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L Hansson

Publications and source records attributed to L Hansson.

At least 37 records · Page 2Linked to original sources
PubMed2001

[Comparison of preventive effect of "new" and "old" antihypertensive agents].

BACKGROUND: Until recently no morbidity-mortality study had examined the effects of newer drugs like angiotensin-converting enzyme inhibitors, calcium-antagonists and alpha-blockers compared to "old" but well-proven thiazide diuretics and beta-blockers in the treatment of essential hypertension. MATERIAL AND METHODS: The prospective and randomized clinical trials CAPPP, STOP-2, NORDIL, INSIGHT and one arm of ALLHAT, with a total of approximately 58,000 middle-aged or elderly hypertensive patients have been assessed. RESULTS: The primary outcome, composite cardiovascular (CV) death, cerebral stroke and myocardial infarction, in one study with heart failure, or composite fatal coronary heart disease and myocardial infarction, was equal in all trials. INTERPRETATION: According to current evidence, prevention of cardiovascular disease in hypertension is the same irrespective of the class of drug.

Adrenergic alpha-Antagonists↗
PubMed2001

Molecular analysis of commensal host-microbial relationships in the intestine.

Human beings contain complex societies of indigenous microbes, yet little is known about how resident bacteria shape our physiology. We colonized germ-free mice with Bacteroides thetaiotaomicron, a prominent component of the normal mouse and human intestinal microflora. Global intestinal transcriptional responses to colonization were observed with DNA microarrays, and the cellular origins of selected responses were established by laser-capture microdissection. The results reveal that this commensal bacterium modulates expression of genes involved in several important intestinal functions, including nutrient absorption, mucosal barrier fortification, xenobiotic metabolism, angiogenesis, and postnatal intestinal maturation. These findings provide perspectives about the essential nature of the interactions between resident microorganisms and their hosts.

Animals↗
PubMed2001

Predictors of social relations in persons with schizophrenia living in the community: a Nordic multicentre study.

BACKGROUND: Deinstitutionalisation has led to persons with serious mental illness spending most of their time outside psychiatric institutions. Not much is known about their social life. The paper presents the results of structured interviews with non-institutionalised persons with schizophrenia about treatment, care and social network. The network data are analysed from three perspectives: finding predictors of the number and of the quality of social contacts, and establishing the respective variables that characterise persons with high, and those with low, scores on both the quantity and quality dimensions of social integration. METHODS: Random samples of persons with schizophrenia receiving outpatient services in ten psychiatric centres in the four Nordic countries were interviewed. The following instruments were used: Interview Schedule for Social Interaction (ISSI), Camberwell Assessment of Needs, Lancashire Quality of Life Profile, General Assessment of Functioning (GAF) and Brief Psychiatric Rating Scale (BPRS), in addition to a checklist covering the utilisation of different services. The ISSI provided the main data for this paper. A restricted number of possible predictors were used in General Linear Model (GLM) factorial analysis and discriminant analysis. RESULTS: A total of 418 persons took part in the study. The overall participation rate was 55%. Social integration in terms of number of contacts was related to a high GAF score, few BPRS negative and hostility symptoms, having contact with user organisations and living in urban (in contrast to rural) areas. Availability of emotional relations was predicted by female sex, low scores on the BPRS hostility dimension, high GAF score, having contact with one's family more than once a month, and living in urban areas. Work, adequate leisure activities and GAF score discriminated between the best and worst integrated groups. CONCLUSIONS: Living in urban areas, being female, having a high GAF score and low scores on hostility predicted better integration in terms of number of contacts and emotional relations.

Adult↗
PubMed2001

Relationships between satisfaction with occupational factors and health-related variables in schizophrenia outpatients.

