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Biomedical subjects

Sigvard Mölstad

Publications and source records attributed to Sigvard Mölstad.

At least 19 recordsLinked to original sources
PubMed2006

Asymptomatic bacteriuria in a population of elderly residents living in a community setting: prevalence, characteristics and associated factors.

BACKGROUND: Asymptomatic bacteriuria (ASB) is common among the elderly in institutional care, but less is known about its prevalence among the elderly living in community settings. Knowledge of the prevalence of ASB in this population could contribute to a reduction in unnecessary use of antibiotics. OBJECTIVE: To study the prevalence of ASB and associated health and social factors in a population of elderly people, aged 80 and over, in a community setting. DESIGN: A cross-sectional study. SETTING: The catchment area of a primary health care centre in a Swedish middle-sized town. METHOD: All residents, aged 80 and over, except for those in institutional living, were invited. A structured interview was carried out and urinary culture obtained. RESULTS: ASB was found in 14.8% of the participants, in 19.0% of the women and 5.8% of the men. In women independent associations with ASB were found for urinary incontinence (OR: 2.99, CI: 1.60-5.60), reduced mobility (OR: 2.68, CI: 1.42-5.03) and oestrogen treatment (OR: 2.20, CI: 1.09-4.45). CONCLUSION: Bacteriuria is common among the elderly living in non-institutional community settings, especially among women, although not as common as among the elderly in institutional settings. A woman over 80, with urinary incontinence, and needing support to walk has a risk of nearly 50% of presenting with ASB, a condition about which there is consensus not to treat with antibiotics. This should be borne in mind when examining patients with diffuse symptomatology and an accidental finding of bacteriuria.

Aged, 80 and over↗
PubMed2006

Infections in families with small children: use of social insurance and healthcare.

OBJECTIVE: To examine infectious symptoms on a daily basis in families with small children and how often these infections cause people to stay at home or seek healthcare. DESIGN: A population-based prospective study. SETTING: Child health clinics in seven municipalities in Sweden. SUBJECTS AND MAIN OUTCOME MEASURES: All family members of 835 families who came with an 18-month-old child to a child health clinic were asked to register all infectious symptoms in a diary for a month. They were also asked to indicate whether they had stayed at home from day-care or school, whether social insurance had been used, and whether they had contacted healthcare facilities or seen a physician. RESULTS: In total, 7% of the 18-month-old children and 34% of the parents had no symptoms during the winter month. The most common symptom was a runny nose. The 18-month-old children had 1.6 symptom episodes with an average duration of 5.6 days. Of the symptom episodes 13% led to contact with healthcare facilities and 6% to an antibiotic prescription. Of the symptom days 27% required staying at home and in 10% social insurance was claimed. CONCLUSION: Symptoms of infection among families with small children were common, with a runny nose being the most common. Physician consultations and antibiotic prescriptions were used in a small proportion of the symptom episodes. Social insurance was claimed in about one-third of the days with absence from day-care.

Adult↗
PubMed2006

The impact of repeated spirometry and smoking cessation advice on smokers with mild COPD.

BACKGROUND: Smoking cessation is the most important therapeutic intervention in patients with chronic obstructive pulmonary diseases (COPD) and the health benefits are immediate and substantial. Major efforts have been made to develop methods with high smoking cessation rates. OBJECTIVES: To study whether a combination of spirometry and brief smoking cessation advice to smokers with COPD, annually for three years, increased their smoking cessation rate in comparison with groups of smokers with normal lung function. METHOD: Prospective, randomized study in primary care. Smoking cessation rates were compared between smokers with COPD followed-up yearly over a period of three years and smokers with normal lung function followed-up yearly for three years or followed-up only once after three years. RESULTS: The point-prevalence abstinence rate and prolonged abstinence rate at 6 and 12 months increased yearly and in smokers with COPD at year 3 was 29%, 28%, and 25%, respectively. The abstinence rates were significantly higher in smokers with COPD than in smokers with normal lung function. Smoking cessation rates among smokers with normal lung function did not increase with increasing number of follow-ups. CONCLUSION: Smokers diagnosed with COPD stopped smoking significantly more often than those with normal lung function.

Adult↗
PubMed2006

A population-based study of different antibiotic prescribing in different areas.

