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K Svärdsudd

Publications and source records attributed to K Svärdsudd.

At least 19 recordsLinked to original sources
PubMed2002

Mortality rates among Swedish physicians: a population-based nationwide study with special reference to anesthesiologists.

BACKGROUND: Recent studies both in the UK and in the USA have indicated a higher mortality rate among anesthesiologists than among other physicians. We therefore decided to investigate the situation in Sweden during the years 1993-99. METHODS: All 26086 doctors in Sweden with a specialist licence in 1993, including those who were retired or who received one until 1999, were identified in official records and followed up regarding survival until 1999; generating approximately 179300 person-years. RESULTS: Overall, 893 deaths occurred during the 7-year follow up. Mean age at death was 72.9 years in the whole population, the lowest being 64.1 years among the anesthesiologists and the highest 77.0 among the pediatricians. However, there were large differences in the age and sex distribution among the specialties. For this reason a series of proportional hazard regression analyses (Cox's) of the mortality rates in the various specialty groups were performed, taking into account the influence of age and gender differences. After this procedure anesthesiologists had a 46% higher mortality rate and pediatricians a 24% lower mortality rate than other specialist groups; both deviations being statistically significant. All other specialties had a mortality risk within the expected range. Anesthesiologists tended to have higher rates than other specialists for most underlying causes of death. CONCLUSION: Anesthesiologists have a higher mortality rate than other specialties. The cause is so far unknown. However, it is unlikely to be caused by obvious confounders such as age, gender, or smoking habits. Other factors linked to occupational exposure should be investigated.

Adult↗
PubMed2002

Prevalence of sleep apnoea and snoring in hypertensive men: a population based study.

BACKGROUND: Several studies have reported an association between sleep disordered breathing (SDB) and hypertension (HT) but there is still a debate as to whether this is an effect of confounders. Some researchers have found an age dependent relationship between SDB and HT with higher risk at lower ages. A case-control study was performed in hypertensive men and non-hypertensive male controls matched for age and body mass index to assess whether there is an independent association between SDB and HT. If so, we further wanted to investigate whether this effect is age dependent. METHODS: An overnight sleep study was performed in a population based, age stratified sample of 102 hypertensive men aged 43-82 years and 102 non-hypertensive controls. RESULTS: Hypertensive subjects had a significantly higher prevalence of SDB than non-hypertensive subjects (apnoea-hypopnoea index (AHI): 10.8 v 7.3; desaturation index (DI): 8.5 v 5.2; AHI >or=10: 37% v 24%, p<0.05; DI >or=10: 29% v 12%; lowest desaturation: mean (SD) 81.9 (7.3) v 84.7 (6.1), p<0.01). After adjusting for neck circumference and physical inactivity, DI >or=10 and lowest desaturation were still independent predictors of HT with adjusted odds ratios of 2.3 (95% CI 1.0 to 5.3) and 0.94 (95% CI 0.89 to 0.99), respectively. When the subjects were split into two groups according to age (<60 and >or=60 years), the influence of DI >or=10 on HT was strongest in the younger men (adjusted OR 4.3 (95% CI 1.0 to 19.3 v 2.1 (95% CI 0.7 to 6.5)) and the association between minimum oxygen saturation (SaO(2)) and HT reached statistical significance in the younger men only. CONCLUSION: SDB is more prevalent in men with HT than in controls. DI >or=10 and lowest desaturation are independent predictors of HT irrespective of confounders. The results indicate that the influence of SDB on HT is more pronounced in younger and middle aged men than in those above 60 years.

Adult↗
PubMed2001

A prospective study of morbidity and mortality rates among farmers and rural and urban nonfarmers.

Farmers are known to have lower morbidity and mortality rates than the mean for other occupational groups in the general population. Whether this is due to the urban-rural health gradient or to occupational factors related to farming is not clear. To explore this issue, we conducted a prospective study of farmers and matched rural and urban referents. Official hospital admission and mortality data for the years 1989-1996 were obtained. The relative risk of being admitted to hospital were 10% higher among rural and urban referents than among the farmers. The biggest differences were seen for mental and cardiovascular disorders. The odds of dying during follow-up did not differ between the two rural groups but were doubled among urban referents. In conclusion, the lower morbidity and mortality rates among farmers are partly due to the urban-rural health gradient but in addition salutogenic factors linked to farming seem to be active.

