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Biomedical subjects

K Svärdsudd

Publications and source records attributed to K Svärdsudd.

At least 73 records · Page 4Linked to original sources
PubMed1996

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↗
PubMed1996

Addressing life style in primary health care.

The problem studied concerns how patients and physicians talk about and make use of information regarding patient life style in the daily practice of primary health care. The study has been carried out at two primary health care centers in central Sweden. Transcribed dialogues between 42 patients and 12 physicians have been used as a data corpus. The analyses concern the interactional patterns in the dialogues between patient and physician, how the interlocutors address life style and for what purposes. The results show a similarity between patients and physicians with respect to the extent to which they use the discourse space. However, salient differences were found in the following way: the physicians not only introduced and closed life style topics more frequently than the patients did, they also used what is referred to as an agenda driven strategy to introduce them. The patients, on the other hand, used an interactively anchored strategy. The patients, by taking the reference in the life world and by making use of the life style topics, present and articulate their identity. The physicians subsume life style issues under a medical framing of the patients' problem and they mainly address life style in order to construe a proto-typical patient rather than an individual.

Adolescent↗
PubMed1996

Serum relaxin, symphyseal pain, and back pain during pregnancy.

OBJECTIVE: Our purpose was to study the relationship between serum relaxin levels and back pain during pregnancy. STUDY DESIGN: A prospective clinical cohort study with repeated examinations was performed. RESULTS: There was an initial increase of relaxin levels until a peak value at the twelfth week followed by a decline until the seventeenth week. Thereafter stable serum levels around 50% of the peak value were recorded. Three months after delivery serum relaxin was not detectable. There was a significant correlation between mean serum relaxin levels during the pregnancy and symphyseal pain or low back pain occurring during late pregnancy as measured by medical history or pain-provoking test. CONCLUSION: Relaxin is known to remodel pelvic connective tissue in several mammalian species during pregnancy. The current data suggest that relaxin might be involved in the development of pelvic pain in pregnant women.

Adolescent↗
PubMed1996

Supraphysiological serum relaxin concentration during pregnancy achieved by in-vitro fertilization is strongly correlated to the number of growing follicles in the treatment cycle.

In order to analyse the relationship between the ovarian response to stimulation in in-vitro fertilization (IVF) treatment cycles and relaxin concentrations during subsequent pregnancies, 31 healthy women pregnant after IVF treatment were studied prospectively. The maximum number of follicles observed from day -4 to day -2 in relation to ovum retrieval and the number of oocytes recovered were recorded. In addition, blood samples were drawn in the follicular phase, the luteal phase, early pregnancy and at gestational weeks 12, 16, 20, 27 and 35 to assess oestradiol, progesterone, human chorionic gonadotrophin and relaxin. The maximum numbers (mean +/- SEM) of follicles observed and oocytes recovered were 9.0 +/- 0.6 and 6.1 +/- 0.5 respectively. The supraphysiological mean relaxin values were strongly correlated to the maximum number of follicles observed (r = 0.72, P < 0.0001) and the number of oocytes recovered (r = 0.64, P < 0.0001), indicating that the source of increased relaxin production during IVF pregnancy might be the ovary. These results are supported by experimental data. In the present study, the occurrence of multiple pregnancy was not associated with higher relaxin concentrations, which is further support for the hypothesis that the ovary is the main source of serum relaxin.

Adult↗
PubMed1995

Irritable bowel syndrome and dyspepsia in the general population: overlap and lack of stability over time.

BACKGROUND & AIMS: It has been suggested that irritable bowel syndrome (IBS) and functional dyspepsia represent the same disease entity, the irritable gut. The aim of this study was to test the stability, consistency, and relevance of the current classification in the entire, unselected population of persons with gastrointestinal and/or abdominal symptoms, including those who had not consulted physicians. METHODS: Sequential postal questionnaires were sent to 1290 representative persons (age range, 20-79 years) sampled from the population. Questions were asked about the prevalence of 24 gastrointestinal and/or abdominal symptoms and the site and type of abdominal pain, if any. RESULTS: The prevalence of dyspepsia was 14% (32% if predominant reflux symptoms and concomitant IBS symptoms were included), and the prevalence of IBS was 12.5%. The 3-month incidence rates of reflux, dyspepsia, and IBS among previously symptomless persons were 0.5, 8, and 2 per 1000, respectively. Of persons with IBS, 87% also fulfilled the dyspepsia criteria, and the overlap between dyspepsia subgroups was more than 50%. The use of stricter criteria did not eliminate this overlap. Over a 1-year period, approximately 50% changed their symptom profile. Principal component analysis did not show any natural clustering of the symptoms. CONCLUSIONS: The separation of functional gastrointestinal symptoms into dyspepsia, its subgroups, and IBS may be inappropriate.