BACKGROUND: Respiratory tract infections are the most common reason for antibiotic prescription in Sweden as in other countries. The prescription rates vary markedly in different countries, counties and municipalities. The reasons for these variations in prescription rate are not obvious. AIM: To find possible explanations for different antibiotic prescription rates in children. DESIGN OF STUDY: Prospective population based study. SETTING: All child health clinics in four municipalities in Sweden which, according to official statistics, had high antibiotic prescription rates, and all child health clinics in three municipalities which had low antibiotic prescription rates. METHOD: During one month, parents recorded all infectious symptoms, physician consultations and antibiotic treatments, from 848 18-month-old children in a log book. The parents also answered a questionnaire about socioeconomic factors and concern about infectious diseases. RESULTS: Antibiotics were prescribed to 11.6% of the children in the high prescription area and 4.7% in the low prescription area during the study month (crude odds ratio [OR] = 2.67; 95% confidence interval [CI] = 1.45 to 4.93). After multiple logistic regression analyses taking account of socioeconomic factors, concern about infectious illness, number of symptom days and physician consultations, differences in antibiotic prescription rates remained (adjusted OR = 2.61; 95% CI = 1.14 to 5.98). The variable that impacted most on antibiotic prescription rates, although it was not relevant to the geographical differences, was a high level of concern about infectious illness in the family. CONCLUSIONS: The differences in antibiotic prescription rates could not be explained by socioeconomic factors, concern about infectious illness, number of symptom days and physician consultations. The differences may be attributable to different prescription behaviour.

Anti-Bacterial Agents↗
PubMed2005

Modelling the spread of penicillin-resistant Streptococcus pneumoniae in day-care and evaluation of intervention.

In 1995, a disease control and intervention project was initiated in Malmöhus county in southern Sweden to limit the spread of penicillin-resistant pneumococci. Since most of the carriers of pneumococci are preschool children, and since most of the spread is believed to take place in day-care, a mathematical model, in the form of a stochastic process, for the spread in a day-care group was constructed. Effects of seasonal variation and size of the day-care group were particularly considered. The model was then used for comparing results from computer simulations without and with intervention. Results indicate that intervention is highly effective in day-care groups with more than ten children during the second half of the year.

Biometry↗
PubMed2005

The management of infections in children in general practice in Sweden: a repeated 1-week diagnosis-prescribing study in 5 counties in 2000 and 2002.

A diagnosis-prescribing study was performed in 5 Swedish counties during 1 week in November in 2000 and repeated in 2002. The aim of the present study was to analyse data for children 0-15y of age who consulted a general practitioner with symptoms of an infection. During the 2 weeks studied, 4049 children were consulted. Respiratory tract infections (RTI) were the predominant diagnoses, above all among the youngest children, while the proportion of urinary tract infections and skin infections increased with increasing age. Between the y 2000 and 2002, the proportion of children allocated the diagnosis streptococcal tonsillitis and pneumonia decreased (p<0.01 and p<0.001, respectively) while the proportion of common cold increased (p<0.001). Antibiotic prescribing decreased from 55% to 48% (p<0.001) for respiratory infections between the years studied. The only significant changes in type of antibiotics prescribed were the increase of isoxazolylpenicillins (p<0.001) used for skin infection and the decrease of macrolides (p=0.001). A diagnostic test was used in more than half of the consultations. Of children allocated a RTI diagnosis, 36% were prescribed antibiotics when a C-reactive protein test was performed compared to 58% in those not tested. Further studies are needed in general practice to determine the optimal use of near-patient tests in children with RTI.

Adolescent↗
PubMed2005

No association between elevated post-void residual volume and bacteriuria in residents of nursing homes.

OBJECTIVE: To evaluate the concept that increased post-void residual urine volume (PVR) is a risk factor for bacteriuria. DESIGN: Cross-sectional study. SETTING: Three nursing homes in Jönköping, southern Sweden. SUBJECTS: A total of 147 elderly residents in municipal nursing homes. MAIN OUTCOME VALUES: PVR volumes measured with a portable ultrasonic bladder scan, urine specimen, and questionnaire data on incontinence, immobility, impaired cognition, neurological diseases, and medications. RESULTS: Mean age was 86 years and 78% were women. The prevalence of a PVR for the four chosen cut-off values (30, 50, 100, and 150 ml) was 51%, 39%, 20%, and 7%, respectively. The prevalence of bacteriuria was 42%, 46% for women and 28% for men. Elevated PVR was not associated with bacteriuria, incontinence, immobility, impaired cognition or neurological disease (stroke, Parkinson's disease). CONCLUSION: Bacteriuria and elevated PVR are common among elderly residents in nursing homes. The study could not confirm that elevated PVR predisposes to bacteriuria in elderly residents in nursing homes.

Aged↗
PubMed2004

Defined daily doses of antimicrobials reflect antimicrobial prescriptions in ambulatory care.

