[A computerized system for regional management of incidents is now tested. A complement to the Lex Maria system, indicates unobserved risks].
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Humans↗
Biomedical subjects
K Svärdsudd
Publications and source records attributed to K Svärdsudd.
Reproductive hormones and aminoterminal propeptide of type III procollagen in serum as early markers of pelvic pain during late pregnancy.
OBJECTIVE: The object was to study serum concentrations of reproductive hormones and aminoterminal propeptide of type III procollagen in early pregnancy as markers of pelvic pain (sacral pain or symphyseal pain) during later pregnancy. STUDY DESIGN: A prospective, clinical cohort study was performed, with repeated examinations of 200 women. RESULTS: Serum concentrations of relaxin and serum concentrations of propeptide of type III procollagen (a collagen turnover marker) measured in early pregnancy were significantly correlated with pelvic pain with onset during pregnancy and reported in late pregnancy (positively and negatively, respectively). In a multivariate analysis, relaxin and propeptide of type III procollagen concentrations remained independently and significantly correlated with pelvic pain. CONCLUSION: Serum concentrations of relaxin and propeptide of type III procollagen measured in early pregnancy may reflect the cause of and indicate an increased risk of pelvic pain (back pain or symphyseal pain) during late pregnancy. The mechanism is unclear.
Adolescent↗
[Significant regional differences in the frequency of vascular surgery].
The six health care regions of Sweden were compared with regard to the frequency of vascular surgery for three diagnoses: chronic lower extremity ischaemia, abdominal aorta aneurysm, and carotid stenosis. In 1995, the frequency of intervention for chronic lower extremity ischaemia varied from 26/100,000 of the population in northern Sweden to 68/100,000 in the southern region, the variation being greater for critical limb ischaemia than for intermittent claudication. In the country as a whole, the frequency of abdominal aorta aneurysm surgery increased five-fold from 1987-89 to 1993-95. During 1995, regional figures varied from 4.7 to 8.4 per 100,000 for elective procedures, and from 3.8 to 5.5 per 100,000 for emergency procedures. Overall surgical mortality varied regionally, and emergency surgery mortality differed between regional and county hospitals. Carotid surgery manifested the greatest regional difference in frequency, which was 7-fold greater in the southern than in the northern region, while its overall mean frequency was 6/100,000.
Aortic Aneurysm, Abdominal↗
Lifestyle discussion in the provision of health care. An empirical study of patient-physician interaction.
The main issue explored is how patients and physicians communicate about lifestyle in the clinical encounter and what role this talk plays in terms of the outcome of the consultation. The data, collected at two primary health care centers, consist of 42 audiorecorded consultations. The analyses are based on these transcribed dialogues. Our study shows that communication about lifestyle issues is used as a source for determining what health care measures are relevant. Physicians provided a variety of types of information and explicit connections were made between lifestyle and the medical problem by physicians as well as patients. Within the process of reaching decisions on advice or treatment, two forms of interaction appeared referred to here as "paternalism" and "mutuality". In general, the results show that the physicians are very cautious about making explicit medical inferences concerning specific issues of the individual's lifestyle.
Adolescent↗
The introduction of H2-receptor antagonists to Scandinavia: effects of experts' opinions.
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Anti-Ulcer Agents↗
Written communication from specialists to general practitioners in cancer care. What are the expectations and how are they met?
OBJECTIVE: To examine how general practitioners (GPs) and specialists assess the importance of different aspects of information regarding cancer treatment in the discharge letter from the hospital. DESIGN: A postal questionnaire study among GPs in two Swedish counties and cancer specialists (oncologists, surgeons and urologists) in six Swedish counties. SUBJECTS: Two hundred and four GPs and 48 cancer specialists. MAIN OUTCOME: Self-evaluation and assessment of the counterparts' evaluation of 17 items concerning cancer care in a discharge letter from hospital specialists to GPs. RESULTS: GPs, especially female GPs, generally rated the items higher than the cancer specialists. The differences were most pronounced in items concerning caring and psychosocial dimensions. Concerning the assessment of the other MD group, GPs deemed specialists as more interested in technical items and less interested in psychosocial items than themselves, whereas specialists believed that GPs had a similar view as themselves. CONCLUSION: The differences in self-evaluation and assessment of the other MD groups evaluation of the content in a discharge letter, concerning cancer patients from hospital specialists to GPs, might reflect different professional strategies in cancer management and hamper the efficiency in the shared care of these patients.
Adult↗
Are health surveys among elderly people worthwhile? The Albertina Project.
