Biomedical subjects

Sölve Elmståhl

Publications and source records attributed to Sölve Elmståhl.

At least 19 recordsLinked to original sources

PubMed2006

Relationships between income, subjective health and caregiver burden in caregivers of people with dementia in group living care: a cross-sectional community-based study.

BACKGROUND: Family caregivers of relatives with dementia report higher level of psychological distress than other caregivers and report their self-related health as poorer than that of comparison groups. AIMS AND OBJECTIVES: The purpose of the study was to examine characteristics of family caregivers and to assess whether income, subjective health, age and relationship were associated with the burden of care they experienced. SETTING: Group living units in southern Sweden. PARTICIPANTS: Fifty caregivers who served as informal caregivers of relatives with dementia in group living care. DESIGN: Interviews regarding economic and social conditions and well-evaluated scales for health and caregiver burden (CB) were used. RESULTS: The majority of the family caregivers were adult children, and twice as many were female than were males. The investigation showed that total burden, strain and disappointment, adjusted for health and age, were related to income. Disappointment showed a relation to subjective health. The adult children showed a significantly higher degree of total burden, irrespective of age, compared to other family caregivers. Low income was associated with a higher degree of burden among adult children. However, elderly participants experienced less of burden than younger ones. CONCLUSION: Our findings indicate that caregivers with low health profile and low income, especially adult children, are associated with higher CB. RELEVANCE TO CLINICAL PRACTICE: People with coexisting risk factors (low income, low perceived health) are the ones who may benefit most from health-oriented interventions.

Adaptation, Psychological↗

PubMed2006

No association between inhaled corticosteroids and whole body DXA in postmenopausal women.

PURPOSE: Postmenopausal women treated with corticosteroids are regarded as a high-risk group due to the effect of both natural bone loss and possible adverse effects of treatment with inhaled corticosteroids (IC). OBJECTIVE: To compare bone mineral density (BMD) in postmenopausal women exposed only to IC (IC group, n = 106) with that of BMD in women not exposed to corticosteroids (n = 124) and women exposed to oral and/or intra-articular injections in addition to inhaled corticosteroids (OC group, n = 31). The women were recruited from a population-based prospective cohort study. METHODS: Dual X-ray absorptiometry (DXA) technique was used to measure BMD in whole body, spine, pelvis and lower extremities. A health questionnaire and an interview about past and present medication use were used. RESULTS: The mean duration and dose of IC were 9.5 +/- 4.5 years and 615 microg daily. Whole body BMD did not significantly differ between the IC group (1.103 g/cm(2)) and the unexposed group (1.087 g/cm(2)). Within the IC group, BMD stratified for cumulative dose of IC, duration or current dose above or below 800 microg did not differ. Z-score BMD for tertiles did not differ when comparing the IC and OC groups. CONCLUSION: No difference in BMD was noted between postmenopausal women exposed to inhaled corticosteroids and unexposed controls nor was there any dose response relationship between inhaled corticosteroid therapy and BMD.

Absorptiometry, Photon↗

PubMed2006

Higher mortality and different pattern of causes of death among foreign-born compared to native Swedes 1970-1999.

In a previous Swedish longitudinal study of mortality among 723,948 foreign born and native-born Swedes, 1970-1999, increased mortality was found among foreign-born persons. This study describes and analyses the differences in mortality between 361,974 foreign-born persons and 361,974 native Swedes during the period 1970-1999, based on data from Statistics Sweden and the National Board of Health and Welfare. The mortality pattern showed dissimilarities; with a significantly higher number of deaths among foreign-born persons in six diagnose groups and a significantly lower mean age at time of death. A high number of deaths were found for migrants from Denmark in Neoplasm, for migrants from Finland and Poland in Diseases of the circulatory system and for migrants from Yugoslavia in Symptoms, signs and ill-defined conditions. There is a tendency to a more similar pattern between foreign- and Swedish-born persons over time. Migration may be a risk factor for health, and therefore seems to be an important factor to consider when studying morbidity and health and when planning preventive work.

