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S Mölstad

Publications and source records attributed to S Mölstad.

31 records · Page 2Linked to original sources
PubMed1997

Duration of nasopharyngeal carriage of penicillin-resistant Streptococcus pneumoniae: experiences from the South Swedish Pneumococcal Intervention Project.

As a part of an intervention project, all detected carriers of penicillin-resistant pneumococci (PRP) (MIC, > or = 0.5 mg/L) in Malmöhus County, southern Sweden, were followed by means of weekly nasopharyngeal cultures. The median duration of carriage in 678 individuals was 19 days (range, 3-267 days). The duration of carriage was longest in children < 1 year old (median, 30 days) and shortest in adults > 18 years old (median, 14 days). Index cases, whose cultures were performed during an acute infection, were carriers for a mean of 10 days longer than asymptomatic contact cases (P < .05). The PRP spontaneously disappeared from the nasopharynx within 4 weeks in 68%, within 8 weeks in 87%, and within 12 weeks in 94% of the individuals. Other significant risk factors for prolonged carriage were the occurrence of > 6 episodes of acute otitis media (AOM) or first episode of AOM before the age of 1 year (P < .01), the carriage of PRP by other family members (P < .05), and the obtainment of a first positive culture during the winter months (P < .05).

Adolescent↗
PubMed1996

Do antimicrobials increase the carriage rate of penicillin resistant pneumococci in children? Cross sectional prevalence study.

OBJECTIVE: To study the correlation of antimicrobial consumption with the carriage rate of penicillin resistant and multiresistant pneumococci in children. DESIGN: Cross sectional and analytical prevalence study. SETTING: Five different communities in Iceland. MAIN OUTCOME MEASURE: Prevalence of nasopharyngeal carriage of penicillin resistant pneumococci in children aged under 7 years in relation to antibiotic use as determined by information from parents, patient's records, and total sales of antimicrobials from local pharmacies in four study areas. RESULTS: Total antimicrobial sales for children (6223 prescriptions) among the four areas for which data were available ranged from 9.6 to 23.2 defined daily doses per 1000 children daily (1.1 to 2.6 courses yearly per child). Children under 2 consumed twice as much as 2-6 year olds (20.5 v 10.9 defined daily doses per 1000 children daily). Nasopharyngeal specimens were obtained from 919 children, representing 15-38% of the peer population groups in the different areas. Pneumococci were carried by 484 (52.7%) of the children, 47 (9.7%) of the isolates being resistant to penicillin or multiresistant. By multivariate analysis age (< 2 years), area (highest antimicrobial consumption), and individual use of antimicrobials significantly influenced the odds of carrying penicillin resistant pneumococci. By univariate analysis, recent antimicrobial use (two to seven weeks) and use of co-trimoxazole were also significantly associated with carriage of penicillin resistant pneumococci. CONCLUSIONS: Antimicrobial use, with regard to both individual use and total antimicrobial consumption in the community, is strongly associated with nasopharyngeal carriage of penicillin resistant pneumococci in children. Control measures to reduce the prevalence of penicillin resistant pneumococci should include reducing the use of antimicrobials in community health care.

Age Factors↗
PubMed1996

Seroprevalence of Helicobacter pylori in south Sweden and Iceland.

BACKGROUND: Seroepidemiologic studies on the prevalence of Helicobacter pylori infection have been reported from several European countries but not from Sweden or Iceland. METHODS: Serum samples were collected from 443 persons in Sweden and 387 persons in Iceland. All the 830 sera were tested with the same enzyme immunoassay test with an acid glycine extract of H. pylori surface proteins as antigen. RESULTS: The antibody levels were low in the young age groups in both Sweden and Iceland, with increasing levels with age. CONCLUSIONS: The results are consistent with previous studies from other comparable countries, but with important differences. The prevalence was lower in Sweden than in other, previously studied, Western European countries, but, on the other hand, the prevalence was slightly higher in Iceland.

Adolescent↗
PubMed1995

Drug prescription attitudes and behaviour of general practitioners. Effects of a problem-oriented educational programme.

A producer-independent, problem-oriented, group-education programme with 2-day meetings on drug treatment in primary health care (PHC) was developed and evaluated. Initially, it was tested on a selected group of general practitioners (district physicians), using a non-exposed group as control. A comprehensive questionnaire was used to test changes in attitudes. There was a significant change in attitudes concerning both general opinions on drugs and drug use, on information about drug treatment, and on use of drugs in selected therapeutic areas. Also, the district physicians became more critical towards information from pharmaceutical companies. Prescribing patterns tended to change in accordance with the attitude changes. Subsequently, the programme was offered to all district physicians (about 550) in the southern Swedish health care region for a 10-year period, with 20-25 district physicians per 2-day meeting. The impact of the programme on the prescribing of a selected group of drugs (antibiotics) was assessed by voluntary registration of prescription by the participants, by regional prescription analyses and by analyses of drug sales data. There were significant, consistent, and sustained changes in the prescribing of antibiotics. The study supports the view that, if drug prescribing in general practice is to be improved, producer-independent, problem-oriented, face-to-face, small-group education on drug treatment is worthwhile.