BACKGROUND: The purpose of this study was to explore relationships between satisfaction with occupational factors, operationalized as occupational status and the total daily occupational situation, and health-related variables among people with schizophrenia. The health-related variables included quality of life, perceived control, sense of coherence, and psychopathology. Gender differences in these relationships were explored as well. METHODS: A sample of 74 individuals, aged 20-55 years, from outpatient psychiatric services were recruited to the study. A variety of interviews and self-rating scales were used in the data collection. RESULTS: When controlling for depressive symptoms, the results showed that satisfaction with employment status was of significance for health among patients with schizophrenia, but satisfaction with the total daily occupational situation seemed to be even more important to quality of life and other health-related aspects. In particular, satisfaction with daily occupations constituted an important dimension for self-rated quality of life. Some minor sex differences could be discerned in the pattern of associations. CONCLUSIONS: The strong association between satisfaction with daily occupations and self-rated quality of life adds a new dimension to the understanding of quality of life for this group of subjects, and suggests that helping to organise an individual's daily occupations ought to be a significant task in planning for psychiatric services.

Adult↗
PubMed2001

Outcome assessment in psychiatric service evaluation.

BACKGROUND: The present paper gives an overview of outcome assessment issues in psychiatric service evaluation, based on seven proposals concerning the content and methodology of outcome assessment. It is stressed that outcome assessments should be performed on both the system and the patient level and that multiple outcome domains should be used, reflecting multiple perspectives of the services. It is also argued that outcome studies benefit from incorporating service use measures in order to enable analyses of costs and cost-effectiveness of services. Outcome studies of community-based psychiatric services have so far mainly investigated service models or programs. CONCLUSIONS: It is concluded that there is a need to investigate the relationship between particular parts and content of services and outcome, in order to increase knowledge of what is effective in community-based psychiatric services.

Community Mental Health Services↗
PubMed2001

Bracing versus nonbracing in rehabilitation after anterior cruciate ligament reconstruction: a randomized prospective study with 2-year follow-up.

This study prospectively randomized 62 patients to rehabilitation programs either with or without postoperative brace for 6 weeks following bone-tendon-bone anterior cruciate ligament reconstruction. The nonbraced group had a smaller knee circumference 2 weeks after surgery. At 6-month follow-up the nonbraced group had a better Tegner score. At 2 years there was no difference between the groups. There was one partial rupture of the graft in the nonbraced group after a new trauma 1 year after surgery. There were no differences between the groups in either subjective or objective knee stability at 2 or 6 weeks or at follow-up 3, 6, and 24 months after surgery. This study found no benefit of using a postoperative knee brace on patients' knee function at any stage up to 24 months after surgery. Furthermore, the braced group was not more stable than the nonbraced group, indicating that the brace does not contribute to a more stable knee during rehabilitation or 2-year follow-up.

Adult↗
PubMed2001

The Nordic Study on schizophrenic patients living in the community. Subjective needs and perceived help.

In a community sample of 418 persons diagnosed with schizophrenia, subjective needs and perceived help was measured by the Camberwell Assessment of Need (CAN). The mean number of reported needs was 6.2 and the mean number of unmet needs 2.6. The prevalence of needs varied substantially between the need areas from 3.6% ('telephone') to 84.0% ('psychotic symptoms'). The rate of satisfaction estimated as the percentage of persons satisfied with the help provided within an area varied between 20.0% ('telephone') and 80.6% ('food'). The need areas concerning social and interpersonal functioning demonstrated the highest proportion of unmet to total needs. In a majority of need areas the patients received more help from services than from relatives, but in the areas of social relations the informal network provided substantial help. In general the patients reported a need for help from services clearly exceeding the actual amount of help received. In a linear regression model symptom load (BPRS) and impaired functioning (GAF) were significant predictors of the need status, explaining 30% of the variance in total needs and 20% of the variance in unmet needs. It is concluded that the mental health system fails to detect and alleviate needs in several areas of major importance to schizophrenic patients. Enhanced collaboration between the care system and the informal network to systematically map the need profile of the patients seems necessary to minimise the gap between perceived needs and received help.

Activities of Daily Living↗
PubMed2001

Perceptions of the real and the ideal ward atmosphere among trainees and staff before and after the introduction of a new work rehabilitation model.

