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H Odeberg

Publications and source records attributed to H Odeberg.

At least 19 recordsLinked to original sources
PubMed2001

[A pop-up menu linked to a computerized drug prescribing system. Prescribing pattern's feedback via a simple and quick method].

It takes time for a GP to acquire sufficient experience of a new drug to be able to prescribe competently. This article describes a project studying the use of computerized records to afford a group of GP's swift feedback on recently introduced drugs of special interest. In the south-east of Sweden a network of primary health care centers has been created in two neighboring counties. The pharmacies of the region are also taking part. When new drugs of particular interest are introduced, each participating GP will automatically see a pop-up menu, asking questions pertaining to each computer-assisted prescription. In the pharmacies, patients are given a questionnaire regarding their expectations with respect to the drug. In this way it will be possible to provide the individual GP swift feedback from a large number of colleagues and patients concerning the drug's effectiveness in clinical practice. We have now been studying the COX-2 inhibitors rofecoxib (Vioxx) and celecoxib (Celebrex). Results show that a pop-up menu used in this way provides the general practitioner quick feed-back on prescribing behavior as well as drug effectiveness in clinical practice.

Attitude of Health Personnel↗
PubMed2000

A comparison of two different team models for treatment of diabetes mellitus in primary care.

The importance of the nurse's role in the management of patients with type 2 diabetes has long since been emphasized. The aim of this study was to test the hypothesis that a structured organization of type 2 diabetes care, with a diabetes nurse working more independently of the general practitioner, has a significant impact on the patient's self-management and quality of care. The test consisted of 394 registered patients, all with an onset of diabetes mellitus occurring after the age of 34, at two primary health care (PHC) districts in Blekinge county in South Sweden. During one year all consultations for both doctors and nurses were analysed, and a structured telephone survey was carried out involving 364 patients who were 84 years or younger. A comparison between the two PHC centres was made regarding quality of care, frequency of consultation, patients' knowledge of their disease, and patients' self-management. The results showed that organizing care of type 2 diabetes in a structured way encourages better metabolic control in spite of less use of oral medication, and among the patients a greater knowledge of their disease and a more active self-management thus favouring implementation of local guidelines. Also, a difference was found in the patients' choice of contact with doctor or nurse regarding their diabetes and even other causes, which shifted the balance from doctor to nurse. This study provides support for organizing type 2 diabetes care in a structured way to increase the quality of care.

Aged↗
PubMed1998

Resistance to activated protein C, highly prevalent amongst users of oral contraceptives with venous thromboembolism.

OBJECTIVE: Inherited resistance to activated protein C (APC resistance), which is caused by a single point mutation in the factor V gene, is a frequent risk factor for venous thromboembolism. The aim of this study was to determine the prevalence of APC resistance and other coagulation disorders in fertile women with venous thromboembolism and also the risk factors these women had been exposed to in connection with thromboembolic events. DESIGN: A retrospective, case-control study of 36 month duration. SETTING: The study was carried out at Blekinge Hospital, Karlskrona, Sweden. SUBJECTS: The study population comprised 27 fertile women age 16-47 years with thromboembolic complications, referred to the department of Internal Medicine at Blekinge Hospital in Karlskrona during a 36-month period. RESULTS: APC resistance was found in 10 out of 27 women. APC resistance was associated with treatment with oral contraceptives in five out of six women and with pregnancy in one of seven women. All women with resistance to APC developed venous thrombosis in association with a predisposing situation (risk situation) such as surgery, trauma, immobilization, pregnancy, inflammatory state or the use of oral contraceptives. Amongst women not resistant to APC, all but one developed thrombosis in connection with a risk situation. CONCLUSION: APC resistance was found to be highly prevalent amongst fertile women with a history of thromboembolic complication occurring during their use of oral contraceptives.

Adolescent↗
PubMed1998

How should blood rheology be measured in macroglobulinaemia?

Blood and plasma viscosity were measured in 13 patients with monoclonal macroglobulinaemia. Blood viscosity was measured at natural hematocrit and after adjustment to 45%. Studies were performed at three different temperatures, +24 degrees C, +32 degrees C and +37 degrees C. Plasma viscosity was measured in a rotational viscometer and in a capillary tube at the above-mentioned temperatures. Blood viscosity was to some extent related to the patients' symptoms, whereas a correlation between blood and plasma viscosity became less pronounced with decreasing shear rates, indicating that plasma viscosity is not a perfect indicator of blood viscosity in macroglobulinaemia. It was shown that red cell concentration, besides the concentration of monoclonal immunoglobulins (= paraproteins (PP)), is an important determinant of blood viscosity. The correlation between red cell concentration and viscosity became stronger with decreasing shear rate. Whole blood viscosity at low shear rates seems to be the best indicator of rheological symptoms in patients with macroglobulinaemia. It is concluded that blood rheology in patients with macroglobulinaemia is best studied at +32 degrees C to +37 degrees C in whole blood and at low shear rates.

