Search PubMed⌕ Search

Biomedical subjects

Bengt Mattsson

Publications and source records attributed to Bengt Mattsson.

At least 19 recordsLinked to original sources
PubMed2006

Predictive factors for long-term sick leave and disability pension among frequent and normal attenders in primary health care over 5 years.

OBJECTIVES: To find predictive factors for long-term sick leave (SL) and disability pension (DP) among frequent attenders (FAs) and normal attenders (NAs) in primary health care. STUDY DESIGN: A cohort study with follow-up over 5 years. METHODS: Groups of FAs and NAs were followed over 5 years. Information about background, situation, sociodemography, life events, social support and sense of coherence were gathered at baseline. Multiple logistic regression analysis was used to determine the influence of each variable on long-term SL and receipt of a DP. RESULTS: During the study period, 18.9% of FAs received long-term SL/DP compared with 6% of NAs. Chronic disease was a predictive factor for long-term SL/DP among FAs [odds ratio (OR) 7.0] and NAs (OR 3.4). Among FAs, a life event was also a predictive factor (OR 2.1). Each additional life event increased the ratio of FAs with long-term SL/DP by 110%. Conflicts and losses had the greatest negative effects on FAs. CONCLUSIONS: FAs are a high-risk group for long-term SL/DP. Besides chronic disease, a life event was the only predictive factor for long-term SL/DP among FAs. These findings indicate that FAs are a vulnerable group for stressful events. Consequently, healthcare personnel should take more notice of life events among FAs.

Adolescent↗
PubMed2006

Impact of medical students' descriptive evaluations on long-term course development.

BACKGROUND: In medical education, feedback from students is helpful in course evaluation. However, the impact of medical students' feedback on long-term course development is seldom reported. In this project we studied the correspondence between medical students' descriptive evaluations and key features of course development over five years. METHODS: Qualitative content analysis was used. The context was consultation skills courses in the middle of the Göteborg undergraduate curriculum during five years. An analysis of 158 students' descriptive evaluations was brought together with an analysis of key features of course development; learning objectives, course records, protocols from teachers' evaluations and field notes. Credibility of data was tested by two colleagues and by presenting themes at seminars and conferences. Authors' experiences of evaluating the course over many years were also used. RESULTS: A corresponding pattern was found in students' descriptive evaluations and key features of course development, indicating the impact of students' open-ended feed-back. Support to facilitators and a curriculum reform also contributed. Students' descriptive feedback was both initiating and validating longitudinal course implementation. During five years, students' descriptive evaluations and teachers' course records were crucial sources in a learner-centred knowledge-building process of course development. CONCLUSION: Students' descriptive evaluations and course records can be seen as important instruments in developing both courses and students' learning. Continuity and endurance in the evaluation process must be emphasized for achieving relevant and useful results.

Adult↗
PubMed2006

Enriched environment after focal cortical ischemia enhances the generation of astroglia and NG2 positive polydendrocytes in adult rat neocortex.

Environmental enrichment (EE) alleviates sensorimotor deficits after brain infarcts but the cellular correlates are not well-known. This study aimed to test the effects of postischemic EE on neocortical cell genesis. A neocortical infarct was caused by distal ligation of the middle cerebral artery in adult spontaneously hypertensive rats, subsequently housed in standard environment or EE. Bromodeoxyuridine (BrdU) was administered during the first postischemic week to label proliferating cells and BrdU incorporation was quantified 4 weeks later in the periinfarct, ipsilateral medial and contralateral cortex. Immunohistochemistry and confocal microscopy were used to analyze co-localization of BrdU with neuronal (calbindin D28k, calretinin, parvalbumin, glutamic acid decarboxylase, tyrosine hydroxylase), astrocytic (glial fibrillary acidic protein, glutamine synthetase, vimentin, nestin), microglia/macrophage (CD11b/Ox-42, CD68/ED-1), oligodendrocyte progenitor/polydendrocyte (NG2, platelet-derived growth factor alpha receptor) or mature oligodendrocyte (myelin basic protein) markers. BrdU positive cells were increased in all analyzed cortical regions in stroke EE rats compared with stroke standard environment rats. Newly born cells in the periinfarct cortex were mostly reactive astroglia. Occasionally, BrdU positive cells in the periinfarct cortex that were negative for glial or microglia/macrophage markers co-expressed markers typical for interneurons but did not express appropriate functional markers. The majority of BrdU positive cells in intact cortical regions, ipsi- and contralaterally, were identified as NG2 positive polydendrocytes. Perineuronally situated newly born cells and polydendrocytes were found to be brain-derived neurotrophic factor immunoreactive. In conclusion, EE enhanced newborn glial scar astroglia and NG2+ polydendrocytes in the postischemic neocortex which might be beneficial for brain repair and poststroke plasticity.