Changes in the ward atmosphere of a psychiatric work rehabilitation unit were investigated. Both trainees and staff filled in the Community-Oriented Programs Environment Scale (COPES) before and after a new rehabilitation model was implemented. It was hypothesised that the levels of autonomy and practical orientation would increase from both the trainees' and staff's perspective concerning the real ward atmosphere and that the staff's perceptions of an ideal ward atmosphere would change in the same way. The staff perceived an increased level of autonomy with respect to both the real ward atmosphere and to what constitutes an ideal ward atmosphere, which partly confirmed the hypotheses, but the level of practical orientation was stable. Concerning the staff's estimate of an ideal ward atmosphere, further changes were an increased level of involvement and a decrease in spontaneity, which was not hypothesised, but was not in conflict with the philosophy behind the new model. From the trainee's perspective there was no change of either autonomy or practical orientation. Instead, there was a decrease in personal problem orientation. Compared to an optimal profile, the ward atmosphere was beneficial, before as well as after implementation of the new programme. Differences were found between the staff and the trainees, but they were not large enough to separate the groups according to what is considered an optimal profile. The few changes found support earlier conclusions that the ward atmosphere is a stable phenomenon over time.

Adult↗
PubMed2001

Ward atmosphere, client satisfaction, and client motivation in a psychiatric work rehabilitation unit.

This study investigated the ward atmosphere of a psychiatric work rehabilitation unit and its relationships to clients' satisfaction with the unit and client motivation, operationalised as proneness to set personal goals for their rehabilitation. The Community-oriented Programs Environment Scale was used and 52 clients participated. Their report of the ward atmosphere was in accordance with recommended levels on 5 sub-scales out of 10. A regression analysis revealed that optimal levels of order-and-organization and support were of importance for satisfaction with the unit. An optimal level of support was associated with a high rating of personal goals. This study added two therapeutically interesting factors-satisfaction and motivation-to the flora of factors that have been related to perceptions of the ward atmosphere.

Adult↗
PubMed2001

How far should we lower blood pressure in the elderly.

In the last few years several large intervention trials have addressed the treatment of hypertension in the elderly and how far blood pressure should be lowered in such patients. The positive results of intervention against high blood pressure in the elderly has resulted in a positive attitude towards treatment and today this is an accepted and highly effective medical intervention. Both stroke and coronary morbidity have been shown to be positively affected as has total mortality. The specific issue, how far to lower blood pressure in the elderly was probably best addressed in the Hypertension Optimal Treatment (HOT) stduy in which about a third of the patients, i.e. >6,000 patients, were > or =65 years of age. In most of the early intervention studies of antihypertensive treatment in elderly patients diuretics or beta-blockers or the two in combination were used as the therapy by which blood pressure was lowered. However, novel therapies, in particular calcium antagonists, have shown benefits of the same magnitude as the older therapies, e.g. in the STONE trial, the Syst-Eur study, the Syst-China study and the STOP-Hypertension-2 study. In the latter study a regimen based on either of two ACE inhibitors was also shown to be equally effective as conventional treatment, based on diuretics and/or betablockers, in the elderly. These trials will be briefly reviewed here as will the SCOPE study which is an ogoing trial in which hypertensive patients aged 70-89 years are being treated with an angiotensin II receptor antagonist under double-blind and placebo-controlled conditions. It can be concluded that a wealth of information, based on large intervention trials, has been accumulated during the last decade. It is quite obvious that the elderly hypertensive patients benefit from antihypertensive treatment to at least the same extent as the young and middle-aged. It appears that blood pressure ought to be lowered down to normotensive values also in the elderly in order to minimize their risk if cardiovascular complications, although more studies would be welcome to address this issue specifically in the elderly.

Aged↗
PubMed2001

The relationship of personality dimensions as measured by the temperament and character inventory and quality of life in individuals with schizophrenia or schizoaffective disorder living in the community.

