Biomedical subjects

S Selander

Publications and source records attributed to S Selander.

At least 19 recordsLinked to original sources

PubMed1997

The discursive formation of health. A study of printed health education material used in primary care.

This study analyses printed educational material on cholesterol, food and health-related lifestyle changes used in primary care in southern Sweden. Two theoretically grounded perspectives are used: orientation of knowledge and rhetoric. According to the first one, the material contained many examples of abstract and detailed knowledge, such as tables of energy contents, and a little less of action-oriented and detailed knowledge, such as food recipes. We also found a few examples of comprehensive, abstract knowledge, such as theoretic explanations. Action-oriented and comprehensive knowledge, relating health to-lifestyle, were rare. The rhetoric style of the material was generally dominated by plain facts, without any identified voice (i.e. sender) or any emotional orientation. Overall, information was not related to 'the voice of the life-world' but to 'the voice of medicine', and it was in character more general than specific.

Books↗

PubMed1997

Guidelines and reported practice for the treatment of hypertension and hypercholesterolaemia.

OBJECTIVE: To monitor changes in family physicians' reported practice on hypertension and hypercholesterolaemia. DESIGN: Random samples of physicians were selected for telephone interviews on their practice regarding cut-off levels and pharmacological treatment of hypertension and hypercholesterolaemia, related to a case scenario of a 48-year-old man, in 1989, 1991 and 1993. SETTING: Primary care facilities in southern Sweden. SUBJECTS: Specialists in family medicine, employed in public primary health care. Participation rates were in 187/201 (93%) in 1989, 236/264 (89%) in 1991 and 257/298 (86%) in 1993. MAIN OUTCOME MEASURES: Cut-off levels and drug treatment preferences for hypertension and hypercholesterolaemia. RESULTS: During the period 1989-1993, decreasing mean cut-off levels for pharmacological treatment of hypertension (P < 0.001) were reported, below the levels of the guidelines. Although betablockers were first choice drug in all three surveys, the proportion preferring this has diminished (P < 0.001), whilst the proportions preferring ACE-inhibitors and calcium channel blockers have increased (P < 0.001 and P = 0.02, respectively). For drug treatment of hypercholesterolaemia, the mean cut-off level remained close to guidelines in all three surveys. The proportion of physicians suggesting resins and nicotinic acid as first choice drug had decreased (P < 0.001 and P = 0.03, respectively), whilst the proportion preferring statins and fibrates had increased (P < 0.001 and P = 0.048, respectively). CONCLUSION: Practice guidelines on hypertension and hypercholesterolaemia have not had the desired impact on physicians' reported practice. The reason for this might be that physicians did not value the guidelines as adequate tools for practice, or that the methods for dissemination, implementation, and maintenance of guidelines were not appropriate.

Anticholesteremic Agents↗

PubMed1997

Understanding the unperceivable: ideas about cholesterol expressed by middle-aged men with recently discovered hypercholesterolaemia.

OBJECTIVE: We aimed to describe the perception of hypercholesterolaemia among middle-aged, urban men who had recently received the diagnosis of moderate hypercholesterolaemia. METHOD: Within a project screening for risk factors for coronary heart disease among 453 men, 63 were identified as moderately hypercholesterolaemic. Among these, 62 agreed to tape-recording and transcription of the first counselling on lipid-lowering, supplied by a registered nurse. The counselling was tailored to fit the needs of the individual patient, taking a starting point in whatever questions the patient expressed. The transcripts of the counselling sessions were analysed for their content. RESULTS: Five major themes were addressed by the men. It was hard to understand and accept the concept of hypercholesterolaemia, as the men did not feel unwell, and thus they did not receive any cues to taking action. Obesity and smoking was regarded as causes of hypercholesterolaemia, although the link between life-style and cholesterol level was unclear. Some men were aware of heredity traits of hypercholesterolaemia. Treatment suggestions included weight reduction and drug treatment, although there were ambiguous feelings towards drugs. Numerous misconceptions about diet were found. Many men expressed resistance to life-style changes and questioned the benefits of risk reduction. Information about hypercholesterolaemia was regarded as unreliable, as different sources gave incongruent information, and the information from individual sources changed over time. CONCLUSION: Unless medical professionals counselling patients for asymptomatic risk factors make efforts to disclose patients' conceptions of the condition, patients may misunderstand and counselling may become ineffective.