Adult↗

PubMed2005

Mortality among 723,948 foreign- and native-born Swedes 1970-1999.

BACKGROUND: Mortality in a population is regarded as an accurate and valid measure of the population's health. There are a few international studies, predominantly cross-sectional, of mortality among all foreign-born compared with an indigenous population, and the results have varied. No Swedish longitudinal study describing and analysing mortality data was found in a literature review. METHODS: This study describes and analyses the differences in mortality between foreign-born persons and native Swedes during the period 1970-1999, based on data from Statistics Sweden and the National Board of Health and Welfare. The database consisted of 723,948 persons, 361 974 foreign-born living in Sweden in 1970, aged > or = 16 years, and 361 974 Swedish controls matched for age, sex, occupation and type of employment, living in the same county in 1970. RESULTS: The results showed increased mortality for foreign-born persons compared with the Swedish controls [odds ratio (OR) 1.08; 95% confidence interval (CI) 1.07-1.08]. Persons who had migrated 'late' (1941-1970) to Sweden were 2.5 years younger at time of death than controls. In relation to country of birth, the highest risk odds were for men born in Finland (OR 1.21), Denmark (OR 1.11) and Norway/Iceland (OR 1.074). Age cohorts of foreign-born persons born between 1901 and 1920 had higher mortality at age 55-69 years than cohorts born between 1921 and 1944. CONCLUSIONS: Migrants had higher mortality than the native population, and migration may be a risk factor for health; therefore, this seems to be an important factor to consider when studying mortality and health.

Adolescent↗

PubMed2005

Older people's views of prioritization in health care.

BACKGROUND AND AIMS: The aim of this study was to investigate and compare older people's views of prioritization in health care with specific regard to age, gender and HRQoL. METHODS: The sample was collected from a prospective longitudinal cohort study, the GAS project (Good Ageing in Skane) that is in progress in Sweden. For this study, 902 persons, 424 men and 478 women, aged between 60 and 93 years, were invited consecutively over a period of 17 months to participate in an additional structured interview based on an interview manual. Socio-demographic and HRQoL data were collected from the GAS project. For the analysis, the sample was divided into age groups: young-old, old-old, and oldest-old. RESULTS: Older people in general did not want age as a criterion for prioritization in health care. When pain was added as a criterion, age became even less important than when it was the sole criterion. The oldest-old, to a higher degree than the other age groups, prioritized younger patients, as did men, while women, more than men, preferred "old age" as an indicator for prioritization. The respondents' views on prioritization were also more associated with age and gender than HRQoL. CONCLUSIONS: Older people's views of priorities seem to differ from previous population-based studies, in that age per se as a criterion for selection between patients was not favored; health and wellbeing were more important. Differences were, however, found within the group of older people, as regards both age and gender.

Age Factors↗

PubMed2005

ADL dependence and perceived health among elderly deaf sign-language users: a comparison with a matched group of elderly hearing people.

The main purpose of the study was to investigate dependence in ADL and perceived health among elderly deaf sign-language users and to compare these findings with data from a matched hearing elderly population sample. Data on the deaf population were collected through assessments and structured interviews in sign language. Data on the hearing population were retrieved from the Swedish National Study and Ageing and Care (SNAC), while only a few variables from the questionnaire were used in the present study. Each deaf individual was matched by three hearing persons. Matching was performed according to gender, age, and living situation. The main finding is that elderly deaf sign-language users are more dependent in ADL but simultaneously report better health than their hearing counterparts. The differences in ADL dependence can be explained by factors linked to the communication problems experienced by deaf sign-language users, but also by cultural factors. The better health reported by the deaf sample may be attributed to adaptive mechanisms that deaf sign-language users have been claimed to develop. This research provides new information on a vulnerable group of elderly people, i.e. deaf sign-language users, that has previously been given little scientific attention.

Activities of Daily Living↗

PubMed2005

Older people's views of prioritization in health care. The applicability of an interview study.

