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Biomedical subjects

L Lindholm

Publications and source records attributed to L Lindholm.

At least 37 records · Page 2Linked to original sources
PubMed1999

Urogenital symptoms in women aged 50-59 years. Women's Health in Lund Area (WHILSA) Study Group.

Problems related to the urogenital tract are common in elderly women. Control of micturition is often impeded and questionnaire-based studies have reported a prevalence of poor control of micturition in about 30% of postmenopausal women. In an ongoing cohort comprising women born between 1935 and 1945, an interim analysis was performed in 1800 women based on an interview and questionnaire. The prevalence of urinary incontinence was found to be 33%, which is in accordance with previous reports. The main difference between the interview and the questionnaire was that the interview could take into account intensity as well as intermittence of symptoms. There were no differences between premenopausal women and postmenopausal women using or not using hormone replacement therapy. In agreement with earlier studies, we found poorer control of micturition in parous women. A higher percentage of incontinence was also found in women who had lost more than 5 kg in body weight during the preceding 5 years. In addition, women with a family history of diabetes were more prone to complaints of incontinence. Of the 155 women who had a family history of diabetes, 66 were incontinent (p < 0.01). It was also found that women who were incontinent were more often on regular surveillance for various diseases, using more medications regularly and had been hospitalized during the last 5 years more often than women who were continent. There were no differences in smoking habits. The present results imply that urinary incontinence in women is of a complicated origin and that the hormonal situation plays a minor role for this socially handicapping symptom.

Cohort Studies↗
PubMed1998

On the measurement of the nation's equity adjusted health.

The aim of this article is to show a method for measuring the nation's equity-adjusted health. In order to estimate what the 'nation's health function' looks like, data from a survey sent to a sample of Swedish politicians were used. The results from the survey can be interpreted as a measure of inequity aversion, and this was applied to data on healthy years (HY) for males in different social groups for the period 1975-1990. The mean of healthy years increased during the period 1986-1990 by 1.09% while equity adjusted healthy years (HY(EDE)) dropped by -1.78%. The nation's health has decreased in spite of the fact that the individual's health has increased.

Adult↗
PubMed1998

Alcohol advice in primary health care--is it a wise use of resources?

Many attempts to calculate costs caused by the use of alcohol in accordance with the cost-of-illness method have been reported in the literature. However, in a decision-making perspective and with a focus on what possible interventions to undertake, cost-benefit or cost-effectiveness studies are more useful. In this study the cost-effectiveness of advice aimed at reducing 'heavy' drinking to 'moderate' drinking is calculated. Results from controlled trials, showing the short-range effects of advice, are combined with observations from long-term epidemiological studies showing the association between alcohol consumption and total mortality. This study shows that advice from primary health care staff has a potential to be a very cost-effective means of intervention. The crucial point seems to be the number of people that makes durable changes in consumption. If about 1% make lasting changes a brief intervention is relatively cost-effective (20,000 ECU/YLS), and if about 10% change resources will be saved in health care. Important effects such as increased quality of life and decreasing production losses are not taken into account.

Adult↗
PubMed1998

How many lives is equity worth? A proposal for equity adjusted years of life saved.

STUDY OBJECTIVE: To present a formula for equity adjusted years of life saved (EYLS). DESIGN: A mailed questionnaire. The survey participants were given a scenario describing a trade off between a health maximization programme and a programme that is less efficient, but eliminates social inequalities. SETTING: Swedish politicians responsible for health care in the county councils. PARTICIPANTS: A sample of 449 Swedish politicians responsible for health care in the county councils. MAIN RESULTS: The principle of health maximization was rejected. Under certain conditions, the Swedish politicians are prepared to sacrifice 15 of 100 preventable deaths to achieve equity. Based on the results a formula for EYLS is presented. CONCLUSIONS: An equity adjusted formula for years of life saved has been proposed, but must be developed and revised according to each country's specific conditions and value premises. In the future, such formulas could serve the purpose of incorporating explicit considerations of equity into cost effectiveness analyses.