Adolescent↗
PubMed2001

Reproductive hormones and stress urinary incontinence in pregnancy.

BACKGROUND: The cause of transient stress urinary incontinence during pregnancy remains uncertain. Anatomical change, such as a pressure effect of the enlarged uterus, changes in renal function, and alterations in bladder and urethral function have been proposed. There is little information about the role of reproductive hormones in stress urinary incontinence with onset during pregnancy. METHODS: In a prospective, longitudinal, observational cohort study 200 consecutive women attending in early pregnancy were observed by repeated measurements of stress urinary incontinence, its possible determinants as well as serum concentrations of progesterone, estradiol and relaxin. RESULTS: The prevalence rate of stress urinary incontinence increased to a stable level of about 25% from mid-pregnancy and increased with parity. A higher serum relaxin value early in pregnancy was correlated to a lower prevalence rate of stress urinary incontinence with onset during pregnancy, also when the influence of potentially important factors was taken into account in a multivariate analysis. No significant difference was shown regarding serum concentrations of estrogen or progesterone, maternal age, weight gain, time since last delivery or smoking, although this can be due to a small sample size. CONCLUSION: The reproductive hormone relaxin might have a role in maintaining urinary continence during pregnancy. A mechanism is uncertain.

Adolescent↗
PubMed2001

Serum cobalamin, folate, methylmalonic acid and total homocysteine as vitamin B12 and folate tissue deficiency markers amongst elderly Swedes--a population-based study.

OBJECTIVES: The possibilities of detecting tissue cobalamin and folate deficiency are under debate. In this report the levels of serum cobalamin, folate, methylmalonic acid (MMA) and total homocysteine (tHcy) and their interrelations in a representative random population sample are presented. DESIGN: Cohort study. SETTING: A general mid-Swedish population. SUBJECTS: A 20% random sample of persons 70 years or older in a defined geographical area were invited to a survey. A total of 235 (85%) persons responded, out of whom 224 had no interfering diseases. MAIN OUTCOME MEASURES: Serum cobalamin, folate, MMA and tHcy. RESULTS: The serum levels of cobalamin, folate, MMA and tHcy were all correlated to cobalamin and folic acid treatment. They were also correlated to the intake of multivitamin preparations. In addition, serum cobalamin was higher in untreated women than in men but not correlated to age. Serum folate was correlated neither to sex nor age. Serum tHcy and MMA were both directly correlated to age but MMA not to sex. MMA was inversely correlated to serum cobalamin but not to serum folate, whereas serum tHcy was inversely correlated to serum cobalamin, folate and creatinine. Neither serum cobalamin, folate, MMA nor tHcy had any significant correlation to haemoglobin, erythrocyte volume fraction (EVF) or mean red cell volume. Half of the study population had abnormal MMA or tHcy levels, suggesting a latent or overt tissue deficiency of cobalamin or folate. CONCLUSIONS: A substantial proportion of the elderly general population had signs of low tissue levels of cobalamin or folate. Amongst those who took multivitamin preparations this proportion was much lower.

Age Factors↗
PubMed2001

Do guidelines matter? A population-based study of diabetes drug use during 20 years.

OBJECTIVE: To analyse diabetes drug use in a defined population during 20 years in relation to recommendations in published guidelines. DESIGN: From the Tierp Study Database, all medical records for diabetes patients at the primary health care centre in Tierp municipality and all prescriptions for diabetes drugs at the local pharmacies during the period 1975-1994 were collected. Data for 2125 persons were obtained, generating 13,190 person-years of observation. SETTING: Tierp primary health care district. MAIN OUTCOME MEASURES: Diabetes treatment. RESULTS: The annual prevalence of diabetes mellitus increased from 2.8% (565 patients) to 3.8% (734 patients). When guidelines emphasised diet treatment, treatment with diet only increased and oral pharmacological treatment decreased. When guidelines emphasised better glycaemic control, diet only decreased and biguanide treatment increased, and when guidelines emphasised vigorous glycaemic control, treatment with diet only decreased further and sulphonylurea and insulin use increased. The substantial age and sex differences in antidiabetic drug use at the beginning of the period were partly reduced over time. CONCLUSIONS: The considerable changes in antidiabetic drug use during the study period coincided with changes in the guidelines issued. The age and sex differences in drug use became less pronounced towards the end of the period.