Adult↗
PubMed1998

Awareness and treatment of cardiovascular disease risk factors among middle-aged Swedish men and women.

OBJECTIVE: To study awareness and treatment of risk factors for cardiovascular disease in a primary care district where a screening program for hypercholesterolaemia involving one third of the population had been conducted 7 years earlier. DESIGN: A semi-structured telephone survey on four risk factors; blood pressure, serum cholesterol, blood sugar, and smoking habits. SETTING: The study was performed in a defined area in Blekinge county in Sweden. SUBJECTS: A random sample of the general population aged 40-49 years, in total 356 people. MAIN OUTCOME MEASURES: Awareness of individual risk factors, for cardiovascular diseases, on-going medication, and lifestyle changes in order to lower individual risks. RESULTS: A total of 95% had had their blood pressure measured at least once, compared with 69% for serum cholesterol. Twenty-two per cent had at some time been told that they had high blood pressure, and, of these, almost half (44%) received pharmacological treatment. Among the 62 subjects who were informed about hyperlipidaemia only 5% were taking a lipid-reducing drug. Among present smokers, 38% had had at least one quitting episode during the previous 2 years with a median duration of 60 days. CONCLUSION: In a general population there is a difference between blood pressure and cholesterol check-up and medicalization. Screening activities seem to raise the awareness of cardiovascular risk factors in a population, but when evaluating the tendency to change lifestyle the contagious effects of screening activities might be taken into account. Finding quick-relapsing former smokers among current non-smokers may be of importance when planning smoking cessation activities.

Adult↗
PubMed1998

Reduced number of circulating monocytes after institution of insulin therapy--relevance for development of atherosclerosis in diabetics?

Twelve patients with Type II diabetes mellitus, insufficiently controlled with oral hypoglycemic agents, were studied before, after 2 months, and after 4 months on insulin therapy. For comparison the same variables were also studied in 10 healthy subjects. From the start, in the diabetic group, the authors found alterations in the hemorheologic parameters indicated by increased values for whole blood viscosity, plasma viscosity, red cell transit time (RCTT), and decreased values for white cell initial relative filtration rate (IrFR). In hematologic parameters they found increased values for mean corpuscular volume (MCV), leukocyte count, counts of neutrophils and monocytes, and a decreased count of lymphocytes. They also found increased values in the lipid parameters P-triglycerides and Apo B/Apo A-I ratio, risk factors of coronary atherosclerosis. After 4 months of insulin treatment whole blood and plasma viscosity were still increased, but there was a partial improvement of lipoprotein abnormalities. Red and white cell filterability, however, tended to normalize. These results indicate that changes in blood cell filterability do not necessarily influence in vitro measurements of blood viscosity. The change in RCTT during the insulin treatment was associated with a decreased MCV and the change in white cell IrFR with a decrease in the number of monocytes. This change of white cell filterability during insulin therapy, probably due to a reduced number of monocytes, may be of interest in the study of atherosclerosis and circulatory disease in diabetics.

Aged↗
PubMed1995

Social network, social support and the concept of control--a qualitative study concerning the validity of certain stressor measures used in quantitative social epidemiology.

Twenty-five in-depth interviews were made with middleaged persons of both sexes, who had suffered a first myocardial infarction (MI) two months previously. The purpose was to assess the layman's understanding of concepts such as social network, social support and control which are exposures commonly used or suggested for use in quantitative research in the area of social epidemiology. The validity of the instruments and the underlying concepts in assessing such exposures has important implications for the interpretation of the association between psychosocial factors and health or health behavior. The layman's understanding of social network and social support concepts seemed unproblematic, but the concept of control was understood in rather disparate ways among those interviewed. The experience of control/decision latitude in the work environment, seemed to form a model for the overall understanding of control among several of those interviewed and there also seemed to be important differences based on gender. Another impression, was that the individual's level of aspiration might be an important confounder in the assessment of control in population studies. It is therefore suggested that epidemiologcal data should be stratifyed by basic demographic variables like age, sex and social class in analyses including the control variable, to improve the valid use of this type of measure.

Aged↗
PubMed1993

Opportunistic screening for hypercholesterolaemia: characterization of two different drop-out groups and status after 2 years.

A total of 507 men and 686 women were opportunistically screened for hypercholesterolaemia and reinvited for a follow-up visit with the nurse after 2 years. Seven-hundred and thirty three (62%) re-attended (group A), while 226 (19%) did not, but saw the nurse at one or more pre-scheduled 6 month check-ups (group B). Two-hundred and thirty-three (20%) did not attend at all (group C). There was no difference between the groups in the number of parallel physician consultations during follow-up. Both groups B and C had higher proportions of smokers than group A. Group C were younger, had lower cholesterol and lower blood pressure (after adjustment for age) than group B, which in turn, had higher cholesterol and blood pressure than group A. The prevalence of hypertension and hypercholesterolaemia declined during the 2 years in group A. Of 189 smokers at baseline, 26 (14%) quit during follow-up. Of the 544 non-smokers, however, 31 (6%) commenced, to out-balance the quitters. Only five of the 43 patients in group A who had a persistent cholesterol of > or = 7.9 mmol/l received medication. It is likely that drop-out from a follow-up programme of this kind is to some extent justified because of the parallel organizations for care.