Animals↗
PubMed2006

Working behaviour of competent general practitioners: personal styles and deliberate strategies.

OBJECTIVE: To study how competent GPs perform their work within the consultation and in relation to the team and practice organization. DESIGN: Ethnographic study with thick description. A participant observation of the GP was followed by a personal interview. A substantial description was elaborated that was analysed qualitatively. SETTING: Primary care surgeries in Sweden. SUBJECTS: A number of competent GPs. RESULTS: Two main categories emerged, deliberated strategy and personal style. These categories set up the individual pattern of working behaviour for each GP. A behaviour that is a deliberate strategy for one GP for the other belongs to his or her personal style. Common denominators in the overall working behaviour were attention to the patient as a person, practising patient-centred medicine, saving the consultations from disturbances, rejecting taking over responsibilities from the patients, and safeguarding own autonomy. CONCLUSION: The transition of deliberate, favourable strategies into one's personal style is an important aspect of professional development. A well-developed personal style is necessary to obtain the spontaneous interchange between attentive listening and detachment characteristic of patient-centeredness.

Adult↗
PubMed2006

More illness and less disease? A 20-year perspective on chronic disease and medication.

BACKGROUND: The implication of medication is that a drug is given against an illness. Over the last few decades an expanding number of drugs have appeared that focus on reducing risk factors and lifestyle conditions. AIMS: To investigate the apprehension in respect of chronic disease among the working population in a Swedish community in 2000 compared with 1980. METHODS: In 1980 and 2000 an analogous questionnaire assessing chronic diseases and medication was mailed to 250 randomly selected persons from a local population between 25 and 70 years of age. RESULTS: Some 80% of the persons (n = 201) replied in 1980 and 78% (n = 195) in 2000. Individuals declaring a chronic disease increased from 23% (46/201) in 1980 to 39.5% in 2000 (p = 0.0005). Corresponding figures for men were 20.6% (20/97) in 1980 and 40.8% (40/98) in 2000 (p = 0,004) and for women 25.0% (26/104) in 1980 and 38.1% (37/97) in 2000 (p = 0.064). Persons who regularly see a doctor increased from 13% to 26% (p = 0.002) and the use of drugs for chronic diseases increased from 19% to 33% (p = 0.002). In 2000 an average of 2.3 drugs per person were used among those with a chronic disease, an increase of 53% since 1980. CONCLUSION: Stated chronic diseases and use of drugs for such diseases increased greatly between1980 and 2000. Prescribing drugs for a "risk" with no apparent illness may be confused with the remedy for an illness.

Adult↗
PubMed2005

Patients' views on interpersonal continuity in primary care: a sense of security based on four core foundations.