Adolescent↗
PubMed2001

Do GPs sick-list patients to a lesser extent than other physician categories? A population-based study.

BACKGROUND: Large differences between physicians in their use of the sickness certification instrument have been described. There are also indications of differences between different categories of physicians, for instance that occupational health physicians and GPs are less generous with certificates of long duration. OBJECTIVES: We therefore decided to test the hypothesis that GPs and occupational health physicians issue more short-term certificates and use partial sick-listing more often than other physicians. METHODS: Certificates for sickness absence during 4 months in 1995 and 2 months in 1996 were collected in eight Swedish counties; a total of 57 563 certificates. From the certificates, a number of variables were extracted. RESULTS: Sickness certificates issued by GPs were on average for a shorter period of time than those issued by other physicians, for the individual certificate as well as for the total sickness period. Occupational health physicians had longer certification periods than GPs but used partial sick-listing more frequently. However, the patients of the various categories of physicians differed regarding age, sex, diagnosis distribution, etc. When the influence of these factors on the duration of the certification periods was taken into account, the GPs still issued significantly shorter periods of sick-leave than the other physicians, followed by the occupational health physicians. CONCLUSIONS: The results may be indicative of a different way of handling the sickness certification instrument among different categories of physicians, especially GPs.

Absenteeism↗
PubMed2001

Natural history of gastroesophageal reflux disease and functional abdominal disorders: a population-based study.

OBJECTIVE: Symptomatic gastroesophageal reflux disease (GERD), dyspepsia, and irritable bowel syndrome (IBS) are generally considered to be chronic conditions, but community-based studies are sparse, and long-term natural history data are unavailable. We aimed to determine the natural history of these conditions. METHODS: A representative Swedish sample (20-79 yr) completed a validated questionnaire over the preceding 3 months. The survey was repeated after 1 and 7 yr in the same target group (n = 1290, 1260, and 1065; response rates 90%, 87%, and 82%, respectively; 79% responded to all three mailings). RESULTS: The prevalence of GERD symptoms remained stable, whereas the prevalence of IBS increased over time, independent of aging. Dyspepsia decreased with advancing age. Although more than half of those with IBS reported the same symptom profile after 1 and 7 yr, there was a substantial symptom fluctuation and symptom profile flux between those reporting dyspepsia, IBS, or minor symptoms. Only a minority with GERD (<10%) changed to dyspepsia and/or IBS, or vice versa. The symptom-free patients remained symptom-free or reported only minor symptoms in > or = 90% of cases. CONCLUSION: There seem to be two distinct populations of symptom reporters, those with dyspepsia or IBS, and those with GERD.

Adult↗
PubMed2001

Prescription drug use, diagnoses, and healthcare utilization among the elderly.

BACKGROUND: More elderly patients affected by severe and chronic diseases are treated in primary care. Reports on the use of prescription drugs by the general elderly population are scarce, and more investigations are needed to optimize pharmaceutical care for these patients. OBJECTIVE: To analyze prescription drug use, diagnoses, and healthcare utilization among noninstitutionalized elderly patients. DESIGN: Retrospective cohort study. SETTING AND PATIENTS: All people > or =65 years old (n = 4642) living in the community of Tierp, Sweden, in 1994 were included. Prescription drug use and healthcare utilization have been registered for all inhabitants of the community since 1972. Information about filled prescriptions and diagnoses were obtained from a computerized research register. RESULTS: Prescription drug use was high among the elderly (78%); the most used pharmacologic groups were cardiovascular, nervous system, and gastrointestinal medications. Women used more prescription drugs than men (average 4.8 vs. 3.8) and had more nonfatal diagnoses. Use of five or more different prescription drugs during 1994 was common (39.0%), and multivariate analysis showed that the greatest number of primary care visits occurred with multiple drug use (> or =5 drugs over 1 y). CONCLUSIONS: This study shows an extensive multiple drug use among elderly people living at home. Whether this multiple drug use per se is harmful to the patients or not could not be evaluated in this study. Further focused investigations are needed to assess the effect of multiple drug use in an elderly population.