Adult↗
PubMed1995

Lifestyle in primary health care discourse.

This study is the first part of the project "Lifestyle Questions in Primary Health Care". The study aims at exploring how lifestyle enters into the health care discourse and what significance such factors are given in the clinical work. The particular problem thus concerns the extent to which lifestyle issues are brought up and attended to in the clinical encounters as well as in the medical records. The study was performed at two primary health care centres in central Sweden. The analyses are based on 42 transcribed consultations and on the medical records produced on the basis of these dialogues. The results show that lifestyle issues are given considerable attention in the primary health care encounter. Roughly one third of the discourse space is devoted to these kinds of topics, and the patients and doctors share the discourse space equally between them. There is also a high consistency between topics given space in the discussion and those that are entered into the medical records. The results also point to what could be conceived as a common discursive code between the health centres studied, indicating that there are similar communicative strategies for discussing lifestyle issues.

Adolescent↗
PubMed1995

Peroperative and immediate postoperative adverse events in patients undergoing elective general and orthopaedic surgery. The Gothenburg study of perioperative risk (PROPER). Part II.

All anaesthetic and surgical procedures impose a certain risk of complications. However, reliable estimates of this risk from prospective studies are rare. This study is a prospective clinical epidemiological study of 1361 consecutive patients subjected to elective general and orthopaedic surgery. These patients were followed from an extensive preoperative assessment to three months after the operation. In this report the peroperative and early postoperative period in the postoperative care unit or intensive care unit is described. General anaesthesia was given to 59% and regional/local anaesthesia to 41%. Adverse peroperative events occurred in 19%. The most common were circulatory events (11%), respiratory (4%), and allergic events (1%). Most events were of minor severity. However, with the official registration system, only 1 out of 8 events was detected. In the postoperative unit one or more adverse event was noted in 47% of the cases. These were dominated by circulatory (18.4%) and respiratory events (5.0%). CNS depression was noted in 6.8% of the cases. Most per- and postoperative event variables were highly correlated to the degree of surgical stress. In conclusion, a new concept for preoperative assessment and the registration of events during and after surgery was used. In this way, a large number of events of importance, not least for quality assurance, were found that would be missed with the official coding system. In a previous report we could show that even minor events affected the cost of care substantially.

Adolescent↗
PubMed1995

Long-term glycemic control relates to mortality in type II diabetes.

OBJECTIVE: To study the influence of long-term glycemic control on mortality in a cohort of newly detected type II diabetic individuals. RESEARCH DESIGN AND METHODS: A total of 411 newly detected type II diabetic individuals diagnosed between 1972 and 1987 were followed until 31 December 1989. Clinical data concerning fasting blood glucose (FBG) values, body mass index (BMI), type of treatment, and concomitant diseases were collected during 8 randomly selected years. Long-term glycemic control was measured as annual averages of FBG values during these years. Mortality data were obtained from official registers. RESULTS: There were 161 diabetic subjects who died during a mean follow-up time of 7.4 years. In univariate analyses, higher age at diagnosis; higher baseline or average FBG; and the presence of heart disease, cerebrovascular disease, or kidney disease at the beginning or during the course of diabetes were related to higher mortality. Type of diabetes treatment or having a diagnosis of hypertension was not related to mortality. In multiple logistic regression analyses, age at diagnosis and average FBG were independently related to all-cause (P = 0.0002), cardiovascular (P = 0.0006), and ischemic heart disease mortality (P = 0.03). No correlations between glycemic control and noncardiovascular deaths were found. In a Cox's regression analysis, average FBG was significantly related to length of survival when age at diabetes diagnosis was taken into account (P < 0.05). Diabetic subjects with average FBG > or = 7.8 mmol/l had 50% higher mortality compared with diabetic subjects with average FBG < 7.8 mmol/l. CONCLUSIONS: Diabetic patients with good long-term glycemic control had a better survival rate than subjects with high average FBG values. The findings should be interpreted cautiously because possible confounding factors such as dyslipoproteinemia and smoking were not studied.

Adult↗
PubMed1995

Helicobacter pylori seropositivity among Swedish adults with and without abdominal symptoms. A population-based epidemiologic study.

