[Loyalty conflicts of the general practitioner. Confidences and secrets can cause ethical problems].
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Confidentiality↗
Biomedical subjects
B Mattsson
Publications and source records attributed to B Mattsson.
Physiotherapeutic treatment in out-patient psychiatric care.
The present paper aims at describing historical features, developmental trends and key concepts in psychiatric physiotherapy (PPT). PPT was offered as an additional treatment to conventional psychiatric care and the aim was to examine the possibility of carrying out PPT with ten unselected patients (n = 10) in an out-patient psychiatric clinic. Symptoms presented: anxiety and phobic states, depression and crisis reactions. The purpose of four individual sessions was to stimulate curiosity and offer exercises concerning body-mind interactions. In examination of data qualitative research methods were used. All patients accepted the offer of PPT and participated in all sessions. Nine reported great or moderate symptom reduction. Of greatest importance for relief of symptoms was the patient's level of 'engagement'. PPT implies physical proximity and an encounter on an existential level. The impact of a complementary physical approach in psychiatric care needs to be further elucidated.
Adult↗
Features of good consultation in general practice: is time important?
OBJECTIVE: To relate specifically defined 'good consultations' (GC) to length of consultation, continuity, patients' age and sex, and different doctors. DESIGN: A questionnaire about consultation length, communication and problem character, given to doctors and patients immediately after consultations. MAIN OUTCOME MEASURES: The number of GCs for different doctors in relation to time, continuity, and patients' age and sex were calculated. SETTING: 581 consultations were registered with six male general practitioners working at three different health centres in Umeå, a university town in northern Sweden. RESULTS: A significant difference in the number of GCs was only found between the doctors (p < 0.01). Length of consultation, patients' age and sex, and continuity and no impact on the GC frequency. CONCLUSION: The doctor as a person and his working style is most important in achieving good consultations in general practice. Length of consultation is less influential.
Adolescent↗
The attitudes of patients and physicians towards placebo treatment--a comparative study.
Placebo treatment in clinical practice can be given either in order to comply with the wishes of the patient, or with the purpose of doing good and not causing harm. In the former instance, the procedure may be in accordance with the interests of the patient, yet be in conflict with the interests of the medical profession. In the latter instance, the procedure presupposes that in most cases the patient has not been informed of the nature of the treatment; this type of procedure may jeopardize a trusting patient-doctor relationship. Therefore, it is of interest to investigate both the extent to which patients and physicians feel they can accept placebo treatment and a paternalistic attitude, and in which particular situations. In order to shed some light on this matter, we compiled a questionnaire built around three case histories which problematize placebo treatment and paternalistic acts. The questionnaire was distributed to 100 patients and 100 physicians. 83 patients and 94 physicians responded. The results show that patients and physicians do not automatically follow specific group interests. Physicians are more inclined to respect the patient's option to refuse medical treatment than the patients are inclined to respect a physician's professional autonomy. Patients appear more to be paternalistic in their judgements than physicians, but one cannot rule out the possibility that the answers of the physicians reflect the fact that placebo treatment represent a socially undesirable behaviour. We conclude that theoretical and normative analyses of the perspective of the actors ought to be supplemented by empirical research.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
Can changes in ward routines affect the severity of dementia? A controlled prospective study.
An extensive new caring program--including the introduction of Individual Care Plans and changes in ward organization, caring techniques, and caring philosophy--was introduced at two psychogeriatric wards with severely demented patients. The hypotheses were that the patients (n = 31) would improve in psychosocial capacity and orientation and the staff work load would decline in contrast to two other wards with a similar clientele (n = 31). After ten months the milieu was more "homelike," routines were more flexible, and the staff communicated more with the patients. However, the hypotheses were not proven. All patients in both groups deteriorated in ADL capacity, orientation, and behavior. The patients in the program wards became significantly more restless and disoriented and ate less than the patients in the contrast wards. The conclusion is that, despite optimal care, a humanistic approach, and support from staff, the progression of dementia symptoms is inevitable.
Activities of Daily Living↗
Brain capillary density and cerebral blood flow after occlusion of the middle cerebral artery in normotensive Wistar-Kyoto rats and spontaneously hypertensive rats.
OBJECTIVE: In order to elucidate why spontaneously hypertensive rats (SHR) develop larger brain infarcts distal to an arterial occlusion than normotensive Wistar-Kyoto (WKY) rats, we determined the surface and volume densities of cerebral capillaries, and the regional cerebral blood flow distal to an arterial occlusion in SHR and WKY rats. DESIGN: Occlusion of the middle cerebral artery was chosen because the middle cerebral artery territory is most commonly affected by cerebral infarcts in man. METHODS: Surface and volume densities of capillaries in the neocortex of the middle cerebral artery territory were measured by stereological techniques on histological sections. Fifteen minutes after ligation of the right middle cerebral artery, regional cerebral blood flow was measured autoradiographically by the [14C]-iodoantipyrine method. RESULTS: The capillary density of the neocortex did not differ between the SHR and WKY rats. The blood flow was significantly lower within the middle cerebral artery territory in the SHR than in the WKY rats. CONCLUSIONS: The reduced blood flow distal to the occlusion in SHR is probably a consequence of structural adaptation of arterial resistance vessels, rather than being caused by reduced capillary density.