Cost-Benefit Analysis↗
PubMed1997

Health motives and life values. A study of young persons' reasons for health.

The aim of this study was to investigate the health motives of young people, i.e. the things that give health meaning. The investigation was carried out as two studies among Finland-Swedish young people aged 13-19. A questionnaire with open questions framed with a multidimensional perspective on health was filled in by 152 pupils at secondary school, 121 pupils at upper secondary school and 115 pupils at vocational school in study I. A theme interview with 15 young persons was the data assembling method used in study II. The data was analysed using the hermeneutical method. The results revealed that a young person's experience of health and idea of what health is cannot be understood in a deeper sense without understanding the young person's health motives. The health motives can be described at different levels as external, internal and fundamental. The different motives for health form health motive complexes, which are based on an aspiration to avoid something perceived as evil, such as illness and suffering. On the other hand, the motives are based on an aspiration to achieve what is good, such as love and life. The motives mentioned as meaningful for health have to do with the things that are valued in life. Consciousness of life values that last and can give meaning provides an answer to the 'why' of health. Humanistic values, existentialistic values, materialistic values or traditionalistic values give the clue to why health is meaningful for a young person. The results also indicated that there are difference in young persons' health motives in different school contexts.

Adolescent↗
PubMed1997

The Captopril Prevention Project (CAPPP) in hypertension--baseline data and current status.

The Captopril Prevention Project (CAPPP) is an ongoing intervention study conducted in 11,019 hypertensive patients in Sweden and Finland. Patients have been randomized to receive either conventional antihypertensive therapy (diuretics and/or beta-blockers) or captopril-based treatment. A prospective, randomized, open, blinded-endpoint evaluation (PROBE) study design is used to compare these two therapeutic regimens as regards cardiovascular morbidity and mortality. The rationale for the CAPPP Study are the many observations of beneficial effects of ACE inhibition, as compared to diuretics and beta-blockers, on intermediary endpoints such as insulin sensitivity, serum lipoproteins, left ventricular hypertrophy and renal function. Captopril has also been shown to be markedly effective in the treatment of left ventricular dysfunction as well as congestive heart failure. The hypothesis is that these differences might result in improved risk reduction when ACE inhibitors are used in the treatment of hypertension. The present paper describes the baseline data and the changes in blood pressure during the first year in the total cohort. During the first year the average blood pressure was reduced by 11/8 mm Hg. A number of substudies have been conducted in the CAPPP Study. In one of these insulin sensitivity was compared in a subgroup of the patients using the euglycemic insulin clamp technique. In another substudy the ACE gene was sequenced and some new polymorphisms were discovered. Several other substudies are in progress or in the planning phase. The main results of the CAPPP Study should be available by mid-1998. Some of the intended anayses of the final results as well as other planned substudies are briefly described here.

Adult↗
PubMed1996

Lisinopril reduces postexercise albuminuria more effectively than atenolol in primary hypertension.

Physical exercise causes transient albuminuria. The mechanisms of postexercise albuminuria are not fully clarified but stimulation of the reninangiotensin system (RAS) probably plays a major role through intrarenal haemodynamic changes causing an elevated filtration pressure. In a randomised, double-blind, crossover study we compared the effects on urinary albumin excretion (UAE) of lisinopril (L) and atenolol (A) therapy, i.e. we aimed to investigate whether inhibition of the RAS or inhibition of beta1-adrenoceptor-mediated effects of the sympathetic nervous system differed with regard to changes in UAE. Sixteen patients with uncomplicated primary hypertension were studied. Four standardised bicycle ergometer exercise tests were performed, before and after each active treatment period. UAE 30 min postexercise, determined by radioimmunoassay, was significantly lowered by both treatments: -278 mu g center dot min-1 (L) and -199 mu g center dot min-1 (A). The reduction of postexercise UAE achieved by treatment with the angiotensin-converting enzyme (ACE) inhibitor (L) was significantly greater than that achieved by the beta1-selective adrenoceptor blocker treatment. Blood pressure (BP) at rest and during exercise were equally reduced by both drugs. In conclusion, this study showed that antihypertensive treatment with an ACE inhibitor was more effective in reducing exercise-induced albuminuria than a beta1-selective adrenoceptor-blocking agent with a similar degree of BP reduction in patients with uncomplicated primary hypertension. This suggests that the RAS plays a major role in postexercise albuminuria in hypertensive subjects. The clinical significance of this finding, however, remains to be clarified.