The influence of personality factors on the appraisal of subjective quality of life in individuals with schizophrenia or schizoaffective disorder is not much investigated. The present study examined this relationship in a sample of 104 patients living in the community. The temperament and character inventory was used to assess personality and the Lancashire quality of life profile was used to assess quality of life. The results showed that lower levels of harm avoidance and higher levels of self-directedness were significantly correlated to a better subjective quality of life. Regression analyses controlling for psychopathology revealed that a higher level of self-directedness was significantly associated with a better subjective quality in all aspects measured and explained the variance in the latter in the range of 4-12%. It is concluded that personality factors are involved in severely mentally ill individuals' assessment of their quality of life and should be accounted for in evaluations of quality of life assessments. The strength and directions of this influence require further studies.

Adult↗
PubMed2001

Comparison of key worker and patient assessment of needs in schizophrenic patients living in the community: a Nordic multicentre study.

OBJECTIVE: The present study is part of a Nordic multicentre study investigating the life and care situation of community samples of schizophrenic patients. The specific aim of the present part of the study was to examine the agreement between patients and their key worker concerning the presence of met and unmet needs in a number of life domains, and help or support given in these domains. METHOD: The comparisons were based on 300 matched pairs of assessments of need using the Camberwell Assessment of Need interview. RESULTS: The results showed that key workers identified slightly more needs, 6.17 vs. 5.76, a significant difference. There was a moderate or better agreement on the presence of a need in 17 of 22 life domains investigated, but in only 11 life domains concerning the presence of an unmet need. Disagreement concerning whether the patient was given the right kind of help or support was even more substantial. CONCLUSION: It is concluded that key workers and patients disagree particularly concerning unmet needs and that this is potentially related to a number of factors associated with the key worker and patient. It is also concluded that further research is needed to increase the knowledge concerning the sources of this disagreement if need assessment is to become a valid basis for service planning and individual treatment planning.

Adult↗
PubMed2001

Mental health care reform in Sweden, 1995.

OBJECTIVE: To describe the content of the Community Mental Health Care reform in Sweden, in effect from 1995 and directed to severely mentally ill people (SMI). METHOD: Evaluating changes, at local and national level, in living conditions among SMI and resources of services directed to them, by using registers, questionnaires, interviews and case studies. RESULTS: A survey, covering 93% of the population, identified 43,000 SMI (prevalence of 0.63%); 4,000 long-stay patients and 400 rehabilitation programmes were transferred from psychiatric services to social services (15% of the budget of psychiatric services). Employment and rehabilitation projects, family support and user programmes and educational projects for social services staff, were launched (funded by state subsidies). CONCLUSION: SMI still have difficulties in obtaining adequate support on the basis of disability laws and there continue to be barriers between social services and psychiatric services.

Health Care Reform↗
PubMed2001

The validity of Antonovsky's Sense of Coherence measure in a sample of schizophrenic patients living in the community.

AIM OF THE STUDY: To examine the construct and predictive validity of Antonovsky's Sense of Coherence (SOC) concept in a sample of schizophrenic persons living in the community. BACKGROUND: The salutogenic model of Antonovsky proposes that the individual's sense of coherence, which is a personal orientation towards life, determines the health experience. The salutogenic perspective might in several advantageous aspects contribute to the care and support for patients with a long and persistent mental illness like schizophrenia. DESIGN: The study is a 18-month follow-up study. Structured interviews were used to interview 120 patients with a diagnosis of schizophrenia or a schizoaffective disorder. Pearlin's mastery scale, Rosenberg's self-esteem scale, the Interview Schedule for Social Interactions (ISSI) and the Brief Psychiatric Rating Scale (BPRS) were used as construct validity measures of the SOC scale. Health related measures such as quality of life, global well-being, satisfaction with health assessed by the Lancashire Quality of Life Profile (LQOLP) and global psychosocial functioning (GAF) were used in calculations of the predictive validity of SOC. RESULTS: The SOC was positively related to mastery, self-esteem and social support but negatively associated to psychopathology. In total, mastery, self-esteem and adequacy of social integration explained 61.1% of the variance in SOC, and mastery contributed with the greatest part of the variance, 46.3% SOC was positively associated to all health related measures and changes in SOC during an 18-month follow-up was positively correlated to changes in overall subjective quality of life, general health, global well-being and global psychosocial functioning. CONCLUSION: The results gave support to the construct and predictive validity of the SOC measure in individuals suffering from a diagnosis of schizophrenia.