AIM: Older people's views of prioritization in health care. The applicability of an interview study. Old age has been stated as a criterion for prioritization in health care, although older people are seldom asked for their opinions. The aim of this pilot study was to investigate the applicability of a questionnaire as a base for an interview study to explore older people's experiences and views of prioritization in health care. DESIGN: Descriptive, with a qualitative and quantitative approach. Fifty-four persons, 32 women and 22 men (aged 60-93 years), were asked to participate in a structured, tape-recorded interview covering their experience and views of the priorities applied in health care. RESULTS: The questions in the interview manual appeared to be applicable for collecting data concerning views of prioritization, but the analysis revealed that certain questions, particularly on economic matters, were missing. The procedure, a personal structured interview had advantages, for example, in capturing the respondents' reflections on the questions. The respondents emphasized the equal value of all human beings and that age is not a basis for prioritization within health care. The respondents also showed an unwillingness to precede anyone in rank. IMPLICATIONS: The questions used proved to be adequate but to be really complete further questions need to be added. This pilot study indicates that older people's views on priorities in health care differ from those expressed by the younger population. The study therefore needs to be replicated in a larger sample to be fully able to understand older people's views of prioritization, which will require exploring gender and age differences as well as other aspects that may explain variations.

Age Factors↗

PubMed2005

Family caregivers' subjective experiences of satisfaction in dementia care: aspects of burden, subjective health and sense of coherence.

Family caregivers experience both positive and negative reactions in caregiving situations. There has been considerably less published about the positive aspects, however. The general aim of this study was to explore a previously developed instrument to study rewards gained by caregivers and to determine the factors associated with satisfaction in family members caring for patients with dementia living at home. The study group consisted of 153 such family members. Standardized interview schedules exploring different background characteristics, and instruments for assessment of the degree of dementia in the patients and the caregivers' total burden and degree of satisfaction were used. Factorial analysis of the Caregiver's Assessment of Satisfactions Index was performed and it became more specific for conditions of dementia when it was reduced. Stressors as measured by the Caregiver Burden scale and satisfaction can coexist and assess different aspects of the caregiver's situation. The caregiver can perceive both moderate burden and great satisfaction at the same time, and further studies may help to broaden our understanding of how we can reduce the degree of burden whilst increasing the sense of satisfaction.

Activities of Daily Living↗

PubMed2004

A longitudinal study integrating population, care and social services data. The Swedish National study on Aging and Care (SNAC).

BACKGROUND AND AIMS: A large, national, long-term, longitudinal, multi-purpose study has been launched in Sweden--the Swedish National study on Aging and Care (SNAC). The study involves four research centers collecting data in four different areas of Sweden. METHODS: The study consists of two parts: the population part and the care and services part. In the population part, a large, representative panel of elders in different age cohorts is followed over time to record and describe the aging process from different aspects. In the care and services part, a systematic, longitudinal, individually-based collection of data is performed concerning provision of care and services together with functional ability, specific health care problems, and living conditions of the recipients living in the area. RESULTS: The data collection in the population part of the SNAC is not yet completed. In the present article, some preliminary results are reported from the care and services part. These pertain to comparisons between the participating areas with respect to the prevalence of disability among those receiving care and social services in their ordinary homes and those receiving care in special accommodation. A comparison is also presented with regard to the amount of home help provided to subjects with a given disability. CONCLUSIONS: This project has several advantages. It is expected to generate a rich data base relevant for future research on aging and care and to have a direct impact on the future Swedish system of care and services for the elderly.

Activities of Daily Living↗

PubMed2004

Unspecific clinical presentation of bowel ischemia in the very old. Digitalis treatment--a reason for higher mortality?