Anti-Bacterial Agents↗
PubMed1994

Dyspepsia in general practice: psychological findings in relation to Helicobacter pylori serum antibodies.

Questionnaire data based on traditional concepts for measuring hypochondriasis and depression were related to serological data on Helicobacter pylori antibodies in 110 of 130 consecutive patients, aged 18-65 yr, consulting for dyspeptic symptoms in general practice. Of the patients thirty-seven (33.6%) and seventy-three (66.4%) were classified as H. pylori positives and H. pylori negatives, respectively, the H. pylori positive patients being significantly older than H. pylori negative patients. Factor analyses of the questionnaire data indicated the heterogeneity of each of the traditional concepts for measuring hypochondriasis and depression but succeeded in differentiating orthogonally between two hypochondriasis factors and three depression factors. Hierarchical regression analyses of factor scores, controlling for the influence of age and sex, indicated higher H. pylori antibody activity to be associated with less hypochondriacal signs of anxiety and uneasiness. It is hypothesized, that in dyspepsia without signs of H. pylori infection, somatization may account to a substantial extent for the illness.

Adolescent↗
PubMed1994

Antibiotics prescription in primary care: a 5-year follow-up of an educational programme.

An educational programme on the use of antibiotics for respiratory tract infections (RTIs) in primary care, initiated among district physicians at the Community Health Centre of Höör, Sweden in 1985, resulted in an overall reduction in prescriptions for antibiotics, particularly broad-spectrum antibiotics. The aim of the present study was to evaluate the long-term effects of the programme on antibiotic prescription patterns at the centre. Since 1985, computerized records have been kept of every consultation at the centre, including details of the attending physician, the patient, diagnosis and type of antibiotic prescribed. Moreover, during a 3-month period in 1991, each pharmacy in the region recorded details of all prescriptions for antibiotics dispensed. Estimated immediately after the programme, the proportion of RTI patients prescribed antibiotics had fallen to 44%, a figure virtually unchanged 5 years later. During the subsequent five-year period, antibiotics dispensed at the pharmacy in Höör were further reduced from 14.1 to 13.2 defined daily doses 1000 inhabitants-1 day-1. As compared with district physicians at other community health centres in the region, those at Höör prescribed more penicillin V (80% of all antibiotic prescriptions) and less broad-spectrum antibiotics. The educational programme, combined with an active interest among district physicians at Höör in current research into antibiotic usage, has thus wrought enduring changes in the pattern of antibiotic prescription. A probable contributory factor was the district physicians' awareness that the computerized registration of diagnosis and treatment enables prescription patterns to be audited at an individual level.

Anti-Bacterial Agents↗
PubMed1994

Dyspepsia in general practice: history and symptoms in relation to Helicobacter pylori serum antibodies.

BACKGROUND: This study was designed to explore the relationships between serologic Helicobacter pylori positivity and demographic, behavioural, and symptomatologic factors in patients consulting for dyspeptic symptoms in general practice. METHODS: H. pylori enzyme-linked immunosorbent assay results and checklist data were collected by general practitioners at three community health centers in southern Sweden from consecutive patients aged 18-65 years with upper abdominal pain or discomfort (dyspepsia). RESULTS: Of the 130 available patients with dyspepsia, 127 agreed to participate, 45 (mean age, 41.2 years) being classified as H. pylori-positive and 82 (mean age, 33.5 years) as H. pylori-negative. Manual workers were diagnosed as H. pylori-positive significantly more often than were non-manual workers (p < 0.05). Of those patients examined earlier by gastroscopy or roentgenography, H. pylori-positives reported stomach or duodenal ulcer significantly more often than did H. pylori-negatives (p < 0.01). H. pylori-positives reported stomach/duodenal ulcer in their parents/siblings to a significantly greater extent than did H. pylori-negatives (45.2% versus 10.1%, p < 0.001). H. pylori-negatives reported stress-generated symptoms significantly more often than did H. pylori-positives (82.9% versus 61.5%, p < 0.01). Hierarchical regression analyses showed that, when age and sex were controlled for, the ability of each of these measures to predict the serologic results remained significant. CONCLUSIONS: Higher levels of H. pylori antibodies in dyspeptic patients appear to be associated with a relatively low self-perception of stress, with manual work, with being older, and with the occurrence, both in the patients themselves and in their close relatives, of stomach/duodenal ulcer.

Abdominal Pain↗
PubMed1992

Production of betalactamase by respiratory tract bacteria in children: relationship to antibiotic use.