Adaptation, Psychological↗
PubMed2001

The relationship between coping strategies and family burden among relatives of admitted psychiatric patients.

Coping strategies as assessed by a projective coping instrument, showed only a weak relationship to perceived family burden and participation in care among 78 close relatives of voluntarily and compulsorily admitted psychiatric patients in this study conducted in two psychiatric services in Sweden in 1997. The results rather indicate that problem solving coping strategies are used when the relatives are in situations amenable to change and that emotion-focused coping strategies are used in situations that are chronic and unchangeable. Furthermore, no differences in coping strategies were found between the relatives and a Swedish normative sample. No relationships were found between coping strategies and when the relative thought that the patient's mental health had led to mental problems in the relative or if the relative experienced that the relationship with the patient had been negatively affected by the mental illness. The usefulness of coping instruments based on personality components in research on family burden is called into question, and a reconsideration of qualitative research methods is recommended.

Adaptation, Psychological↗
PubMed2001

Characteristics of 15,314 hypertensive patients at high coronary risk. The VALUE trial. The Valsartan Antihypertensive Long-term Use Evaluation.

Valsartan is an orally active, selective antagonist of the angiotensin II-1 (AT1) receptor developed for the treatment of hypertension. The Valsartan Antihypertensive Long-term Use Evaluation (VALUE) Trial of Cardiovascular Events in Hypertension is a double-blind, randomized prospective, parallel group study designed to compare the effects of valsartan with those of the calcium-antagonist amlodipine on the reduction of cardiac morbidity and mortality. Patients with essential hypertension, aged 50 years and older, and at particularly high risk of coronary events were enrolled. 18,119 patients were screened and 15,314 patients in 31 countries were randomized mainly between January 1998 and December 1999. These hypertensives had a mean blood pressure of 154.7/87.5 mmHg at the time of their randomization to blinded medication. The population comprises both genders (men 57.6%), Caucasians (89.1%), mean age 67.2 years, mean body mass index 28.6 kg/m2, coronary heart disease (45.8%), high cholesterol (33.0%), type 2 diabetes mellitus (31.7%) and smokers (24.0%). More than 92% of the randomized participants had been treated for high blood pressure for at least 6 months when screened for the study. The randomized population is now being treated (goal blood pressure < 140/90 mmHg) in adherence with the protocol until at least 1450 patients experience primary cardiac endpoint defined as clinically evident or aborted myocardial infarction, hospitalization for heart failure or death caused by coronary heart disease.

Aged↗
PubMed2001

The relationship between dose and antihypertensive effect for different AT1-receptor blockers.

Hypertensive patients require adequate control of blood pressure to limit the development of cardiovascular complications. The introduction of the angiotensin II type I (AT1)-receptor blockers was an important breakthrough, offering effective control of blood pressure with placebo-like tolerability. The relationship between dose and antihypertensive effect has been more or less well defined for the different AT1-receptor blockers currently available. Attempts to compare the antihypertensive effects of different AT1-receptor blockers using meta-analyses of several studies have been performed, although the results of such analyses are often limited by the inconsistencies of included trials and the inability to examine primary data and methodology. Furthermore, it is important to include data from the most up-to-date studies and to ensure correction of placebo effects, which tend to differ considerably between studies and contribute in varying degrees to the apparent therapeutic efficacies observed. Consequently, while meta-analysis can be useful in determining dose-response relationships for individual drugs, randomized, prospective, double-blind, head-to-head comparative studies are the only accurate means of comparing efficacy between drugs. A number of such trials have confirmed the superior efficacy of candesartan cilexetil and irbesartan compared with losartan in terms of reduction in blood pressure and maintenance of antihypertensive efficacy between doses.

Angiotensin Receptor Antagonists↗