Adult↗
PubMed1991

Opportunistic screening for hypercholesterolaemia with participants selected by the general practitioner. Inclusion and drop-out rate.

The objective of this study was to evaluate a method for opportunistic hypercholesterolaemia screening in primary care. At Lyckeby Primary Health Care Centre in Southern Sweden, where six general practitioners provide care to a population of 15,706 inhabitants, screening of patients aged 25-59 years was integrated with regular case-finding for hypertension. The specific characteristic of the programme was that the general practitioner adjusted, from day to day, the inclusion rate to actual resources. The study evaluated implementation during 3 years; after this time, 27 per cent of the target population was included. The included portion of those who visited the centre was 48% between ages 40 and 59 years, and 20% of those between 25 and 39 years. Compliance with the follow-up protocol differed according to age and risk group. The reattendance rates were better for those aged 40-59 years compared to the younger. It is concluded that opportunistic screening is most feasible in ages 40-59 years, while for younger people traditional population strategies may be preferable. If integrated with regular case-finding and treatment follow-up for hypertension, which are long well established components of general practice, no extra resources are needed for implementation.

Adult↗
PubMed1991

Social network and social support predict improvement of physical working capacity in rehabilitation of patients with first myocardial infarction.

A cohort of 50 patients under 70 years of age who had suffered their first myocardial infarction (MI) entered an exercise-based rehabilitation programme. An extensive personal interview concerning psychosocial factors, including social network and social support, as well as an assessment of an array of clinical and laboratory variables was made before the patients were discharged from the hospital. A follow-up 6 months later of the 40 patients that completed the programme showed that material social support and social anchorage at baseline predicted improvement in physical working capacity, independently from age, gender and important clinical variables. The authors conclude that psychosocial factors could be predictors of equal importance as many of the standard risk factors and clinical assessments in the rehabilitation of a majority of post-MI patients. It is suggested that training programmes should provide opportunities for involvement of the patients' social network, in order to benefit from optimal social support during the rehabilitation process.

Adult↗
PubMed1991

S-erythropoietin levels decrease in patients with chronic hypoxia starting domiciliary oxygen therapy.

Consecutive determinations of erythropoietin in serum (s-Epo) were made in ten patients with chronic hypoxia starting domiciliary long-term oxygen therapy (LTO). After 24 h of supplementary oxygen treatment there was a fall in the median s-Epo level from 11.3 to 4.4 IU.l-1 (p less than 0.01). The initial decrease in s-Epo in conjunction with oxygen treatment was not sustained after one and three months of LTO. S-Epo levels above the reference range (3.3-13.5 IU.l-1) were found in three patients before and during LTO and in another two patients during LTO. Markedly elevated s-Epo levels were found in two patients with hypoxia and hypercapnia at the time of blood sampling. A significant negative relationship was found between the arterial oxygen tension and the log value for the s-Epo level (r = 0.40, p less than 0.005). The s-Epo levels were found to be normal in half of the measurements in patients using oxygen less than 15 h daily, a fact that indicates that s-Epo measurements are probably not suitable as indicators of compliance with LTO.

Aged↗
PubMed1989

Studies on blood viscosity during the menstrual cycle and in the postmenopausal period in healthy women.

Blood viscosity was measured in 14 healthy, menstruating women, aged 17-51 years and in 10 healthy, postmenopausal women, aged 55-64 years. The fertile women were studied once a week during a normal menstrual cycle and the postmenopausal women twice with an interval of 2 weeks. Blood viscosity was measured at natural hematocrit as well as at hematocrit 45%. In the postmenopausal women no changes in blood viscosity were found. In the fertile women, blood viscosity at hematocrit 45% was lowest at the start of the menstrual bleeding and increased to a peak at day 7 (p less than 0.01), with a similar pattern when measured at natural hematocrit. Plasma viscosity also had its lowest value at the onset of menstrual bleeding, increasing to a maximum at day 21. Changes in plasma triglycerides, but not in fibrinogen or cholesterol, seemed to contribute to this increase. Plasma factors only partly explained the variations in blood viscosity, and changes in red cell properties were also found to be of importance. The clinical significance of these rheological changes remains to be established, but at least theoretically there may be an increased risk for thromboembolism, e.g. at surgery, during days 5-15 of the cycle. In studies on blood flow and rheological conditions in fertile women, it seems advisable to standardize for time in the menstrual cycle.

Adult↗