BACKGROUND AND AIMS: Ischemic bowel disease predominantly affects the elderly (>65 years). Early diagnosis and treatment are of vital importance for the outcome. The vague symptoms of ischemic bowel disease entail a risk of delayed diagnosis, with a subsequent risk of increased mortality. The aims of this retrospective study were to identify symptoms and prodromes, to study factors associated with mortality in ischemic bowel disease, and to describe the influence of age, by comparing patients <80 and > or = 80 years. METHODS: The subjects of the study were 135 patients, mean age 77 years, admitted to Malmö University Hospital, Sweden, between 1987 and 1996, with a ICD-9 diagnosis of acute or chronic splanchnic ischemia. RESULTS: Patients aged 80 years or more presented with a significantly higher prevalence of confusion (29% vs 12%), hematemesis (57% vs 14%), vomiting (82% vs 65%) and dehydration (58% vs 36%) at admission compared with patients aged under 80 years, and presented a higher mortality (87% compared with 65%, p=0.003). The prevalence of digitalis treatment was 34%, which was high compared with other Swedish cohort studies. Digitalis, adjusted for age, congestive heart failure and atrial fibrillation, was associated with increased mortality (odds ratio 4.6, 95% CI 1.3-16.1). Prodromal signs predicted poor outcome, and were found in one out of 4 patients, without any age differences. CONCLUSIONS: Bowel ischemia in the very old is associated with a different clinical presentation and a higher mortality compared with younger patients. Digitalis treatment seems to be associated with increased mortality in ischemic bowel disease. Prodromal signs are prognostically unfavorable.

Abdominal Pain↗

PubMed2004

Home care aides in the administration of medication.

OBJECTIVE: To assess to what extent home care aides (HCAs) within the social services are engaged in medication administration, including their knowledge of how to perform this work correctly, and also to assess their knowledge of pharmacology, adverse drug effects, diseases, and symptoms. Furthermore, we wanted to study if there were any changes to be seen in these areas since a previous study. DESIGN: A repeated survey, carried out in 1998, 5 years after a cross-sectional study. In a stratified sample of personnel within the social services in nine of Malmö's (Sweden) 10 administrative districts, a questionnaire with multiple-choice and open-ended questions was answered individually and under supervision. Statistical analyses were carried out using the chi-square test, except for logistic regression where odds-ratios were presented. STUDY PARTICIPANTS: Employees (341) within the social services in the municipality of Malmö, of whom 313 were HCAs and 28 were supervisors, most of whom also were HCAs, at a total of 36 workplaces. The study 5 years earlier included 393 employees, of whom 39 were supervisors and 354 were HCAs. MAIN OUTCOME MEASURES: Where possible, the answers in the knowledge test were classified as 'correct', 'partially correct' or 'erroneous', or were assigned to the group 'do not know/have not answered'. RESULTS: Most (95%) of the HCAs were engaged in medication administration. On average, 53% managed to give a correct or partially correct answer on questions concerning medication administration. The result concerning indications for common drugs was 55%, contra-indications and adverse drug effects 25%, and symptoms 59%. Some general improvements in knowledge were seen from 1993 to 1998, mostly in the area of medication administration, but the results also indicated a change for the worse in the area of indications for common drugs. CONCLUSIONS: Although most HCAs are engaged in medication administration, to a great extent they lack knowledge in the area. There is a need for additional personnel with the appropriate professional background, i.e. registered nurses, and a need for further training of HCAs in order to ensure patient safety. With respect to this, issues of learning and quality improvement are discussed.

Cross-Sectional Studies↗

PubMed2003

Monochromatic phototherapy in elderly patients: a new way of treating chronic pressure ulcers?

BACKGROUND AND AIMS: Monochromatic pulsating light may have effects of importance for wound healing, and promising results were obtained in an open study on the healing of pressure ulcers, which motivated the present study. METHODS: One hundred and sixty-four in- and outpatients with grade II and III ulcers were treated with monochromatic pulsating light or placebo over the ulcerated area, according to a specific therapeutic program. RESULTS: No significant effects were observed in the total material. In a subanalysis of grade II ulcers, there was a tendency toward better healing in the monochromatic light group (p = 0.06). A significantly larger reduction in pressure ulcer size was noted among patients in the treatment group with low body weight (BMI < 20). CONCLUSIONS: Monochromatic pulsating light may have effects on pressure ulcer healing, and a new study focusing only on grade II ulcers is under way.

