[Uppsala model for smoking cessation. Smokers formulate own motivation for smoking cessation].
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Female↗
Biomedical subjects
M Holm
Publications and source records attributed to M Holm.
Normalization of resistance artery structure and left ventricular morphology with a perindopril-based regimen.
Twenty-five patients with newly diagnosed or poorly regulated essential hypertension were randomly selected from a larger group referred to hospital. Treatment was initiated with perindopril (4 to 8 mg od). If normotension was not achieved, isradipine (5 to 10 mg od) was added and, if necessary, hydralazine was added. Before treatment and at the end of a nine-month period of normotension (diastolic blood pressure less than 90 mmHg), 24 h blood pressure and echocardiographic measurements were performed and resistance artery structure was determined. Twenty age- and sex-matched normotensives were used as controls. During antihypertensive treatment, mean blood pressure was reduced from 128 +/- 11 to 103 +/- 6 mmHg. Left ventricular mass was reduced from 300 +/- 76 to 198 +/- 54 g. The media:lumen ratio of the resistance arteries decreased from 9.8 +/- 2.6% to 7.8 +/- 1.9%. Control subjects exhibited a media:lumen ratio of the same magnitude (7.9 +/- 2.0). Regression of left ventricular mass correlated significantly with regression of the media:lumen ratio with a coefficient of 0.59 (P < 0.05). Results indicate that a perindopril-based regimen is extremely efficient in normalizing resistance artery and cardiac ventricular structures within one year of treatment. The impact of these findings on the excess cardiovascular morbidity and mortality in arterial hypertension still remains to be demonstrated.
Antihypertensive Agents↗
Purification of SEF1 proteins binding to transcriptional enhancer elements active in T lymphocytes.
Binding sites for SL3-3 enhancer factor 1 (SEF1) are important for the transcriptional activity in T lymphocytes and the tumorigenicity of SL3-3 murine leukemia virus. SEF1 is also implicated in the activity of many other leukemia, lymphoma, and sarcoma virus enhancers, and enhancers of genes for T cell receptor-CD3 subunits. We have purified several proteins binding to SEF1 sites from bovine thymus using a five-step purification procedure. The proteins migrated as 19 distinct bands representing molecular masses from 23 kDa to about 200 kDa in SDS-polyacrylamide gel electrophoresis. Ten DNA binding proteins, with molecular masses between 23 and 67 kDa, could be isolated after separation by SDS-polyacrylamide gel electrophoresis. The DNA binding specificities of these proteins were similar and corresponded to that of the SEF1 binding activity in nuclear extracts. Each of these isolated SEF1 proteins also bound to the essential delta-E3 element of the human T cell receptor delta enhancer. Antibodies against one SEF1 protein only reacted with the protein used for immunization, which indicates a limited homology between at least some SEF1 proteins. We also present data suggesting that SEF1 proteins exist in multiple forms with differences in their DNA binding specificity, and that high affinity DNA binding of the SEF1 proteins requires protein phosphorylation.
Animals↗
Stroke rehabilitation in Stockholm. Basis for late intervention in patients living at home.
In order to identify the basis of late-therapy intervention in patients with stroke, we studied a population-based sample of 20 patients. The requests were that they should be living at home 1-3 years after being hospitalized, and that they had declared themselves in need of rehabilitation services. The assessment of abilities and activities of the patients was related to the model of human occupation developed by Kielhofner and co-workers. Most individuals reported a change in activity and interest patterns after stroke, and high motivation in current activities. The cognitive functions were within normal limits for all tested patients. However, the motor abilities and verbal performances were frequently affected and varied considerably. About 3/4 of the patients were not motivated to change their level of dependence in personal and instrumental ADL. Social and leisure activities outside the home were identified as the most promising goals for community-based rehabilitation programmes. Focusing on such activities, potential improvement in quality of life for this population could be achieved by individually-planned rehabilitation programmes using non-professional collaborators and patient organizations.
Activities of Daily Living↗
Stroke rehabilitation: identification of target groups and planning data.
In order to ascertain the need for late stroke rehabilitation in South-West Stockholm (SWS) and explore the conditions for experimental stroke outcome research, we followed a population-based, systematic sample of incident stroke patients, hospitalized during the period 1987-1988, using computer files and a telephone interview. The annual incidence of first-ever or recurrent transitory ischaemic attack (TIA) or acute stroke during the period was 2.83 per 1000. In December 1989, approximately 3% of these incident patients declared subjective residual dysfunction, were living at home and were considered potential candidates for rehabilitation. The estimated prevalence of home-bound individuals with residual dysfunction due to stroke was 0.74 per 1000 (95% CI 0.51-1.04). The average duration of hospitalization for these patients was 95.2 days. Approximately 3/4 of them were interested in further conventional rehabilitation. The group not interested in this therapy were mainly females and were older. They scored lower in personal ADL and mental activity, but similarly in motor function. We concluded that the prevalence need for rehabilitation after stroke in the SWS community amounted to at least 1/1000. Early rehabilitation in the community, linked to post-acute stroke care with reduction of hospital stay would be functionally and socially advantageous and cost-effective for more than 25% of the incident stroke cases. Stroke rehabilitation and clinical follow-up are closely related processes that should be evaluated simultaneously.