BACKGROUND: A deep and comprehensive understanding of what patients value about having a personal doctor in primary care is lacking. OBJECTIVES: To acquire a comprehensive understanding of the core values of having a personal doctor in a continuing doctor-patient relationship in primary care among long-term, chronically ill patients. METHOD: In this qualitative study, 14 chronically ill patients at three primary health care centres were strategically selected. The centres were selected to include patients with experiences from both long-term and short-term doctors. The patients were asked about their views on having a personal doctor in a continuing doctor-patient relationship in primary care compared with having different short-term doctors. Sixteen health care professionals were interviewed about what chronically ill patients convey to them about having a personal doctor in contrast to seeing different short-term locum doctors. The in-depth interviews were transcribed verbatim and analysed by qualitative content analysis. RESULTS: The core category, i.e. a universal concept that many patients used to describe the impact of having access to a personal doctor, was a sense of security. This was based on four main categories or core foundations which were: feelings of coherence, confidence in care, a trusting relationship and accessibility. In turn, the four main categories emerged from two to four of subcategories. CONCLUSION: The foundations that underpin the value of personal care from the patients' perspective could be based on categories found in this study.

Adult↗
PubMed2005

Enriched environment increases neural stem/progenitor cell proliferation and neurogenesis in the subventricular zone of stroke-lesioned adult rats.

BACKGROUND AND PURPOSE: The subventricular zone in the adult brain is identified as an endogenous resource of neuronal precursors that can be recruited to adjacent lesioned areas. The hypothesis was tested that postischemic environmental enrichment might enhance subventricular zone cell genesis. METHODS: A cortical infarct was induced in adult spontaneously hypertensive rats by ligating the middle cerebral artery distal to the striatal branches, after which animals were housed in either standard or enriched environment and allowed to survive for 5 weeks. The thymidine analogue bromodeoxyuridine was administered during the first postischemic week. The generation of neural stem/progenitor cells and neuronal precursors in the subventricular zone were studied with cell specific markers such as Ki67 and phosphorylated histone H3 (cell proliferation), Sox-2 (neural stem/progenitor cells), bromodeoxyuridine (slowly cycling, nonmigratory putative neural stem cells), and doublecortin (newborn immature neurons). RESULTS: Proliferating cells in the subventricular zone were identified as chiefly neural progenitors but also putative neural stem cells and neuronal precursors. Five weeks after stroke, proliferation in the subventricular zone was lower in stroke-lesioned rats housed in standard environment compared with nonlesioned rats. Postischemic environmental enrichment normalized cell proliferation levels, increased the numbers of putative neural stem cells as assessed with bromodeoxyuridine, and increased doublecortin-positive neuroblasts, which extended in migratory chains toward the infarct. CONCLUSIONS: Enriched environment increased the neural stem/progenitor cell pool and neurogenesis in the adult subventricular zone 5 weeks after a cortical stroke. This might be of potential importance for tissue regeneration.

Animals↗
PubMed2005

Interpreters' experiences of general practitioner-patient encounters.

OBJECTIVE: To study interpreters' experiences of problems in cross-cultural communication with special regard to the general practitioner (GP)-patient encounter. DESIGN: A focus-group interview with authorized interpreters was carried out. A phenomenographic method was used in the analysis. SETTING: Primary health care. RESULTS: The interpreters displayed a number of problems mainly related to the difficulty in balancing the triad relation (GP-patient-interpreter), the role of the interpreter in relation to other healthcare staff, the time aspects of the translation procedure, and the problems of diverse health beliefs and cultural inequalities. CONCLUSION: The interpreters notice a set of difficulties that need to be highlighted in order to improve consultations with cross-cultural GP-patient encounters.

Adult↗
PubMed2005

Instrumental strategy: A stage in students' consultation skills training? Observations and reflections on students' communication in general practice consultations.

OBJECTIVES: To explore and examine students' abilities to communicate with patients during a general practice course in the final year of the curriculum and to analyse and consider this experience in relation to earlier consultation training. SETTING: General practice courses in the undergraduate curriculum. DESIGN: Qualitative data analysis was used. A special focus-group interview of experienced supervisors was performed and analysed (editing analysis). Credibility of data was tested at local seminars and conferences. Authors' experiences of observing student consultations over many years were also used. RESULTS: A main theme, 'open invitation', emerged based on categories 'initially attentive' and 'listening attitude'. In contrast, the second main theme was 'instrumental strategy', based on the following categories: 'one-sided collection of medical facts' and 'relationship-building lost'. The students also had difficulties in devoting attention to patients' life experiences. An hourglass metaphor of students' and young physicians' progression of communication strategies is presented. The narrow part of the hourglass corresponds to an instrumental strategy at the end of undergraduate clinical education. CONCLUSIONS: An instrumental strategy may be a stage in student's consultation learning progression that interferes with communication training. A question is raised: is training of a patient-centred approach throughout the clinical curriculum needed for optimal development of consultation skills? Further research is needed to test this hypothesis.