Aged↗

PubMed2003

Is there an association between inhaled corticosteroids and bone density in postmenopausal women?

BACKGROUND: During the last decades, there has been increased concern about the association between oral corticosteroid (OC) therapy and osteoporosis. OBJECTIVE: The question currently discussed is whether inhaled corticosteroids (ICs) in recommended doses have any clinically relevant effects on bone mineral density (BMD). METHODS: We compared BMD in postmenopausal women exposed to corticosteroids only in inhaled form (IC group, n = 106) with that in women not exposed to corticosteroids (unexposed group, n = 674). BMD was also studied in 49 women exposed to OCs, intra-articular injections, or both in addition to ICs (OC group). The women were recruited from a population-based prospective cohort study. METHODS: We used a dietary survey, bone density measurement of the forearm, and a health questionnaire including an interview about past and present medication use. RESULTS: Mean BMD did not significantly differ between the IC group (0.434 g/cm2) and the unexposed group (0.429 g/cm2). The mean duration and dose of ICs was 8.2 +/- 5.03 years and 853 microg daily. Within the IC group, BMD stratified for cumulative dose of IC, duration, or current dose greater than or less than 1000 microg did not differ. BMD in the OC group was lower than that in the IC group (0.408 vs 0.434 g/cm2). CONCLUSION: No difference in BMD was noted between the IC group and unexposed control subjects, nor was any dose-response relationship observed between IC therapy and BMD.

Administration, Inhalation↗

PubMed2003

Hypertension and changes of cognitive function in 81-year-old men: a 13-year follow-up of the population study "Men born in 1914", Sweden.

BACKGROUND: The relationship between blood pressure levels and decline of cognition has been discussed previously, but little is known about the confounding effect of lifestyle factors, antihypertensive treatment and disease in the elderly. OBJECTIVE: To examine the association between systolic (SBP) and diastolic (DBP) blood pressure, changes of DBP and SBP and hypertension (HT) on cognitive function, while controlling for confounding factors. DESIGN: A longitudinal cohort study of men born in 1914 and residing in the municipality of Malmö studied at age 68 and 81 years. SETTING: Probands invited to a university clinic. SUBJECTS: One hundred and eighty-six out of 281 invited men still alive in 1995/6 participated in the most recent follow-up. MAIN OUTCOME: Change of the cognitive performance in the verbal (Paired Associates and Synonyms), spatial (Block Design and Benton Visual Retention test) and speed (Digit Symbol Substitution) functions. RESULTS: DBP by tertiles at 68 years, but not HT, was inversely related to verbal, spatial and speed performance at 81 years. Only spatial function was related to SBP at 68 years. The association between DBP and SBP by tertiles, and spatial functions (Block Design and Benton Visual Retention test) remained after controlling for education, marital status, smoking, alcohol and physical activity, and intermediates such as arteriosclerotic manifestations (block design, beta = 0.17; = 0.029) in multiple regression models. A decrease in DBP was likewise related to spatial (beta = 0.16; = 0.049) and speed performance (beta = 0.17; = 0.039) in the same regression model. CONCLUSIONS: Evidence is found to support the hypothesis that hypertension, especially high DBP in late midlife, is associated with a decline in spatial performance of cognitive functions in elderly men.

Aged↗

PubMed2002

[Unqualified home care aides put the patient at risk. Better knowledge concerning drug administration must be required].

During the last few years the home care services have had to face an increased responsibility for medical tasks. A study in the city of Malmö in 1993, repeated in 1998, shows that 95% of the health care assistants are engaged in the administration of medication. The studies demonstrate that health care assistants have inadequate knowledge not only about medicines and their administration but also about common diseases and their symptoms. Delegating the task of medication administration to non-nurse personnel within the social services therefore entails an increased risk for the patient.

Clinical Competence↗

PubMed2002

Cerebral perfusion deficits in age-associated memory impairment. The role of tobacco smoking.