Adult↗

PubMed1997

Health beliefs and heart disease risk among middle-aged Swedish men. Results from screening in an urban primary care district.

OBJECTIVE: To study the relationship between individual health beliefs and risk factors for coronary heart disease. DESIGN: Health beliefs indices, formed by factorial analysis of ratings of statements on health related matters in a questionnaire, were related to risk factors for coronary heart disease, assessed with physical examinations and self reports of medical history and habits. SETTING: An urban primary care district in Malmö, Sweden. SUBJECTS: A random sample of middle-aged men, invited to a health check-up. RESULTS: The participation rate was 453/705 (64%). "Perceived threat to health caused by illness" was positively related to previous information on high blood pressure, high plasma cholesterol, and/or diabetes (p = 0.01). In a model of logistic regression, adjusted for age, cohabitation, and previous medical history, health belief index on "threat to health" was related to low exercise habits (RR = 1.06, CI 1.01, 1.12). "Perceived control over illness" was related to high alcohol consumption (RR = 0.86, CI 0.75, 0.97), smoking (RR = 0.89, CI 0.79, 0.99), and high diastolic blood pressure (RR = 0.84, CI 0.75, 0.95). CONCLUSION: This cross-sectional study demonstrates relations between health beliefs, previous health-related experiences, and risk behaviour. To explore the causality of the former, longitudinal studies of changes in health beliefs after medical information are required.

Analysis of Variance↗

PubMed1995

My family dies from heart attacks. How hypercholesterolaemic men refer to their family history.

Patients often worry considerably about biomedically mild and self-limiting conditions. A previous study on non-selected primary care patients showed that this could be partly explained by frequent associations with cases of serious illness in their family histories. This study further investigated these phenomena in middle aged men with a recent diagnosis of hypercholesterolaemia. Sixty-three out of 453, 35-45-year-old male participants were diagnosed with moderate hypercholesterolaemia (6.5-7.7 mmol/l) in a health survey and received 20-30 minutes of life-style counselling. These sessions were audio-taped, transcribed and analysed with respect to the subjects' references to their family histories. Of the 63 men, 28 (45%) mentioned their family history. The main content category in these talks was perceived threat or risk, comprising the seriousness of the event in the family history on one hand and its believed relevance on the other. Fatal, serious or premature disease was discussed. Prevailing lay knowledge and beliefs about hypercholesterolaemia, risk factors and disease causation seemed to determine what conditions in the family history were judged relevant by the men. Several of the men referred to heredity and several regarded emotional closeness important. In a few cases the event referred to mainly functioned as an illustration or example of lay knowledge and beliefs. This study provides support for the view that the family history can play an important role for how asymptomatic patients interpret their risk factors for disease. This is important for the development of consultation skills.

Adult↗

PubMed1995

Reported treatment of hypertension by family physicians in Sweden and Minnesota: a physician survey of practice habits.

OBJECTIVES: To compare family physicians' reported practice habits on hypertension in Sweden and Minnesota, and to assess to what extent different national guidelines account for differences. DESIGN: Random samples of family physicians were selected for telephone interviews on their practice of hypertension. SETTING: Primary care in southern Sweden and in Minnesota. SUBJECTS: Family medicine specialists. Participation rates were 236/264 (89%) in Sweden and 183/209 (88%) in Minnesota. MAIN OUTCOME MEASURES: Cut-off levels, and non-pharmacological and pharmacological treatment of hypertension, related to three case scenarios: a 48-year-old man, a 65-year-old man and a 65-year-old woman. RESULTS: Swedish physicians reported significantly higher levels of diastolic blood pressure than Minnesota physicians for the institution of treatment of hypertension for all case scenarios. In both countries, physicians adhered to the cut-off levels of their national guidelines in the case of the 48-year-old man. Minnesota physicians did not use age as a modifying factor for treatment cut-off levels, as did Swedish physicians. Swedish physicians emphasized alcohol, fat and stress reduction, and Minnesota physicians weight and salt reduction as non-pharmacological treatment. While Swedish physicians generally preferred beta-blockers, Minnesota physicians chose ACE inhibitors or calcium channel blockers as the first choice drug. CONCLUSION: Swedish and US guidelines on hypertension were identical except for higher cut-off level for drug treatment in Sweden. Minnesota physicians reported cut-off levels close to national guidelines. For 65-year-old patients, Swedish physicians reported applying a higher cut-off level than indicated by guidelines. Swedish physicians also reported preferring less expensive drugs. As a consequence of the differing national guidelines and the identified physicians' practice habits in the two medical communities, it is likely that the segments of the populations treated and the drug costs differ substantially.