Animals↗
Factors associated with consultation length and characteristics of short and long consultations.
Consultation length illustrates how general practitioners balance contradictory concerns such as productivity and quality, listening to patients, and handling their own stress. Important factors for consultation length are list size, characteristics of doctors and patients, and character of the problem. The purpose of this study of 463 consultations was to describe factors that are associated with short and long consultations and to examine the relative influence on the consultation length of patients' age and sex, character of the problem, continuity, and the 'doctor's speed'. A questionnaire was used for both doctors and patients. Short consultations were often made by younger male patients about physical problems, while long consultations often were made by older patients about problems with both psychological and physical dimensions. The 'doctor's speed' explained 22.5%, character of the problem 11.6%, and patient's age 2.9% of the variation in consultation length.
Adolescent↗
Dementia day care and its effects on symptoms and institutionalization--a controlled Swedish study.
OBJECTIVE: To examine the effects of Day Care (DC) on demented patients. DESIGN: A prospective non-randomized concurrent-control study. PARTICIPANTS: 55 demented patients in DC and 44 controls. SETTING: Sundsvall, an industrial community in northern Sweden. MAIN OUTCOME MEASURE: Cognition, ADL-functions, behaviour and institutionalization. RESULTS: Measurements of cognition, ADL-functions, and behaviour showed no or only small differences between the groups. After one year, 24% of the patients in the DC-group were institutionalized, compared with 44% of the controls. In the control group, the exhaustion of spouse and supervision need were highly correlated to institutionalization (p < 0.001), while high physical nursing load was correlated to institutionalization in the DC-group (p < 0.01). CONCLUSION: DC postpones institutionalization, probably because of less exhaustion of spouses and decreased supervision need.
Activities of Daily Living↗
Separation and distress--sickness absence and health screening in newly divorced middle-aged Swedish men.
The present study aimed at a description of the sickness absence pattern during 1982-1989 in 32 men who divorced in 1984. Another purpose was to carry through a health screening of the men within six months after the marital disruption focusing on risk factors concerning cardio-vascular disease (smoking, overweight, hypertension) and high alcohol consumption (elevated GGT). The year of divorce and the successive three years (1984-1987) were characterized by high sickness rates (average 21,7 days/year, variation 19,4-26,6) compared to a reference group (average 16,6, variation 14,9-18,1). In the remaining four years (1982-1983 and 1988-1989) the sickness absence was lower in the divorced group (average 12,2, variation 8,7-18,0, reference group: average 17,3, variation 14,8-20,0). The increase was mainly due to short absence periods (self-certifications). The health screening (health examination and record analysis) (n = 29) revealed high frequency of daily smoking and alcohol overconsumption. Overweight and hypertension were not overrepresented. The findings are discussed in relation to a supposed male reaction style to separation. The impact of social isolation is stressed.
Absenteeism↗
Variation in dietary fibre, beta-glucan, starch, protein, fat and hull content of oats grown in Sweden 1987-1989.
Samples of oat groat from cultivars grown in Sweden during 3 years (1987-1989, 50 samples/year) were investigated. On an average, the kernels contained 15.9% protein, 7.0% fat, 9.7% dietary fibre and 63.2% starch (% of dry matter). The coefficient of variation was highest for fat (26%) and lowest for starch (7%). The thousand kernel weight was on average 34.7 g. The content of dietary fibre and fat was significantly negatively correlated and the starch positively correlated with the thousand kernel weight. The samples contained mean (and range) 9.7% (5.0-13.4) total dietary fibre, 3.5% (2.0-5.0) soluble dietary fibre, and 4.6% (3.5-5.7) beta-glucan. The beta-glucan content was significantly positively correlated with insoluble and total dietary fibre as well as with the fat content, and significantly negatively correlated with starch.
Dietary Fiber↗
[Physician's role demands self-criticism].
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Attitude of Health Personnel↗
Materials techniques for lining composite resin restorations: a critical approach.
Composite resin restoration of posterior teeth necessitates a reassessment of cavity insulation and dentine conditioning. The primary function of cavity insulation under composite resin restorations is to prevent the formation of a bacterial, fluid-filled gap nearest the cavity walls. Gap formation can contribute not only to sensitivity to cold but also to pulpal complications and secondary caries. Unfortunately, none of the currently available systems for cavity insulation fulfil this basic requirement. The evidence suggests, however, that the most effective insulator is a very thin liner which does not pool in retention grooves and which can cover the entire cervical wall as well as the remaining cavity walls, except for etched enamel. Such a liner should not bond to composite resin and thus be detached from the dentine during polymerization contraction of the composite. Nor should it be leached away by the oral fluids. In order to preserve the liner, the air-filled contraction gap which forms between liner and composite should be impregnated with resin immediately after the major setting contraction of the composite. In this context the use of retention grooves in Class II and Class V cavities is recommended, to minimize the effect of thermal and occlusal stress. Combined with etched enamel walls, well-placed retention grooves can reduce the risk of gap formation and creep due to mechanical stress and the deformation potential of the tooth structure and the filling. The smear layer can disappear entirely and be replaced by fluid and bacteria. It should therefore be removed, but the smear plugs blocking the apertures of the dentinal tubules should be left undisturbed and reinforced by impregnation with fluoride.(ABSTRACT TRUNCATED AT 250 WORDS)
Composite Resins↗
Attitudes towards predictive testing in Huntington's disease--a deep interview study in Sweden.