BACKGROUND: Data on actual antimicrobial prescriptions are rarely made available and the World Health Organization (WHO) recommends using the number of defined daily doses (DDDs) as a measurement unit for inter-country comparisons of antimicrobial use in outpatients. However, because antimicrobials are given for limited periods of time and the DDDs may not represent the doses used in practice, this measurement unit has been blamed for poorly reflecting the number of antimicrobial prescriptions in outpatients. METHODS: For 11 out of 15 European countries, data on national outpatient sales of antimicrobials and on antimicrobial prescriptions to outpatients in 1997 were purchased from the Institute for Medical Statistics (IMS) Health. For two additional countries, i.e. Sweden and Denmark, similar data were obtained from the National Corporation of Swedish Pharmacies and the Danish Medicines Agency, respectively. The relationships between the number of DDDs and the number of prescriptions, on the one hand, and the antimicrobial use density (DDD per 1000 inhabitant-days) and the prescription rate (prescriptions per 1000 inhabitants), on the other hand, were assessed with the two-tailed Spearman coefficient for non-parametric correlations. RESULTS: The number of DDDs, as defined by the WHO, and the number of prescriptions of antimicrobials to outpatients in European countries in 1997 were strongly correlated. Similarly, the antimicrobial use density and the prescription rate in these countries were strongly correlated. These relationships were found for total systemic antimicrobials and for all major antimicrobial classes. CONCLUSION: Our results confirm the relevance of the number of DDDs per 1000 inhabitant-days as a measurement unit to compare outpatient antimicrobial use among countries or regions.

Ambulatory Care↗
PubMed2004

Excessive use of rapid tests in respiratory tract infections in Swedish primary health care.

A 1-y retrospective study of problem oriented electronic patient records, for encounters concerning respiratory tract infection, was performed. The aim was to analyse the management of respiratory tract infections in primary health care in terms of diagnostic coding, tests and antibiotic treatment using data from electronic patient records. 12 primary health care centres with a registered population of 102,050 residents in 3 counties in southeast Sweden participated. Data were retrieved electronically from records of patient encounters concerning respiratory tract infections. The data were: patient age and gender, date of contact, diagnostic code, CRP and GABHS tests and results, as well as antibiotic prescriptions. In a total of 19,965 encounters, the most frequent diagnoses were common cold (40%), acute tonsillitis (18%), and acute bronchitis (15%). A total of 4445 GABHS tests (in 22% of encounters) and 6141 CRP tests (31%) were performed, and both tests were done in 1910 encounters (10%). A total of 7934 antibiotic prescriptions were registered. The proportion of patients tested and prescribed an antibiotic varied greatly between centres. We found an excessive, and much varying, use of rapid tests in encounters for respiratory tract infections. Data retrieval from electronic patient record systems was a feasible method to study the use of laboratory tests in relation to pharmacological treatment.

Adolescent↗
PubMed2004

Data from electronic patient records are suitable for surveillance of antibiotic prescriptions for respiratory tract infections in primary health care.

Diagnoses and antibiotic treatments were analysed in relation to respiratory tract infections (RTI). A 1-y retrospective study was made of electronic patient records (EPR) for encounters concerning RTIs in primary health care in Sweden. The study covered a registered population of 102,050 individuals at 12 primary health care centres in 3 counties. Data were recorded on number of episodes, encounters, diagnostic codes and antibiotic prescriptions. The yearly number of episodes of RTIs was 16,964 or 166 per 1000 inhabitants per y. The total number of encounters was 19,965. The most frequent diagnoses were common cold (40%), acute tonsillitis (18%), and acute bronchitis (15%). The yearly number of antibiotic prescriptions was 7961, accounting for 47% of the episodes or 78 per 1000 inhabitants per y. The most frequently prescribed antibiotics were phenoxymethylpenicillin (61%), tetracyclines (18%) and macrolides 8%). Standard EPRs provide a feasible source of clinical information which, taking limitations into consideration, could be used for the follow-up of trends in antibiotic prescribing and of adherence to guidelines with regard to RTIs.

Adolescent↗
PubMed2004

Management of urinary tract infections in primary care: a repeated 1-week diagnosis-prescribing study in five counties in Sweden in 2000 and 2002.