Adrenergic beta-Antagonists↗
PubMed1996

An epidemiological approach towards measuring the trade-off between equity and efficiency in health policy.

The concept of social welfare functions has been discussed in health economic literature, as it provides a way of examining the extent to which society is prepared to accept a trade-off between efficiency and equity. In this paper requirements for meaningful empirical estimates of the willingness to accept lower per capita health status in order to achieve greater equity are examined. Results from a pilot study aimed at testing the proposed measurement procedure are reported. They show that at least two thirds of the politicians who participated are prepared to accept a lower growth in per capita health in exchange for increased equity. Accordingly, we found a weak empirical support for the common health economic assumption that only total health benefit should guide the use of resources.

Cost-Benefit Analysis↗
PubMed1996

Different levels of sensory neuropeptides (calcitonin gene-related peptide and substance P) during and after exercise in man.

The aim of this study was to investigate the regulation of two sensory peptides calcitonin gene-related peptide (CGRP) and substance P, reflected as circulating levels during provocation of the sympathetic nervous system. Levels in hypertensives, diabetics (NIDDM) and controls were assayed before, during and after an exercise test (average work load carried out was 76 +/- 10 kJ). CGRP levels increased progressively during exercise (P < 0.001), with maximum level at maximum exercise. This was significant in all three groups; hypertensives P < 0.001, diabetics P < 0.01 and controls P < 0.001. No differences in circulating revels of CGRP between the three groups were found. Substance P levels were fairly constant during exercise but increased 30 min after exercise (P < 0.01) in the total group. We hypothesize that CGRP might provide a counter-regulatory mechanism to the sympathetic vasoconstrictor transmitters noradrenaline (NA) and neuropeptide Y (NPY) during sympathetic activation. Substance P did not increase during exercise. This suggests differential regulation and function of the two vasodilatory peptides.

Adult↗
PubMed1996

Cost effectiveness and equity of a community based cardiovascular disease prevention programme in Norsjö, Sweden.

STUDY OBJECTIVE: To evaluate the cost effectiveness and equity of a community based cardiovascular disease prevention programme. DESIGN: A prospective cross sectional design. SETTING: A community based intervention to reduce cardiovascular disease in the district of Norsjö (n = 5500), Sweden. The intervention was aimed at both the general population and at individuals thought to be at special risk, the emphasis being on changing dietary habits and reducing cholesterol concentrations. PARTICIPANTS: The participants were men and women aged 30-60 years. MAIN RESULTS: The mean serum cholesterol concentration in the Norsjö population was reduced by nearly 20% during the first six years of intervention. It was estimated that the programme's overall total societal costs were 363,000 pounds and estimates of the cost per year of life saved ranged from 14,900 pounds to net savings, according to different assumptions. Taking only health care costs and savings into account, the cost per year of life saved ranged from 1100 pounds to 4050 pounds. The results varied between different sex and age groups, but not between social classes. Even if a causal relationship exists between low cholesterol concentrations and excess mortality, the estimated side effects of lowering cholesterol values in Norsjö were negligible in comparison with the expected benefits. CONCLUSIONS: The community based intervention in Norsjö seems to be cost effective even under conservative assumptions. The approach used seems to have benefited all social classes. Cost effectiveness analyses that take consequences for equity into account are valuable tools in decision making.

