the problems involved in treating depression and concomitant medical disease, there are virtually no longitudinal studies on drug utilisation among depressed patients. METHOD: Use of prescription drugs among all first-time users of antidepressants in a defined population five years before and six years after the index (first) treatment was compared to a referent group without antidepressant treatment. The generalised estimating equations (GEE) method was used for analysis. RESULTS: The antidepressant-treated group used considerably more non-psychotropic drugs during the whole study period than the referent group. They also used more psychotropic drugs, a use which increased in connection with the initiation of antidepressant treatment, and stayed high for a further five years. CONCLUSIONS: The high use of prescription drugs indicated widespread somatic and psychiatric health problems during the whole study period. Antidepressant-treated patients are at risk for drug interactions and adverse effects, and would benefit from a closer collaboration between psychiatry and medicine.

Adolescent↗
PubMed1996

Antidepressant-treated patients in ambulatory care. Mortality during a nine-year period after first treatment.

BACKGROUND: Non-institutionalised patients treated with antidepressants have been shown to have indicators of a generalised vulnerability, such as high rates of health service use and excessive prescription drug use. Therefore, mortality in this patient group is of interest. METHOD: All first-incidence antidepressant users in a defined population during a five-year period were identified. Their total mortality during a nine-year follow-up was analysed. Cox proportional hazards regression was used to analyse total mortality, and mortality in cardiovascular disease, controlling for baseline chronic medical disease. RESULTS: Antidepressant treatment at the index date was a statistically significant predictor for increased long-term mortality in the over-65s, even when controlling for pre-existing chronic medical disease. Baseline ischaemic heart disease and concurrent antidepressant treatment significantly predicted mortality from cardiovascular causes. CONCLUSION: Prescribed antidepressant treatment identifies patients who are at risk of increased mortality. For the physician in ambulatory care, knowledge of a patient's antidepressant treatment history may be a valuable tool in managing patient care.

Adolescent↗
PubMed1993

Factors associated with high-quantity prescriptions of benzodiazepines in Sweden.

An important aspect, when discussing the prescribing and use of psychotropics, is the amount of drug prescribed at each visit. In this study the Swedish Diagnosis and Therapy Survey was used in order to analyze high-quantity prescriptions of benzodiazepines. The total amount of benzodiazepines prescribed--measured as defined daily doses (DDD)--was calculated for each visit. Prescriptions with quantities equal to or greater than the 90th percentile applied on the distribution of prescribed DDD per visit were defined as high-quantity prescriptions. Using this definition, prescriptions on 200 DDD or more--14.9% of all--were classified as high-quantity prescriptions. In the analysis the proportions of high-quantity prescription in different subgroups were compared. The study showed that there was a strong relationship between age of the patient and high-quantity prescriptions while the sex of the patient was of minor importance. Doctors specializing in internal medicine and psychiatrists prescribed high-quantity prescriptions to a greater extent than other doctors but differences with regard to the doctor's ages were small. Patients with sleeping disturbances obtained high-quantity prescriptions to a greater extent than other patients while patients with nervous problems obtained fewer. Patients with new prescriptions on benzodiazepines obtained high-quantity prescriptions to a lesser extent than patients making repeat visits. In addition the study showed that it was not as common with high-quantity prescriptions in the three major cities and in the most sparsely populated communities as in mid-sized communities.

Adolescent↗
PubMed1991

Small-scale preparations in Sweden. Extemporaneous preparations and stock preparations at eleven community pharmacies.

Small-scale preparations, i.e. non-registered drugs that are extemporaneously prepared for each patient or made in larger batches for stock keeping, form a small but important group of drugs, especially for patients with rare diseases or allergies. Small-scale preparations are not included in the otherwise comprehensive statistics compiled by the National Corporation of Swedish Pharmacies and this makes knowledge of the use of these drugs limited. The occurrence of small-scale preparations was studied at eleven community pharmacies over a three-year period (1987-1989) by analysis of the orders from the pharmacies to the four production units of the National Corporation of Swedish Pharmacies in the first quarter of each study year. The number of small-scale preparations dispensed were compared with the total sales of drugs at each pharmacy. The proportion of small-scale preparations in the total drug sales was about 1.5% throughout the study period, but there were fluctuations over time at the individual pharmacies. The most common dosage forms were creams, liniments and mixtures. Dermatological drugs in different dosage forms were the most frequent (almost 50%). This was probably because of the necessity for a great variety of different strengths among these drugs.

Community Pharmacy Services↗
PubMed1982

The influence of a hospital drug committee's recommendations on the use of analgesics as evaluated by drug-use data.

Drug-use data in a large university hospital have been used as a means for evaluating the influence of the recommendations given by a drug committee on the use of analgesics. The results generally show a reasonable adherence to the recommendations in the hospital. A selected clinic, the Department of Oncology, where special efforts were directed, showed particularly close adherence to the guidelines given.

Analgesics↗