BACKGROUND: The role of Helicobacter pylori in functional dyspepsia is unclear. The aim of this population-based study was to determine whether the prevalence of H. pylori infection is higher among people with dyspepsia or irritable bowel syndrome (IBS) than among symptomless persons after control for age, sex, and socioeconomic status. METHODS: In a postal questionnaire we asked a representative sample (20-79 years; n = 1260) from a Swedish municipality about abdominal symptoms in the preceding 3 months. A randomly selected subsample, 50 with dyspepsia, 50 with IBS, and 50 symptomless, matched with regard to age, sex, and education, were tested for the presence of IgG antibodies to H. pylori, using the HM-CAP immunoassay. RESULTS: Fifty-five persons (38%) were H. pylori-seropositive. The seroprevalence among dyspeptics (33%) did not exceed that in healthy people (48%) or in those reporting IBS (33%). The prevalence increased with age and with lower social class, but the latter association disappeared when age was taken into account. Neither sex nor symptom intensity predicted Helicobacter seropositivity. CONCLUSION: Our data are incompatible with an important aetiologic role for H. pylori in functional dyspepsia.

Age Distribution↗
PubMed1994

A randomized study of manual therapy with steroid injections in low-back pain. Telephone interview follow-up of pain, disability, recovery and drug consumption.

A total of 101 outpatients with acute or sub-acute low-back pain was randomly allocated to one of two treatment groups. One group was given standardised conventional and optimised activating treatment by primary health care teams. The other group received, according to a pragmatic approach, another treatment programme including manipulation, specific mobilisation, muscle stretching, autotraction and cortisone injections. The treatment effect was evaluated by standardised telephone interviews 3, 7, 14, 21 and 90 days after the start of treatment. The two groups were similar in most of the pretrial variables, including age, sex, occupation, education, previous low-back pain problems, previous treatment, sick-leave, findings at the physical examination, quality-of-life score, presence of common symptoms, disability rating and pain score. In the early phase as well as at the 90 days' follow-up, the group receiving manual therapy had significantly less pain, less disability, faster rate of recovery and lower drug consumption, indicating that this type of treatment is superior to conventional treatment.

Adult↗
PubMed1994

Sensitive patient-doctor communications relating to the breasts and prostate.

This study was carried out at two primary health care centers in separate counties in central Sweden. Data derive from recordings of consultations of 42 patients and their general practitioners. The patients and the doctors were interviewed separately after each consultation. The analysis is based on the audio-recordings as well as on verbatim transcripts of the consultations. It focuses on communications about the topics relating to the breasts and the prostate and how these topics are dealt with during the consultations. These topics were brought up in seven (29.2%) of the 24 consultations with female patients and four (22.2%) of the 18 consultations with male patients. A common pattern of the outcome as regards information was that the patient was given neither the tool, i.e., knowledge about bodily functions, nor methods for detecting an abnormality. The patients indirectly evinced ignorance with regard to the body, examinations, and diseases, and did not ask any direct questions that required answers.

Adolescent↗
PubMed1994

Factors related to perceived health among elderly people: the Albertina Project.

The Albertina Project is an epidemiological study of the medical, social and economic situation among people aged 75 years or older in Uppsala, Sweden. In this report, health conditions, quality-of-life measures and housing problems affecting it are presented. A postal questionnaire was sent to an 11% random sample (n = 959) of the eligible population out of which 706 (74%) persons responded. Nearly one-third of the elderly people could not read a newspaper with or without glasses, more than one-third had impaired hearing, 47% had some sort of mobility problem and 66% reported some form of sleeping problem. Forty-two per cent felt lonely sometimes or often and 65% were worried, in most cases about the risk of falling. In spite of this, 87% rated their health as good and 79% were content or rather content with their situation. Even though eyesight and hearing problems were common in this study, they did not affect perceived health to any large extent. Mobility problems and sleeping problems had a greater impact. The most important factors related to perceived health were activity score, contentment and mobility problems. Contentment was affected by activity score and loneliness and the latter was in turn affected by age and type of dwelling. The practical implication of these findings is that perhaps more attention should be focused on efforts to improve old people's satisfaction with their life situation rather than on marginal improvements of their medical situation.

Activities of Daily Living↗
PubMed1994

The Gothenburg study of perioperative risk. I. Preoperative findings, postoperative complications.

The Gothenburg study of Perioperative Risk is a prospective clinical-epidemiological study designed to elucidate factors affecting the perioperative risk in unselected adult patients undergoing elective general or orthopaedic surgery. In this report reference data regarding preoperative characteristics and postoperative complications are presented. 1770 adult patients scheduled for elective general, urological, peripheral vascular or orthopaedic operative procedures were invited to a preoperative clinic. 81% agreed to participate and were assessed in a standardised way by means of questionnaires, interview, physical examination and laboratory screening. 82% had a previous or present condition in the medical history of some concern to the assessor. 71% had a finding of significance on physical examination. In 8% the assessment prompted further investigations or precautions. Throughout their hospital stay, all the 1361 participating patients were visited daily by an especially trained nurse with the task of registering the occurrence of complications. In 30% an untoward event occurred postoperatively--in 1% a severe one, in 21% a mild event, and in 8% an intermediate one. The complication rate was higher in vascular surgery (69%) than in orthopaedic (33%) and general/urological surgery (26%). Not only the severe and intermediate but also the mild complications affected the number of days in hospital.