OBJECTIVE: To study the need for health screening among elderly people. SETTING, DESIGN AND SUBJECTS: A random sample of 605 people 75 years or older from the general population of Uppsala, Sweden received a postal questionnaire on health issues, and a random subsample of 101 persons were offered a health survey. MAIN OUTCOME MEASURES: Symptoms and signs of disease in questionnaire or at health examination. RESULTS: Thirty-nine people came to the health examination at the primary health care centre (PHCC), 15 were examined in their homes, and 11 were interviewed by telephone. Seventy-eight findings were made in the PHCC group, out of which 60 were known by the proband and 18 were new. In ten cases some action was taken. Of the 54 people examined, 50 persons had one or several findings. The most prevalent problems were hypertension, urinary incontinence, and hearing problems. However, few of these problems warranted referral to a general practitioner or hospital. CONCLUSIONS: It appears that a health survey of elderly people yielded little new information on the state of health among those surveyed at the time of the data collection. The bearing on the present-day situation is discussed.
Aged↗
Back pain in in-vitro fertilized and spontaneous pregnancies.
The influence of ovarian stimulation in in-vitro fertilization (IVF) on the prevalence of back pain with onset during pregnancy was studied in 31 women who became pregnant after IVF treatment and compared with that of 200 spontaneously pregnant women. A two times higher prevalence rate of sacral pain in late pregnancy was reported among IVF pregnant women (P < 0.0001), as well as a significantly higher prevalence rate of positive results of pelvic pain provocation tests performed in late pregnancy (0.0001 < or = P < or = 0.015), as compared with that of the spontaneously pregnant women. Among the IVF pregnant women, there was a significant positive correlation between relaxin concentrations in early pregnancy and the outcome of pelvic pain provocation tests (0.44 < or = r < or = 0.51, P < 0.05). In addition, the serum relaxin concentration was the factor that best explained differences in sacral pain prevalence. When the influence of serum relaxin concentration on back pain prevalence was taken into account, women carrying multiple pregnancies had no more pain than women carrying singletons, and IVF pregnant women had no more pain than spontaneously pregnant women. These results support the hypothesis that relaxin is involved in the generation of pelvic pain in pregnant women.
Adolescent↗
Moderate alcohol consumption and cardiovascular disease: is there evidence for a preventive effect?
It is well-known that the intake of large quantities of alcohol is hazardous to the health. During the last few decades, moderate alcohol consumption has been claimed to have a protective effect in the cardiovascular system. For this study, literature search and review on moderate alcohol consumption and cardiovascular disease was performed. Data from ecological studies indicate that the consumption of wine, but not hard liquor or beer, are associated with a reduced mortality from cardiovascular diseases. Data from case-referent studies indicate no beneficial effect at all, whereas data from prospective cohort studies indicate a beneficial effect from all types of alcohol. There are several interpretational problems involved in this issue. No results from interventional studies are available. In the absence of such data, less valid conclusions are drawn from other types of studies. The soundness of conclusions based on comparisons of moderate drinkers and abstainers in case-referent and cohort studies has been questioned, because abstainers may have a higher than normal incidence of cardiovascular disease due to self-selection. Several possible modes of action have been proposed. However, provided that there is a protective effect of moderate alcohol consumption, there is no hard evidence that any of the proposed modes of action would be the sole one. Probably more than one mechanism is involved.
Alcohol Drinking↗
Reported health status among farmers and nonfarmers in nine rural districts.
Farmers appear to have a lower morbidity and mortality rate than other occupational groups. Whether this better health is due to exposure to farming or to the well-known fact that rural populations have better health than urban ones, irrespective of occupation, is not clear. To explore this problem, all male farmers in nine administrative areas and age-matched nonfarmers from the same rural areas were sampled and invited to participate in a survey. 1782 (76%) men responded. We found that farmers had somewhat lower rates of outpatient health care utilization for causes other than trauma and fewer hospital admissions. These differences were independent of the urban-rural factor and could not be explained by traditional determinants of health and health care utilization. Other factors, linked to farming or to farmers' lifestyles, are probably involved.
Adult↗
Increased mortality among sleepy snorers: a prospective population based study.