Activities of Daily Living↗
SEF1 binding is important for T cell specific enhancers of genes for T cell receptor-CD3 subunits.
A family of proteins, denoted SL3-3 enhancer factor 1 (SEF1), interacts with DNA sequences in the T cell specific enhancer of SL3-3 murine leukemia virus and in the enhancers of several other viruses. A putative SEF1 binding site was also identified in the T cell specific enhancer of the gene encoding the human T cell antigen receptor (TcR) associated CD3-epsilon polypeptide. In this study we show that the identified sequence is a strong SEF1 binding site, and that purified SEF1 proteins bind specifically to the sequence. We report also that the SEF1 binding site is important for T cell specific activation of transcription by the CD3-epsilon enhancer. We show that SEF1 binding sites are present also in the T cell specific enhancers of other subunits of the TcR-CD3 complex, and that SEF1 proteins appear to play a central role in the T cell specific expression of this set of enhancers.
Animals↗
[Sleeping pills--still a problem].
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Denmark↗
[General practitioners' attitude to prescription of psychopharmaceuticals. Autonomy versus paternalism, education and understanding of disease].
The object of this investigation was to illustrate the attitudes of general practitioners to prescription of psychotropic drugs and to mental illness. The qualitative research interview method was chosen as the method employed here. Fourteen general practitioners were interviewed while one did not wish to participate. A marked difference was found between the attitudes of the general practitioners to respect the autonomy of the patients or to act paternally. The paternal general practitioner could either prescribe psychotropic drugs on his own initiative or refuse prescription. General practitioners who respected autonomy were relatively restrictive in their prescribing habits so that respect for autonomy was by no means expression for free prescription of psychotropic drugs. Their goal was that the patient should be placed in a situation where he/she could choose and determine personally. The general practitioners considered that their undergraduate and postgraduate training in treating patients with mental illness was inadequate. Taking into consideration how frequently patients with conditions of this nature are seen in general practice, this must be regarded as a serious deficit in medical training. A number of general practitioners have, however, received postgraduate training in this subject. General practitioners did not consider patients who consulted them with mental conditions as mentally ill but they did not have an alternative disease model by which they could classify the problems and complaints of these patients.
Attitude of Health Personnel↗
[Patients' attitude to long-term use of benzodiazepines. A questionnaire study].
The object of this investigation was to illustrate patients understanding of the background for commencing and continuing or discontinuing, respectively, benzodiadiazepine medication with emphasis on attitudes, norms and values on which this medication is based. The quantitative research interview method was selected as the method employed here. Twenty-one patients participated. Ten of these continued medication. Nine patients had originally discontinued medication but had begun again for various reasons. Two patients had discontinued medication completely. Patients who employed benzodiazepines daily had only few trepidations about consumption of drugs while patients who only employed medication occasionally had a series of trepidations. Nevertheless, a considerable tendency to return to benzodiazepines under conditions of stress was observed. The justification for intake of benzodiazepines was frequently altered during the course of time. Considerable "medicalization" of non-medical problems was observed. The problems for which the patient was prescribed medication with benzodiazepines were frequently bio-psycho-social-extential problems. The majority of patients were, however, aware of this "medicalization". Benzodiazepines were not employed as euphoric agents.
Attitude to Health↗
Features of Sjögren's syndrome in patients with primary biliary cirrhosis.
Twenty-six consecutive patients with primary biliary cirrhosis (PBC) from northern Sweden were studied regarding the occurrence and features of Sjögren's syndrome (SS). In more than 50% of the patients the rose bengal dye test showed conjunctival and/or corneal staining. In six patients keratoconjunctivitis sicca (KCS) was present with positive rose bengal and Schirmer tests. In a further three patients only the results of the Schirmer tests were abnormal. Radiological findings of sialectasia were demonstrated in six patients, five of whom had KCS. Two of the seven patients who fulfilled our criteria for Sjögren's syndrome were HLA-B8 positive. A high prevalence of increased immune globulins and rheumatic factor was found, but this did not correlate with the presence of Sjögren's syndrome. Some features of Sjögren's syndrome were found in 73% of PBC patients, and keratoconjunctivitis sicca and/or sialectasia were found in 27% of PBC patients. This constitutes a high frequency of secondary manifestations of the liver disease.