Sales of antibiotics have increased in Sweden during the past decade. This has been paralleled by an increase in the frequency of beta-lactamase-producing respiratory tract bacteria. To investigate the effects of regional differences in use of antibiotics on beta-lactamase production in respiratory tract bacteria, we collected nasopharyngeal specimens and information about antibiotic use from 1133 children attending day-care centres in four rural municipalities with low use, and one urban municipality with high use of antibiotics, use being assessed from pharmacy sales. The frequency of beta-lactamase production among isolates of Branhamella catarrhalis and Moraxella nonliquefaciens was significantly higher in the urban municipality. This appeared to be a long-term ecological effect of differences in the level of use of antibiotics between the urban and rural populations, rather than an effect of recent antibiotic treatment of individual patients.

Anti-Bacterial Agents↗
PubMed1990

Emergence and persistence of beta-lactamase-producing bacteria in the upper respiratory tract in children treated with beta-lactam antibiotics.

PURPOSE: To assess the ecologic impact, in terms of selection of beta-lactamase-producing respiratory tract bacteria, of a single course of peroral beta-lactam antibiotics. PATIENTS AND METHODS: One-hundred fifty consecutive children with clinical signs of bacterial respiratory tract infection were randomly assigned to a seven-day course of treatment with either penicillin V, amoxicillin, or cefaclor. Bacteriologic specimens were collected before treatment, at its termination, and at follow-up four weeks later. RESULTS: All three drugs investigated caused a similar increase in beta-lactamase-producing bacteria, both in absolute and relative terms, an increase that persisted over a period of at least one month after completion of treatment. CONCLUSION: Penicillin V, amoxicillin, and cefaclor all act as selective agents for beta-lactamase-producing bacteria in the upper respiratory tract. Treatment with a peroral beta-lactam antibiotic puts patients at risk of becoming persistent carriers of beta-lactamase-producing bacteria.

Amoxicillin↗
PubMed1990

Prescription of antibiotics to out-patients in hospital clinics, community health centres and private practice.

Prescription of antibiotics in Sweden varies between countries within a range of 13-20 DDD/1000 inhabitants/day. In Malmöhus county, which accounts for the highest prescription rate, the amounts and proportions of erythromycin and tetracyclin prescribed are particularly large. All prescriptions for antibiotics dispensed in half of the pharmacies in the county during a one-week period were examined with respect to type of antibiotic and category of physician responsible for the prescription. Among 5,165 antibiotic prescriptions examined, broad spectrum antibiotics were more frequent in urban than in rural areas, and were more often prescribed by hospital physicians and private practitioners than by district physicians. Erythromycin was particularly often prescribed by paediatricians, the frequency being comparable to that of phenoxymethylpenicillin. Retrospective analysis of consultations at the ENT and paediatric clinics for respiratory tract infections showed that phenoxymethylpenicillin was not always the drug of choice by hospital physicians, despite a recommendation to that effect by the Board of Health and Welfare. The findings suggest that the choice of antibiotics is determined not only by medically relevant factors and Board recommendations but also by the habits of the consulting physicians.

Anti-Bacterial Agents↗
PubMed1989

Reduction in antibiotic usage following an educational programme.

The past decade has seen a steady increase in the consumption of antibiotics in Sweden, most of which are prescribed for respiratory tract infections. Trends in the prescribing of antibiotics for respiratory tract infections at the community health centre in Höör, southern Sweden, analysed before and after an educational programme, showed a significant reduction in the use of antibiotics, 67.6% of patients (n = 216) having been prescribed antibiotics before the programme in contrast to 43.9% (n = 212) afterwards. The reduction was particularly marked with regard to erythromycin and broad-spectrum antibiotics, and in cases of rhinitis/rhinopharyngitis, pharyngitis and bronchitis. On an annual basis, the reduction was equivalent to 2.5 defined daily doses per 1000 inhabitants per day. The study has shown that a reduction in antibiotic usage for respiratory tract infections can be achieved without changing the indications for antibiotic treatment.

Anti-Bacterial Agents↗
PubMed1988

Beta-lactamase production in the upper respiratory tract flora in relation to antibiotic consumption: a study in children attending day nurseries.

The occurrence of beta-lactamase production in Haemophilus influenzae, Branhamella catarrhalis and Moraxella nonliquefaciens was compared in 191 healthy children attending day nurseries in 2 municipalities differing with regard to the prescription rate of beta-lactam antibiotics. A significantly higher frequency of beta-lactamase production was recorded in M. nonliquefaciens isolated in the municipality with the higher prescription rate. A corresponding difference was not recorded for H. influenzae or B. catarrhalis. Approximately 75% of the nasopharyngeal pathogens H. influenzae, B. catarrhalis and Streptococcus pneumoniae, as well as the commensal M. nonliquefaciens, were eliminated and often replaced by other strains of either species over a period of one month. Although none of the children were on antibiotics a substantial proportion of the acquired strains produced beta-lactamase. This suggested that the carrier rate of beta-lactamase producing strains of the respiratory tract is not only related to the effect of recent antibiotic treatment but also to the prevalence of such strains in the population.

Anti-Bacterial Agents↗