Adult↗
PubMed1994

Dyspnoea, asthma, and bronchospasm in relation to treatment with angiotensin converting enzyme inhibitors.

OBJECTIVE: To evaluate the occurrence of asthma and dyspnoea precipitated or worsened by angiotensin converting enzyme inhibitors. DESIGN: Summary of reports of adverse respiratory reaction in relation to treatment with angiotensin converting enzyme inhibitors that were submitted to Swedish Adverse Drug Reactions Advisory Committee and to World Health Organisation's international drug information system until 1992. Sales of angiotensin converting enzyme inhibitors in Sweden were also summarised. SUBJECTS: Patients receiving angiotensin converting enzyme inhibitors who reported adverse respiratory reactions. MAIN OUTCOME MEASURES: Clinical characteristics of adverse reactions of asthma, bronchospasm, and dyspnoea. RESULTS: In Sweden 424 adverse respiratory reactions were reported, of which most (374) were coughing. However, 36 patients had adverse drug reactions diagnosed as asthma, bronchospasm, or dyspnoea. In 33 of these cases the indication for treatment with angiotensin converting enzyme inhibitors was hypertension, in only three heart failure. The respiratory symptoms occurred in about half of the patients within the first two weeks of treatment, and about one third needed hospitalisation or drug treatment. Dyspnoea symptoms occurred in conjunction with other symptoms from the airways or skin in 23 out of the 36 cases. In the WHO database there were 318 reports of asthma or bronchospasm, 516 reports of dyspnoea, and 7260 reports of cough in relation to 11 different angiotensin converting enzyme inhibitors. CONCLUSION: Symptoms of airway obstruction in relation to treatment with angiotensin converting enzyme inhibitors seem to be a rare but potentially serious reaction generally occurring within the first few weeks of treatment.

Adult↗
PubMed1994

Can social class differentials in hypertension be explained by the general susceptibility hypothesis?

In a population-based, cross-sectional study of 310 treated hypertensives (HT) and 288 matched normotensive controls (NT), social and biological variables were investigated. HT comprised a higher proportion of individuals in lower socioeconomic strata (P < 0.001) and lower social class distribution (defined by occupation and educational level) than NT. However, lower estimated risks (odds ratios, OR) for hypertension were found in lower social strata than in higher ones for most biological variables. This does not support the hypothesis of an increased general susceptibility in lower social classes to standard risk factors as a main factor behind the higher prevalence of hypertension, in as much as the ORs for most variables were not higher in the lower classes than in the higher ones. Thus, there may exist some, as yet undefined, and more specific risk factors for hypertension which are more prevalent in lower social strata. Interestingly, it was demonstrated that the prevention potential regarding intervention against biological risk factors had about the same magnitude in the different social strata.

Case-Control Studies↗
PubMed1994

125I-labelling of an internally 75Se-labelled monoclonal antibody--biodistribution in tumour-bearing nude mice.

A monoclonal antibody, C215, was first internally labelled with 75Se-methionine and then labelled with 125I. The biodistribution of the dual-labelled [125I][75Se]C215 was studied in tumour-bearing nude mice killed 3 days after injection. The biodistribution of the dual-labelled [125I][75Se]C215 was compared with the biodistribution of single-labelled [131I]C215 and [75Se]C215. Iodine-labelled antibodies seem to be damaged during iodination, affecting the disappearance rate and tumour uptake. There were no signs of dehalogenation of circulating antibodies or antibodies taken up in the tumour.

Adenocarcinoma↗
PubMed1994

Are people willing to pay for a community-based preventive program.

This pilot study is the first known attempt to test the willingness-to-pay or willingness-to-accept (WTP/WTA) method of assessment on a community-based primary prevention program against cardiovascular disease. The results indicate that the population's perceived WTA outweighs the program's costs by at least three to one. However, the methodological problems of using the WTP/WTA method in community-based programs are far from solved, and further research in this area is required.

Cardiovascular Diseases↗