Adult↗
[General practitioners' training in psychiatry and prescription of psychotropic drugs. 2. Attitudes of physicians to training in psychotherapy and the extent of their prescriptions].
The object of this investigation was to describe and analyse differences in psychiatric training and attitudes to and employment of psychotropic drugs among general practitioners with and without training in psychotherapy, respectively. The investigation was carried out as a multicentre questionnaire investigation in the County of Aarhus with participation of 192 out of 215 (89%) doctors who were invited. Thirty-nine of the participating general practitioners (20%) had participated in a supervised course in psychoanalytically orientated psychotherapy. Doctors who were trained in psychotherapy had more rarely had appointments in psychiatric departments than other doctors. Doctors trained in psychotherapy prescribed fewer benzodiazepines than other doctors (p less than 0.05) and there was psychotherapy chose psychotherapy more frequently (p = 0.02) and more rarely tendency to a lower total prescription of psychotropic drugs. Doctors trained in a psychotropic drugs (p = 0.004) than doctors without this training as treatment for patients with psychosocial conflicts and they more rarely chose psychotropic drugs to supplement psychotherapy (p less than 0.0001). It is concluded that one of the ways of reducing the massive use of psychotropic drugs in Denmark is to improve general practitioners' training in psychotherapy.
Anti-Anxiety Agents↗
[General practitioners' training in psychiatry and prescription of psychotropic drugs. 1. Education, attitudes and extent of prescribing].
The object of this investigation was to describe prescription of psychotropic drugs by general practitioners in relation to their training and attitudes to employment of psychotropic drugs in the treatment of psychosocial conflicts. The investigation was carried out as a multicentre questionnaire investigation in the County of Aarhus in which 192 (89%) out of 215 general practitioners who were invited participated. In brief and prolonged psychosocial conflicts, 58 (31%) and 149 (81%), respectively, considered that prescription of psychotropic drugs constituted poor treatment. More than half of the general practitioners found that the amounts of psychotropic drugs prescribed by themselves and other general practitioners were excessive and that they were, themselves, responsible for this. The majority of the general practitioners found that their attitudes were of great significance for their prescriptions of psychotropic drugs and 71 out of 191 practitioners (37%) found that the pressure of work usually or frequently influenced this. A total of 107 (56%) had had appointments in psychiatric departments (average duration six months) prior to establishment as general practitioners. A total of 117 (61%) had received some form of postgraduate psychiatric training after establishment as general practitioners while 29 (20%) had not received any form of psychiatric training or postgraduate psychiatric education. No connection could be demonstrated between psychiatric training and the extent of prescription of psychotropic drugs.
Attitude of Health Personnel↗
[Prescription of benzodiazepine sedatives in general practice].
A review of the prescriptions dispensed by all pharmacists in the County of Arhus during a week in January 1989 resulted in information about 3,212 prescriptions for benzodiazepine hypnotics sedatives by the general practitioners in the county. The majority of prescriptions were for men in the age group 60-69 years and women in the age group 70-79 years. After age standardization, the extent of prescription was found to increase with age to reach extent of 267.1 and 347.9 defined daily dosages (DDD)/1,000 inhabitants/day for men and women, respectively in the age group of 90 years or more. A total of 70.8% of the prescriptions and 81.6% of the prescribed DDD were for preparations with prolonged effects. More of the elderly women than the middle-aged and younger women were prescribed preparations with prolonged effects (p less than 0.01). Prescription of tablets with double doses (2 DDD per tablet) were responsible for 40.4% of the prescribed DDD of hypnotics/sedatives with prolonged effect and 33.0% of the total quantity of medicine calculated in DDD. It is concluded that general practitioners should attempt to reduce the extent of prescription of benzodiazepine hypnotics sedatives and that the registering authorities should investigate the justification of continued registration of preparations with prolonged effects and that ths general public should be informed about how unsuitable employment of sleeping pills can be, except for very brief periods.
Adolescent↗
Factors of importance for the use of PAP-SMEAR in a Danish county without systematic screening.