Adrenergic beta-Antagonists↗

PubMed1991

Dissemination and implementation of guidelines for lipid lowering.

Lipid lowering practice as reported by family physicians is described and related to current guidelines. During autumn 1989, a random physician sample was invited to a telephone interview, and 187 (93%) participated; they were asked about their awareness of consensus statements about hyperlipidaemia and their present practice habits in the diagnosis and treatment of hyperlipidaemia. Most commonly named sources of information were continuing medical education, consensus reports, professional journals and commercial sources. Most commonly used reference literature was consensus reports. The mean upper limit for desirable cholesterol in a 48-year old man was given as 6.2 mmol/l (recommended 5.2 mmol/l); non-pharmacological treatment was considered at 6.4 mmol/l (recommended 6.5) and pharmacological treatment at 8.0 (recommended 7.9). Exact consensus values were known by a minority of the physicians. Three-quarters of the physicians could name a first choice lipid lowering drug and half had a second choice. With the exception that those aware of a consensus report gave a significantly lower cut off point for pharmacological treatment (p = 0.043), there was no relationship between practice habits and source of information. Those stating consensus guidelines as their prime reference also gave a significantly lower cut-off point for non-pharmacological treatment (p = 0.036). We conclude that to influence medical practice, guidelines need extensive support from educational activities and quality assurance.

Analysis of Variance↗

PubMed1987

Transfer factor for adjuvant immunotherapy in cervical cancer.

In a prospective randomized double-blind study of 60 patients with invasive cervical cancer, 32 were treated with transfer factor (TF) derived from leukocytes of the patients' husbands, and 28 were treated with placebo. Within the first 2 years after radical hysterectomy, five out of 32 TF-treated patients and 11 out of 28 placebo-treated patients developed recurrence of malignancy. Excluding one further patient with intercurrent death this difference is significant (chi 2 = 3.9915; P less than 0.05). Subdividing the collectives, significant differences were found in patients aged below 35 years and in patients with stage I disease. Identical immune profiles were checked in leukocyte donors prior to leukophoresis and were serially checked in patients. Antigen-specific correlations were found between donors' and recipients' reactivities but not between donors' reactivity and recipient's course of the disease.

Clinical Trials as Topic↗

PubMed1983

[Transfer factor as adjuvant immunotherapy in invasive cervix cancer. Report of a double-blind study].

From 1977 to 1982 a prospective randomized double-blind study comparing transfer-factor (TF) versus placebo was conducted in invasive cervical cancer patients after radical surgery and irradiation. The husbands of the cancer patients were selected as leukocyte donors for TF preparations. 60 patients entered the study; 28 patients received placebo and 32 patients received TF. The comparability of both collectives was excellent concerning age and tumor stage. One patient treated with TF died intercurrently. The rate of recurrence of cancer was 5 in the 31 TF-treated patients and 11 in the 28 patients receiving placebo, which was significantly different (p less than 0,05). This difference was even greater when only patients treated for at least 3 months were compared (3 recurrences in the TF-group and 11 recurrences in the placebo-group). Further aspects of this clear clinical results are discussed.

Adult↗

PubMed1977

Cronkhite-Canada syndrome. Case report.

The case report of a 72-year-old man with the characteristic clinical and pathologic-anatomic picture of the Cronkhite-Canada syndrome is presented. The clinical features and the radiographic appearance of the gastrointestinal tract suggested Ménétrier's disease. Subtotal gastrectomy was performed and at the subsequent pathologic-anatomic examination, the diagnosis of Cronkhite-Canada syndrome was made. The patient slowly recovered over the following five months while being treated with the so-called astronaut diet (Vivasorb) supplemented with vitamins, iron and electrolytes. He died five months after surgery from intercurrent disease. The differential diagnosis of gastrointestinal polyposis with or without mucocutaneous pigmentation is briefly discussed. The histochemical characteristics of the epithelium in the gastric and colonic polyps was studied in some detail. The authors believe that the gastrointestinal polyps in the Cronkhite-Canada syndrome are regenerative and non-neoplastic in nature.

Aged↗

PubMed1970