BACKGROUND: The long term health consequences of snoring and sleep apnoea syndrome are still uncertain. This study was conducted to assess the mortality risk associated with snoring and excessive daytime sleepiness (EDS), the two main symptoms of sleep apnoea syndrome, in men. METHODS: In 1984 a sample of 3100 men aged 30-69 responded to a postal questionnaire including questions about snoring, EDS, and the prevalence of various diseases (response rate 77.1%). Mortality data for the period 1985-1995 were collected for the complete sample. RESULTS: During the 10 year follow up period 213 men died, 88 of cardiovascular diseases. Compared with subjects with no snoring or EDS in 1984, men with isolated snoring or EDS displayed no significantly increased mortality. The combination of snoring and EDS was associated with a significant increase in mortality. However, the relative rates decreased with increasing age, and in men aged 60 and above no effect on mortality was found. Men below the age of 60 with both snoring and EDS had an age adjusted total death rate which was 2.7 times higher than men with no snoring or EDS (95% CI 1.6 to 4.5). The corresponding age adjusted hazard ratio for cardiovascular mortality was 2.9 (95% CI 1.3 to 6.7) for subjects with both snoring and EDS. Further adjustment for body mass index and reported hypertension, cardiac disease, and diabetes reduced the relative mortality risk associated with the combination of snoring and EDS to 2.2 (95% CI 1.3 to 3.8) and the relative risk of cardiovascular mortality to 2.0 (95% CI 0.8 to 4.7). CONCLUSION: Snoring without EDS does not appear to carry an increased risk of mortality. The combination of snoring and EDS appears to be associated with an increased mortality rate, but the effects seems to be age dependent. The increased mortality is partly explained by an association between "snoring and EDS" and cardiovascular disease.
Adult↗
Snoring and hypertension: a 10 year follow-up.
In many cross-sectional studies an association has been found between snoring and hypertension. However, differing results have been obtained when confounding factors have been taken into account. To establish whether snoring is a risk factor for developing hypertension, a population-based, prospective survey was performed. In 1984 and 1994, 2,668 males, aged 30-69 yrs at baseline, answered questionnaires concerning sleep disturbances and somatic disease. Of the habitual snorers in 1984, 12.5% reported that they had developed hypertension during the period, compared with 7.4% of the remaining subjects (p<0.001). In a multiple logistic regression model persistent snoring, i.e., reported habitual snoring in both 1984 and 1994, was found to be an independent predictor for the development of hypertension among males aged 30-49 yrs (odds ratio 2.6, 95% confidence interval 1.5-4.5) after adjustments for age, body mass index (BMI), weight gain, smoking, alcohol dependence, and physical inactivity. Among the subjects aged 50-69 yrs in 1984, no association between snoring and development of hypertension was found. Although based only on reported data, the results indicate that persistent snoring is an independent risk factor for the development of hypertension among males aged <50 yrs. Prospective surveys, including whole-night sleep recordings, are needed to establish whether this is due to a higher prevalence of obstructive sleep apnoea syndrome among snorers or whether nonapnoeic snorers with increased upper airway resistance also have an increased risk of developing hypertension.
Adult↗
A 10-year follow-up of snoring in men.
STUDY OBJECTIVES: Little is known about the natural development of snoring, and this survey was conducted to study the development of snoring in men over a 10-year period. DESIGN: Population-based prospective survey. SETTING: The Municipality of Uppsala, Sweden. PARTICIPANTS AND MEASUREMENTS: In 1984, 3,201 randomly selected men aged 30 to 69 years answered a questionnaire on snoring and sleep disturbances. Of the 2,975 survivors in 1994, 2,668 (89.7%) answered a new questionnaire with identical questions to those used at baseline. Questions about smoking habits, alcohol, and physical activity were also added. RESULTS: Habitual snoring was reported by 393 men (15.0%) in 1984 and by 529 (20.4%) 10 years later. In both 1984 and 1994, the prevalence of snoring increased until age 50 to 60 years and then decreased. Risk factors for being a habitual snorer at the follow-up were investigated using multiple logistic regression with adjustments for previous snoring status, age, body mass index (BMI), weight gain, smoking habits, and physical activity. In men aged 30 to 49 years at baseline, the predictors of habitual snoring at the follow-up, in addition to previous snoring status, were as follows: persistent smoking (adjusted odds ratio, 95% confidence interval) (1.4, 1.1 to 1.9), BMI 1984 (1.1, 1.02 to 1.1/kg/m2) and weight gain (1.1, 1.03 to 1.2/kg/m2). Among men aged 50 to 69 years, after adjustments for previous snoring status and age, weight gain was the only significant risk factor for developing habitual snoring (1.2, 1.05 to 1.4/kg/m2). CONCLUSIONS: In men, the prevalence of snoring increases up to the age of 50 to 60 years and is then followed by a decrease. Weight gain is a risk factor for snoring in all age groups, while smoking is mainly associated with snoring in men <60 years of age.
Adult↗
Factors associated with birth weight in Sweden: the study of men born in 1913.