BACKGROUND AND AIMS: Several studies report a high prevalence of memory complaints in the elderly, non-demented population. Since the pathogenesis and diversity of memory impairment in healthy people is still an unresolved issue, we designed our study to ascertain the occurrence of brain abnormalities in Age-Associated Memory Impairment (AAMI) by measuring regional cerebral blood flow (rCBF). METHODS: Fifty-three subjects were invited to the case-control study: 26 subjects who fulfilled the AAMI criteria, and 27 controls (age, mean+/-SD 65.8+/-7.3 vs 65.5+/-6.7). rCBF was determined using 99mTC-ECD SPECT by relative measurements made in the cortical and white matter regions and in the thalamus. RESULTS: The AAMI group vs controls had restricted rCBF in the temporal lobe of the left hemisphere (median; 85.8 vs 87.8, p=0.04), in the thalamus (median; 87.3 vs 89.8, p=0.036) and the frontal white matter (median; right hemisphere 80.0 vs 84.1, p=0.01; left hemisphere 77.7 vs 81.6, p=0.04). AAMI subjects who previously smoked had lower rCBF values in the temporal, parietal, occipital and frontal lobes bilaterally, and poorer memory test results than ex-smoker controls. By contrast, rCBF did not differ between non-smoking AAMI subjects and controls. CONCLUSIONS: Compared to controls, AAMI subjects had restricted rCBF, A history of previous smoking could partly contribute to the rCBF differences between these groups. Further studies on failing memory and rCBF in representative cohorts of smoking and non-smoking populations are now needed.

Aged↗

PubMed2002

Replication and construct validation of the Barrow Neurological Institute Screen for Higher Cerebral Function with a Swedish population.

A Swedish translation of the Barrow Neurological Institute Screen for Higher Cerebral Functions was administered to 52 normal control subjects and 36 patients with well-documented brain dysfunction. Findings replicated those reported in American samples. Level of performance was strikingly similar between Swedish controls and American controls, especially in individuals between 15 and 39 years. Swedish patients with brain dysfunction performed at levels significantly below the Swedish control subjects. The sensitivity of the test was 83% (correctly classifying 30 of 36 patients); patients with a higher level of education were misclassified. The present study replicates earlier findings and adds to the construct validity of the Barrow Neurological Institute Screen. This test may also prove useful for studying rehabilitation outcomes in Swedish patients.

Adolescent↗

PubMed2002

Invitation to a population-based cohort study: differences between subjects recruited using various strategies.

AIM: The present study compares subjects recruited to a population-based prospective cohort study by community versus personal invitation, and subjects responding late versus early to personal invitation. Subjects were compared with respect to sociodemographic characteristics, selected lifestyle factors, cancer incidence and mortality. METHODS: The Malmö Diet and Cancer Study recruited a total of 28,098 subjects between 1991 and 1996. Entire birth-year cohorts, born 1923-50, were recruited using community directed (passive) invitation, and a personal letter of invitation (active recruitment). Information on sociodemography and lifestyle was obtained using a self-administered questionnaire. Anthropometric measurements were assessed at a physical examination. Cancer incidence and cause of death were retrieved using record linkage with national registries. RESULTS: Subjects responding to community directed invitation were older, and more often females, than participants recruited using personal invitation. Furthermore, participants recruited through passive invitation had a comparably more favourable situation with regard to sociodemographic and lifestyle factors. They also had a lower frequency of prevalent disease, lower incidence of cancer and lower mortality. Contrary to this, men were more likely to respond late to a personal letter of invitation and late responders were also older, as compared with subjects responding early to personal invitation. Furthermore, those who responded late had a comparatively unfavourable socioeconomic situation and were characterized by a high prevalence of current smoking, obesity, weight change, and prevalent disease. CONCLUSIONS: Subjects who are recruited using different strategies in population-based cohort studies may have different sociodemographic and lifestyle characteristics, and may vary with regard to prevalent disease, cancer incidence and subsequent mortality.

Adult↗