A diagnosis-antibiotic prescribing study was performed in 5 counties in Sweden during 1 week in November in the y 2000 and 2002, respectively. As part of the study, the characteristics and clinical management of patients who received diagnoses of urinary tract infections (UTIs) (n = 1564) in primary care, were analysed. 85% of the visits were by women, and 74% of all consultations were diagnosed as lower UTIs. One or more diagnostic tests were performed in 98% of the women with suspected lower or recurrent UTIs and 95% were prescribed an antibiotic. The most commonly prescribed antibiotics for lower UTIs were trimethoprim followed by pivmecillinam and a quinolone. The study indicated a change in antibiotic prescribing with improved adherence to the national recommendations. There was an increase of prescribed nitrofurantoin and a decrease of prescribed quinolones to women with lower UTIs between the studied y. Furthermore, 3-d treatment with trimethoprim increased although the prescribed duration was mostly 7 d. In contrast to the guidelines, few urine cultures were performed. The study highlights the necessity of updating the guidelines for the management of lower UTIs in general practice.

Adolescent↗
PubMed2004

Limited spread of penicillin-nonsusceptible pneumococci, Skåne County, Sweden.

In response to increasing frequencies of penicillin-nonsusceptible pneumococci (PNSP), for which the MIC of penicillin was >0.12 mg/L, in Skåne County, southern Sweden, national recommendations were initiated in 1995 to limit the spread of pneumococci with high MICs (> or =0.5 mg/L) of penicillin (PRP), especially among children of preschool age. Traditional communicable disease control measures were combined with actions against inappropriate antimicrobial drug use. During the first 6 years that these recommendations were applied in Skåne County, the average frequency of penicillin-resistant pneumococci has been stable at =2.6%, as has the average PNSP frequency (7.4%). However, PNSP have been unevenly distributed in the county, with the highest frequencies in the southwest. Simultaneously, the rate of antimicrobial drug use for children <6 years of age was reduced by 20%. Thus the spread of PNSP between and within the municipalities in the county has been limited.

Anti-Bacterial Agents↗
PubMed2003

Utilisation of antibiotics in young children: opposite relationships to adult educational levels in Danish and Swedish counties.

BACKGROUND: Antibiotic utilisation varies profoundly among and within countries, and the extent of antibiotic utilisation correlates with the frequency of bacterial resistance, particularly among children. Hence, it is important to assess which factors may influence prescribing. In addition to variations in morbidity, health-care organisation, drug regulatory and supply systems, prescriber's attitudes, parents' behaviour, attitudes and socio-economic positions seem important. We compared socio-economic position (educational level of adults) and antibiotic utilisation in children in the municipalities within a Danish and a Swedish county which are geographically close, have similar social and economic development, and similar drug regulatory and supply systems. METHODS: Data on antibiotic utilisation (1998), expressed in defined daily doses per 1000 inhabitants per day (DDD/TID), were obtained from the Copenhagen County Health Insurance register and from the National Corporation of Swedish Pharmacies. Data on municipal educational levels were obtained from Statistics Denmark and Statistics Sweden. RESULTS: The utilisation of antibiotics in 0- to 6-year-old children was higher in the Swedish than in the Danish county but varied between the municipalities within both the Swedish (9.6-17.7 DDD/TID) and the Danish (8.0-12.9 DDD/TID) counties. Most notably, utilisation rates correlated negatively with the education levels in the Danish (r=-0.539, P=0.021) but positively in the Swedish (r=+0.390, P=0.025) municipalities. CONCLUSION: The observed variations in antibiotic prescribing may reflect different parental and/or prescriber attitudes towards use of antibiotics and they emphasise that antibiotic prescribing is influenced by factors other than the prevalence of bacterial infections. Relationships between socio-economic position (educational level) and drug utilisation should not be generalised from one area to another.

Anti-Bacterial Agents↗
PubMed2003

Reduction in antibiotic prescribing for respiratory tract infections is needed!

In general practice, approximately 25% of consultations are related to infectious diseases. The emergence and spread of resistant bacteria are related to antibiotic use on an individual and on a community level. Antibiotic prescribing differs profoundly from one European country to the next, though there is no evidence of differences in the prevalence of infectious diseases. Most respiratory tract infections are self-limiting conditions, and recent evidence shows that antibiotics only slightly modify the course of most respiratory tract infections. The general practitioner should focus on patients with more severe symptoms who might benefit more from antibiotic treatment. In general, antibiotics should be prescribed for acute pneumonia. In addition, we may offer antibiotics to a selected group of patients with more severe symptoms of maxillary sinusitis, pharyngotonsillitis and acute exacerbation of chronic obstructive pulmonary disease/chronic bronchitis. In the diagnostic procedure, rapid tests of Streptococcus pyogenus and C-reactive protein may be valuable in carefully selected cases. Penicillins (penicillin V, amoxycillin) should be the first choice in most respiratory tract infections. Larger studies in general practice are needed to analyse the impact of antibiotic prescribing on morbidity, the occurrence of rare complications and spread of resistance. The greatest challenge will be to implement current knowledge in daily praxis.

Anti-Bacterial Agents↗