Do various General Practice factors influence the participation rate (PR) in the cytological investigation for preventing cancer of the cervix uteri in counties without systematized screening? This was studied in the county of Aarhus, Denmark, where there are no systematic cytological examinations (CE). We studied a random sample of 2023 women aged 27.5 years to 47.5 years. Essential differences in PR depended on various practice characteristics. Practices with the highest average use of CE services, as counted by the Regional Health Authorities, also had the best PR. The relative chance of being sufficiently examined was almost twice as great among patients in active practices compared with other practices. Furthermore, practices with at least one female practitioner and practices that wanted the introduction of systematic screening had a significantly higher PR. There was a slightly higher PR for patients in large practices. Type of practice, i.e. whether single or partnership, and the individual practitioner's attitude to the efficiency of the present opportunistic screening were not related to the PR. Finally, a slightly lower PR was found among patients in the city of Aarhus, whereas the PR in the major cities of the county as a whole did not differ from the coverage rate in the county in general. It is concluded that the Health Authorities' average figure for CE-use/1000 women in the individual practice is the most significant factor that determines the CE rate for any given patient. Variation in the PR in different practices is unacceptably large if all the women are to receive a uniform CE screening offer.
Adult↗
Intervention against long-term use of hypnotics/sedatives in general practice.
The aim of the study was to evaluate the efficiency of different strategies of intervention to reduce prescription of hypnotics/sedatives in general practice. All 356 general practitioners in the county of Aarhus, Denmark, were divided in three groups. One group received personal information at meetings, another received written material about proper use of hypnotics/sedatives and information about their own prescription rate, and the third group constituted a control group. The prescription rate was recorded before and after the intervention. There was a general decline in the prescription rate recordings, but there were no significant differences between the intervention groups and the control group.
Adolescent↗
One year follow-up of users of benzodiazepines in general practice.
The aim of the study was to monitor discontinuation of benzodiazepine prescribing among patients who were either first-time or long-term users. The study was carried out as a one-year follow-up study in general practice in the County of Arhus, Denmark. In all, 201 patients with first-time prescriptions and 607 patients with long-term prescriptions participated, and in the one-year follow-up period 55% and 12%, respectively, stopped having further prescriptions of benzodiazepines or other psychotropic drugs. Older first-time users continued significantly more often than younger. In an age and sex-stratified analysis, users of benzodiazepine hypnotics/sedatives continued significantly more often than users of benzodizepine tranquillizers among first-time users (odds ratio (OR) 2.15) as well as long-term users (OR: 2.16). Continuation of long-term use was significantly correlated with the female sex (OR: 1.71), living alone (OR: 1.97), daily use (OR: 4.17), high amounts of defined daily doses (DDD) per prescription, and a high ratio between prescribed daily dose and DDD.
Adolescent↗
[Prescription of psychopharmaceuticals in general practice. 1. A registry study in the county of Arhus].
Prescription of psychotropic drugs by general practitioners was registered by means of a multicenter-questionnaire investigation in the County of Arhus. A total of 227 doctors registered 4,180 prescriptions to 3,756 patients during one week. The sex ratio (m/f) was 0.5, calculated not only from the number of prescriptions but also from the defined daily doses (DDD). The frequencies of prescribing increased markedly with age so that for men and women in the age group 70+, these were 188 and 322 DDD/1,000 of the population per 24 hours, respectively. Benzodiazepines constituted 67.3% of all of the prescriptions and 76.9% of the prescribed DDD while neuroleptics constituted 13.6% and 3.9% and antidepressives 9.5% and 7.0%, respectively. Neuroleptics were prescribed in doses of about 1/5 DDD. About 50% of the first prescriptions but only 17% of the renewed prescriptions were undertaken by direct doctor-patient contact in connection with consultations or visits in the home. Prescription of psychotropic drug by general practitioners is estimated to constitute just under 90% of the psychotropic drug in the County of Arhus.
Adolescent↗
[Prescription of psychopharmaceuticals in general practice. 2. Purpose, psychiatric diagnosis and treatment, addiction].
From a multicentre-questionnaire investigation in general practice, the prescription of psychotropic drugs to 3,756 patients is described as regards the object, psychiatric diagnosis and treatment and addiction. Twice as many women as men were prescribed psychotropic drugs but no sex differences of significance were present between the relative distributions of the various objects of prescription. 83-90% of the psychotropic drugs were prescribed as hypnotics or tranquilizers while 9-13% were prescribed for the treatment of psychoses. Two thirds of the psychotropic drugs were prescribed for patients who were considered mentally normal, including those suffering from environmental and psychosocial problems while only 1/3 of the patients had a real psychiatric diagnosis. Between 18 and 81% of the patients for whom psychotropic drugs were prescribed, depending upon the pharmacological group, did not have any real psychiatric illness. In over 50% of the patients, the psychotropic drugs prescribed was the only form of treatment, 17% had received interview treatment from the general practitioner and 17% had received treatment from a specialist in psychiatry or had been admitted to a psychiatric department. Approximately 20% of the patients for whom psychotropic drugs were prescribed were potential or genuine addicts.
Adolescent↗