Age Distribution↗
PubMed2000

The relationship between age, gender, well-being and symptoms, and the use of pharmaceuticals, herbal medicines and self-care products in a Swedish municipality.

BACKGROUND: A relatively small proportion of the population accounts for a substantial part of the public drug cost. Therefore, identifying the characteristics of high users of drugs is an important step towards limiting the cost of drugs. The aim of this study was to assess the relationship between age, gender, well-being and symptoms, and the use of pharmaceutical specialities, herbal medicines and self-care products. METHODS: A postal questionnaire was sent to a representative population sample (n = 1.312) from a small Swedish municipality. The relationship between age, gender, well-being and symptoms, and the use of drugs and self-care products was tested using multivariate analysis. RESULTS: The questionnaire was answered by 827 subjects. The use of prescribed pharmaceuticals increased with age in both genders. Women used prescribed and non-prescribed pharmaceuticals as well as herbal medicines and self-care products more than men. Subjects who reported low scores for well-being had significantly higher odds of having used prescribed pharmaceuticals than subjects with high scores. Bad perceived health was the only well-being measure that was associated with high odds for the use of herbal medicines. Most symptoms occurred more frequently in users than in nonusers of pharmaceuticals. Subjects with many symptoms (six or more) had higher odds of having used pharmaceuticals and self-care products than those with few symptoms. CONCLUSION: High age, female gender and low perceived well-being significantly increased the use of drugs, particularly prescribed pharmaceuticals. Subjects with many symptoms used pharmaceuticals and self-care products more than those with few symptoms.

Adolescent↗
PubMed2000

Reported current use of prescription drugs and some of its determinants among 35 to 65-year-old women in mid-Sweden: A population-based study.

To investigate prescribed drug utilization in a middle-aged female population and factors possibly related to drug consumption in this population. A random sample of 4200 women aged 35-65 years, drawn from the population register of seven countries in mid-Sweden, received a postal questionnaire. Two thousand nine hundred ninety one (2991) (71.2%) women responded. Forty percent (40%) of the women were currently using drugs and 12% of the users were taking four drugs or more. Polypharmacy increased by age. A large number of factors were correlated with current drug use. In multivariate analyses age, perceived health, body mass index, and educational level remained significantly related to drug use, while factors such as menopausal state, smoking habits, employment status, marital status, and physical activity lost their significance. Current drug use among women increased by age, bad perceived health status, obesity, and college or university education.

Adult↗
PubMed2000

Secular changes in cardiovascular risk factors over 30 years in Swedish men aged 50: the study of men born in 1913, 1923, 1933 and 1943.

OBJECTIVES: To study secular trends in cardiovascular risk factors in men aged 50 over a period of 30 years. DESIGN: Cross-sectional studies of successive cohorts of men from 1963 to 1993. SETTING: City of Göteborg, Sweden. SUBJECTS: Four random population samples of men born in 1913, 1923, 1933 and 1943, aged 50 when they were examined in 1963, 1973, 1983, and 1993 (n = 855, 226, 776, and 798, respectively). MAIN OUTCOME MEASURES: Anthropometric measurements, blood pressure, serum cholesterol and triglycerides and smoking habits over three decades. RESULTS: Over 30 years, men increased in weight from a mean (SD) of 75.9 (11.0) kg to 82.8 (12.1) kg and gained 3.4 cm in height, with a net increase in body mass index from 24.8 (3.2) to 26.0 (3.4) kg m-2 (P < 0.0001), and a concomitant increase in waist circumference. The proportion of men who were overweight but not obese (BMI = 25-30 kg m-2) increased from 38 to 47%, whereas the prevalence of frank obesity (more than 30 kg m-2) increased from 6% in 1963 to 11% in 1993. Despite the increase in weight, mean systolic blood pressure fell by almost 10 mmHg (P < 0.0001). Mean serum cholesterol concentration decreased from 6.42 (1.12) to 5.88 (1.04) (P < 0.0001). Serum triglycerides increased from 1.26 (0.77) to 1.69 (1.04) mmol L-1 (P = 0.001). The proportion of men who smoked decreased from 56% in 1963 to 30% in 1993 (P < 0.0001). This was due more to an increase in smoking cessation rates than to an increase in the proportion of men who had never smoked. In particular, smokers and former smokers are now more obese than the corresponding categories 30 years ago and smokers are no longer leaner than men who have never smoked. CONCLUSIONS: Over a period of 30 years, serum cholesterol as well as systolic blood pressure and the prevalence of smoking decreased. This favourable decline in coronary risk factors was offset by an appreciable increase in body mass index and waist circumference.