Clinical Competence↗
PubMed2004

["...always giving comfort". General practitioners and the everyday consolation].

Since the time of Hippocrates" ... to always comfort" has been regarded as a part of every physician's profession. However, this daily phenomenon of medical practice has not been studied very much so far. Consolation is sometimes emphasized when care is more prominent than cure, as in palliative or intensive care or when seeing family members during these circumstances. Six general practitioners in a focus-group interview presented narratives about their experience of consolation in the consultation. They also described the last time they managed to comfort a patient. The narratives were analysed by an empirical psychological phenomenological method. Four themes emerged that gave a meaning to consolation: "presence", "be in contact", "confirmation" and "restoration". The consultations were characterized by acceptance, freedom, respect and absence of demand. However, consolation could also be associated with negative features such as instrumental and ritual behaviour and a "top-down" attitude that inhibited the healing process. Consolation as an important element of medical practice needs to be further studied.

Adaptation, Psychological↗
PubMed2004

Doctor for patients or doctor for society? Comparative study of GPs' and psychiatrists' assessments of clinical practice.

OBJECTIVE: To study general practitioners' (GPs') inclination to be the advocate of their patients or representatives of the society. The GPs' opinions were compared with those of psychiatrists. DESIGN: A postal questionnaire with two case histories. Loyalty towards the social insurance or towards a patient in distress, and loyalty towards a patient seeking asylum or towards society were posited. The degree of distress and urgency of the patients' situation varied. SUBJECTS AND SETTING: A random sample of Swedish GPs (n =167) and psychiatrists (n =112). RESULTS: All doctors significantly changed their minds when asked to fake a psychiatric diagnosis compared with a somatic diagnosis. Compared with psychiatrists, general practitioners tend to be more pragmatic (p =0.016) and in addition female doctors in some cases in both groups seem to be more pragmatic (p =0.023). Good clinical practice seems to be of importance in both groups. If the patient's life is threatened doctors are, however, prepared to overrule their own professional interests. The interests of society seem not to have any strong support in either of the two groups or the two cases. CONCLUSIONS: GPs as well as psychiatrists find it less improper to fake a psychiatric diagnosis than to fake a somatic. GP tends to be more pragmatic than psychiatrists and female doctors tend to be more pragmatic than male in both groups.

Adult↗
PubMed2004

What happened to the prescriptions? A single, short, standardized telephone call may increase compliance.

BACKGROUND: Patients' compliance with prescribed prescriptions and doctors' advice is a prerequisite for successful treatment. Compliance is estimated to be <or=50% in the treatment of hypertension. Thus, it is important to find simple methods to increase compliance. OBJECTIVES: Our aim was to estimate the extent to which patients visit the pharmacy and redeem prescribed items after seeing a GP, and to assess if a phone call 1 week later improves compliance. METHODS: A total of 399 patients attending a primary health care centre receiving prescriptions were randomized to active intervention receiving a short standardized follow-up telephone call or to standard intervention receiving no telephone call. The doctors' prescriptions were later compared with the dispensed drugs at the pharmacies. RESULTS: A majority of the patients (90%) redeemed prescriptions. Women redeemed prescriptions to a greater extent than men, both in the control group (P = 0.023) and in the intervention group (P = 0.0003). A telephone call 1 week later increased the proportion of patients that redeemed their prescriptions (P = 0.023). Further analysis showed that only women were affected by the telephone call. Twenty percent of the prescriptions were drugs for cardiovascular diseases (CVDs). The proportion of dispensed drugs for CVD was only 66%, compared with 88% for all other drugs (P = 0.001). CONCLUSION: A single, short, standardized telephone call increases women's compliance. Women also redeem prescriptions more often than men irrespective of a telephone call. The compliance and treatment of CVD are not acceptable, and seem to be lower for men than women.