Ten persons with a 50% risk of inheriting Huntington's disease were interviewed in depth about experiences of the disease with special regard to their attitude to a predictive test. The persons showed great interest, concern and worry about a test: six were generally positive while four were negative or uncertain. Every interview had a very personal character and early life experiences seemed to have a determinative influence on the attitude to the test. Persons who were without symptoms of the disease and had passed the mean age of onset within the family (usually older individuals) were largely enthusiastic about a test, as were those with slight and undetermined symptoms. Younger persons, especially those with a qualitatively good contact with the affected parent, seemed to be less interested. Contradictions during the interview were more common among those positive to testing and an ambivalence among many was reflected in a tendency towards changing opinions over time.
Adult↗
General practice in the undergraduate curriculum: 20 interviews with Southampton final-year students.
The Primary Medical Care Group at the University of Southampton contributes to the medical curriculum in the first, third and final years. A visiting lecturer from Sweden took the opportunity to interview a sample of 20 final-year students using a qualitative approach. Questioning centered on the impact of the primary care course both in relationship to medicine as a whole and to general practice. It was found that primary medical care was often not seen as a central or integral part of the curriculum but many students acknowledged its important contribution to seeing the patient as a whole and in integrating the various other parts of the curriculum, with significant opportunity for role modelling and informing career choice. A hidden curriculum emerged of attitudes which provided a conflict for some students. Improvements should include clearer dovetailing of primary medical care with other curricular components, limitation of aims with more specific and rigorous assessment and a wide strategy of staff development not confined to those directly involved in general practice attachments.
Adult↗
Premature deaths among men in a Swedish municipality--social characteristics prior to death.
Premature deaths among 91 men in a Swedish municipality were analyzed regarding social class, immigrant status and their contacts with the Social Services because of alcohol abuse. Unskilled manual workers were overrepresented (54% versus 28% in an age-adjusted male reference group) and self-employed (other than professionals) were underrepresented (4% versus 15%). The job situation was, however, rather stable and low unemployment (1%) was at hand. The proportion of men born in Finland was high (20%). All men in this group belonged to the lowest social class. Single men (unmarried or divorced) were overrepresented compared to the Swedish group (72% versus 40%). Cardio-vascular disease was a common cause of death among the Finnish men (56% versus 36%). Combining medical and social data revealed alcohol abuse among 40% of the 91 men (50% among the Finnish and 37% among the Swedish men). The most complete information was given by the primary health care records where 89% with alcohol abuse were identified, which is a high proportion compared to other studies. Only 28% were considered to have alcohol abuse according to the Social Services.
Adult↗
[A prognostic test of Huntington disease--detailed interviews with persons at risk].
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Adult↗
[The scientific basis of general medicine. Increased importance of qualitative research].
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Family Practice↗
Prospective evaluation of serum CA 125 levels in a normal population, phase I: the specificities of single and serial determinations in testing for ovarian cancer.
To determine the potential efficacy of the CA 125 assay as one component of a strategy for early detection of ovarian malignancy, serum CA 125 levels were determined in 1082 women 40 years of age or older in Stockholm. Initial serum CA 125 levels exceeded 35 U/ml in 36 women (3.3%) and 65 U/ml in 11 women (1.0%), placing the exact 95% upper confidence limits on false positive rates for a single screen at 4.3 and 1.7%, respectively. Follow-up CA 125 levels were obtained for those women with initially elevated levels and a group of age-matched controls. Mean CA 125 levels declined significantly for women with initially elevated levels (P = 0.0014). Interindividual variation and variation within individual subjects over the entire follow-up period were 52 and 35%, respectively. Of the 36 subjects with initially elevated serum CA 125 levels, only 2 showed a doubling of these levels; in only 1 of these 2 was this increase sustained. Intensive clinical follow-up with pelvic examination and ultrasonography, with investigators blinded to CA 125 results, led to the diagnosis of Stage III ovarian cancer in the latter individual. Diagnosis was made 21 months after the initially elevated serum CA 125 measurement and 15 months after the first measured doubling of that level. Because no other malignancies were identified at entry or during the follow-up period (median 560 days) in the women with elevated CA 125 levels, the specificity of the assay over that time period would have been 99.9% using the doubling of an initially elevated value as the criterion for determining positivity and 100% using as the criterion a sustained increase in level for those with initially elevated levels that doubled. These results support the continued investigation of longitudinally collected CA 125 levels to identify individuals at high risk for ovarian malignancy.
Adult↗