STUDY OBJECTIVE: To analyse factors associated with birth weight and to evaluate the validity of obstetrical data. DESIGN: Obstetrical data were retrieved for singleton men born in 1913 and living in Gothenburg, Sweden in 1963. Information on birth weight, maternal age, marital status, parity, social class, proteinuria, gestational age, and place of birth (home or hospital) was obtained from these birth records. SETTING: Sweden. PARTICIPANTS: Fifty year old men living in Gothenburg, Sweden, in 1963. MAIN RESULTS: Obstetrical records were obtained for 524 men (65%). Place of birth, gestational age, maternal age, parity, proteinuria, and marital status were all significantly correlated to birth weight. In multivariate analyses, place of birth, gestational age, parity, and proteinuria influenced birth weight. There was a substantial difference in mean birth weight between hospital deliveries (3352 g) and home deliveries (3817 g), which could be explained only partly by sociodemographic variables. Birth weight increased with parity and gestational age in home delivered babies as well as those delivered in a hospital. CONCLUSIONS: The validity of obstetrical records from 1913 was good. The place of birth (home or hospital) is strongly associated with birth weight and may be a confounding factor in studies of the implications of birth weight for future risk of disease or death.
Aged↗
The concept of status incongruence revisited: a 22-year follow-up of mortality for middle-aged men.
The purpose of this study was to analyse the relationships between status incongruency and mortality. From the concept of status incongruence two incongruent groups were defined, those with high education and low social position (socially downward drifters) and those with low education and high social position (socially upstarters). A cohort of middle-aged men (n = 855), all born in 1913 and living in the city of Gothenburg, Sweden were followed during a period of 22 years. The socially downward drifters had a significantly increased risk for: non-cause specific (overall) mortality, more potential years of life lost and mortality caused by coronary heart disease. These differences were still evident after taking other risk factors into account. The socially upstarters had, on the other hand, lower mortality risks and win years. Imbalance between educational level and attained social position appears to affect survival in a long term follow-up.
Cardiovascular Diseases↗
Discriminatory power of tests applied in back pain during pregnancy.
STUDY DESIGN: A longitudinal, prospective, observational cohort study. OBJECTIVES: To assess the relationship between clinical back status and reported pain locations during and after pregnancy. SUMMARY OF BACKGROUND DATA: Back pain during pregnancy is a frequent clinical occurrence, even during the early stages of pregnancy. The cause is unclear. There are few data describing the results of a general physical examination of the back during pregnancy and there are no data on serial examinations. Such data could provide information about what structures cause the pain, which might have implications for the choice of treatment. METHODS: A cohort of 200 consecutive women attending an antenatal clinic was observed throughout the pregnancy terms, and repeated measurements of back pain and its possible determinants were taken using questionnaires and physical examinations in a standardized way, including a series of tests of configuration, mobility, and pain provocation. RESULTS: Pain provocation tests were better at discriminating among women who reported back pain from women who reported no back pain from tests of configuration or mobility. The discriminatory power of the tests was better in the lower part of the spine than in the upper part. The best discrimination was achieved by combining some of the tests. CONCLUSIONS: The results indicate that not one but several pain-releasing structures may be involved. These are probably the various pelvic ligaments, which may form a functional unit. These findings may have therapeutic implications.
Adolescent↗
[Great interest in registration of incidents. Worry about reporting to HSAN may put a brake on it].
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Accident Prevention↗
Back pain during pregnancy: a prospective study.
STUDY DESIGN: A longitudinal, prospective, observational, cohort study. OBJECTIVES: To describe the natural history of back pain occurring during pregnancy and immediately after delivery. SUMMARY OF BACKGROUND DATA: Back pain during pregnancy is a frequent clinical problem even during the early stages of pregnancy. The cause is unclear. METHODS: A cohort of 200 consecutive women attending an antenatal clinic were followed throughout pregnancy with repeated measurements of back pain and possible determinants by questionnaires and physical examinations. RESULTS: Seventy-six percent reported back pain at some time during pregnancy. Sixty-one percent reported onset during the present pregnancy. In this group, the prevalence rate increased to 48% until the 24th week and then remained stable and declined to 9.4% after delivery. The reported pain intensity increased by pain duration. The pain score correlated closely to self-rated disability and days of sickness benefit. CONCLUSIONS: Back pain during pregnancy is a common complaint. The 30% with the highest pain score reported great difficulties with normal activities. The back pain started early in pregnancy and increased over time. Young women had more pain than older women. Back pain starting during pregnancy may be a special entity and may have another origin than back pain not related to pregnancy.
Adolescent↗