Cardiovascular Agents↗
PubMed2002

Environmental influences on functional outcome after a cortical infarct in the rat.

The effect of postoperative housing conditions on functional outcome and brain-derived neurotrophic factor (BDNF) gene expression was evaluated 1 month after a distal ligation of the right middle cerebral artery (MCA) in spontaneously hypertensive rats. Two days postoperatively the rats were randomized into four groups; individually housed with no equipment (deprived group), individually housed with free access to a connected running wheel (running group), housed together in a large cage with no equipment (social group) or in the same size of cage furnished with bars, chains and various things to manipulate (enriched group). The enriched rats had significantly higher scores when crossing a rotating horizontal rod than deprived and running rats. The social group performed significantly better than the deprived group. The BDNF gene expression in the ipsi- and contralateral cortex, thalamus, hippocampus and cerebellum did not significantly differ between the groups. The weight of the adrenal glands was significantly increased in running rats suggesting that postischemic running may be stressful. We conclude that the beneficial effect of postischemic environmental enrichment is likely to be a combination of social and various physical activities, and that BDNF gene expression 1 month after a cortical infarct did not correlate with functional outcome.

Animals↗
PubMed2002

The concept of "psychosomatic" in general practice. Reflections on body language and a tentative model for understanding.

In medicine, the concept "psychosomatic" indicates both dualism and polarisation. "Could it mean something psychic or is it something somatic?" This artificial dichotomy and body/mind split is not as apparent in general practice as it is in other medical disciplines. In general practice, the prerequisites for a division are overlooked. Following the work of Piaget, the article outlines manifestations of a body/mind unity as exposed in the language. Words and expressions describing the way we move, stand and walk therefore indicate our attitude and state of mind. Our body language conveys a message. The importance of breathing and its relation to our emotions is highlighted. The function of breathing is said to represent a bridge between the conscious and the unconscious--breathing can be controlled by our will, but generally we breathe reflexively. Restricted breathing is not just a mechanical process; it is shown that there is a connection between breathing and our emotions. Finally, a model of the "human organism" is presented linking four concepts, "human activity", "organ functions", "physical body" and "neurophysiological functions". Activities within the different systems are linked and relate to each other. The model supports the necessity to overcome the body/mind split, which is one of the obstacles to the fulfillment of good quality general practice.

Family Practice↗
PubMed2002

Effects of cortical ischemia and postischemic environmental enrichment on hippocampal cell genesis and differentiation in the adult rat.

The study aimed to elucidate the effects of cortical ischemia and postischemic environmental enrichment on hippocampal cell genesis. A cortical infarct was induced by a permanent ligation of the middle cerebral artery distal to the striatal branches in 6-month-old spontaneously hypertensive rats. Bromodeoxyuridine (BrdU) was administered as 7 consecutive daily injections starting 24 hours after surgery and animals were housed in standard or enriched environment. Four weeks after completed BrdU administration, BrdU incorporation and its co-localization with the neuronal markers NeuN and calbindin D28k, and the astrocytic marker glial fibrillary acidic protein in the granular cell layer and subgranular zone of the hippocampal dentate gyrus were determined with immunohistochemistry and were quantified stereologically. Compared with sham-operated rats, rats with cortical infarcts had a five-to sixfold ipsilateral increase in BrdU-labeled cells. About 80% of the new cells were neurons. Differential postischemic housing did not influence significantly the total number of surviving BrdU-labeled cells or newborn neurons. However, postischemic environmental enrichment increased the ipsilateral generation of astrocytes normalizing the astrocyte-to-neuron ratio, which was significantly reduced in rats housed in standard environment postischemically.

Animals↗