Adult↗
PubMed1994

Implementation of a structured care programme for diabetes mellitus in a defined population in mid-Sweden.

A local programme for diabetes care, based on the Swedish national programme, was introduced in the Köping-Arboga-Kungsör area in mid-Sweden in 1984. Before the programme was implemented, a survey of diabetes care was performed in the area. Two years later, a new survey involving 92% of 1253 diabetes patients in the area was performed to see if the programme was associated with an improved level of care, more optimal treatment and better metabolic control. A significant number of Type 2 patients were referred from hospital outpatient clinics to the primary health care centres. The proportion of patients on diet only increased from 26% to 30% and the average number of daily injections among insulin-treated patients increased. The average number of check-ups by a doctor decreased and the number of check-ups by specially trained nurses increased. Overall, the number of check-ups per year increased from 3.1 to 3.8. The proportion of the patients fulfilling the HbA1c criterion of 'good metabolic control' (< or = 6.0%) increased significantly, as did those fulfilling the fasting blood glucose criterion (< or = 7.0 mmol l-1). Serum cholesterol and serum triglyceride levels increased. Relative weight, blood pressure, smoking habits, and exercise habits were unchanged. In conclusion, the quality of diabetes care was improved after the diabetes care programme was implemented.

Adult↗
PubMed1994

Social mobility and health in a prospective study of middle-aged men.

Many social factors and social phenomena and their influence on health are now of interest for epidemiological research and also for health policy. On social phenomenon of interest is mobility in the social structure of society. In this prospective study of a sample of 50-year-old men born in 1913 in Gothenburg, Sweden, it was possible to study intergenerational social mobility and different measures of ill-health, like health complaints, incidence of myocardial infarction and mortality. The results of the study indicate that individuals who find themselves in a lower social group than that of their father at the age of 50 exhibit a somewhat poorer subjective state of health and report more complaints and symptoms at the age of 60. They also tended to be slightly more at risk with regard to myocardial infarction, but there were no mortality differences in a long-term follow-up.

Absenteeism↗
PubMed1994

The epidemiology of abdominal symptoms: prevalence and demographic characteristics in a Swedish adult population. A report from the Abdominal Symptom Study.

The prevalence of abdominal symptoms was studied by means of a postal questionnaire sent to a representative sample (n = 1290) of the adult population of a Swedish municipality. The subjects were asked about the occurrence of 35 abdominal symptoms during the preceding 3 months. The participation rate was 89.6%, and 54.3% of the responders reported at least one discomforting abdominal symptom. The overall prevalence rate was significantly higher in women than in men, and the highest rate (75%) was found among young women. The average number of symptoms per individual was also significantly higher in women. The overall prevalence rate in women decreased significantly with age, irrespective of menopause. The prevalence of most individual symptoms decreased with age and/or was higher in women. However, the prevalence of symptoms indicative of gastro-oesophageal reflux disease did not vary with age or sex. The prevalence of symptoms usually regarded as ominous did not increase with age; in some instances it even decreased. With the exception of reflux symptoms and night pain, the apparent disappearance with increasing age implies that most of the complaints are of functional origin.

Abdominal Pain↗
PubMed1994

Intervention against ischaemic heart disease risk factors in primary health care in a semi-rural community. The population study "50-year-old people in Kungsör".

OBJECTIVE: To see whether a program for screening and intervention against ischaemic heart disease (IHD) risk factors could be integrated into the ordinary work of a primary health care centre. DESIGN: Longitudinal population study with baseline screening, intervention, and one-year follow up. SETTING: Kungsör, a semi-rural community in mid-Sweden. PARTICIPANTS: All 50-year-old men and women in Kungsör. MAIN OUTCOME MEASURES: Feasibility, participation rate, change of traditional IHD risk factors and self-assessed well-being measures. RESULTS: Blood pressure and serum cholesterol were significantly reduced. Smoking rates and BMI were not affected. The advice given had the same effect, whether given by the doctor or the nurse. Videotaped information had no further effect on the risk factor levels. There was no obvious evidence of negative psychological effects of screening and intervention. CONCLUSIONS: Primary health care provided an excellent base for the study and the project could be performed within the ordinary setting. The risk reduction was of a similar magnitude to that in the large-scale preventive trials without any evidence of negative psychological effects of screening and intervention.

Cohort Studies↗