Aged↗
PubMed2000

The prevalence of migraine in women aged 40-74 years: a population-based study.

The objective of this study was to investigate the age-dependence of the prevalence and characteristics of migraine headache and migraine visual aura. A neurologist interviewed 728 women attending a mammography screening programme. International Headache Society (IHS) criteria were used. The lifetime prevalence of migraine headache was 31.5% and the 1-year prevalence 18.0%. The magnitude of the decline of the prevalence of active (one or more attacks in the previous year) migraine headache was estimated to 50% per decade. The prevalence of active migraine visual aura was 3.8%. This did not vary by age. Except for the pain intensity and the presence of nausea, other characteristics and concomitant symptoms did not change with age. Active migraine headache and migraine visual aura in middle-aged and older women are common and modified differently by age. We suggest that the decline of prevalence of active migraine headache with age is caused by a decrease in pain intensity.

Adult↗
PubMed2000

Identifying dyspepsia and irritable bowel syndrome: the value of pain or discomfort, and bowel habit descriptors.

BACKGROUND: The utility of current diagnostic criteria for dyspepsia and irritable bowel syndrome (IBS) in clinical practice is largely unknown. We aimed to compare the diagnostic value of different definitions and questionnaires in a population. METHODS: The Abdominal Symptom Questionnaire (ASQ) was mailed to a representative sample (n = 1506, 20-87 years old), and every fifth person (n = 302) concomitantly received the Bowel Disease Questionnaire (BDQ). The diagnostic agreement for dyspepsia and for IBS, defined in accordance with the Manning and the modified Rome criteria and a new simple definition, was analysed. RESULTS: In the ASQ the agreement on the IBS status for the three IBS definitions was > or = 88%, and in the BDQ > or = 93%. Agreement for the three definitions on the two questionnaires was > or = 88% regardless of which definition of IBS was applied. Agreement between questionnaires was similar (88%) for dyspepsia. For both IBS and dyspepsia the kappa coefficients indicated moderate to substantial concordance. 'Pain or discomfort' did not cover all linguistic aspects of dyspepsia. Prevalence rates of dyspepsia were comparable in the ASQ and BSQ, whereas higher prevalences of IBS with the ASQ was related to the cutoff levels for reporting abdominal pain or discomfort. CONCLUSION: It is possible to identify IBS more simply by self-report questionnaires.

Adult↗
PubMed2000

Effects on physicians' sick-listing practice of an administrative reform narrowing sick-listing benefits.

OBJECTIVE: To find out whether administrative changes regulating sick-listing benefits affect sick-listing practice among physicians in hospitals and primary health care. SETTING: New sick-listing cases from four social security offices in mid-Sweden. DESIGN: A natural experiment design was used with a sample of newly started sick-listed cases collected 6 months before a sick-listing reform and a further sample taken 6 months after. The data were collected in a 1-year follow-up period in both samples. MAIN OUTCOME MEASURES: Net days of sick-listing and percentage partial sick-listings. Compliance by doctors in providing information asked for in sickness certification forms. RESULTS: Doctors filled in the forms more completely after the reform than they did before it. There was an inverse correlation between completeness of information and length of sick-listing. When potential confounding factors were taken into account, no change was seen in the proportion of partial sick-listing, in the mean number of net days of sick-listing or in the distribution of length of sick-listing periods. The proportion of all sick-listings made by general practitioners increased. CONCLUSIONS: Administrative changes restricting sick-listing benefits did change some aspects of sick-listing practice but had no effect on length of sick-listing.

Adult↗