Biomedical subjects

P Bjurulf

Publications and source records attributed to P Bjurulf.

At least 37 records · Page 2Linked to original sources

PubMed1991

The accordance of diagnoses in a computerized sick-leave register with doctor's certificates and medical records.

A register has been built for planned epidemiological studies of sick-leave, containing all cases exceeding 6 days in a population of 184,000, over a period of 3 years. The diagnoses were coded from medical certificates. To assess the quality of this information this study reviews the medical certificates of 2,364 cases. In 299 cases the corresponding medical records are reviewed and independent diagnoses made. The coding and entering of data into the register is correct in 98% of cases. The independently-made diagnoses match exactly the ones registered in 50% of cases. When grouping the diagnoses into 39 groups, the match on group level is 72%. Ten percentage points of the mismatch are caused by specified overlaps between groups. The remaining 18% mismatch is caused mainly by different interpretations or unspecific labelling of the disease states, not so much by them being obscure in themselves or by doctor covering up unpleasant diagnoses.

Absenteeism↗

PubMed1990

Effect of dietary supplement on nutritional status and clinical outcome in 501 geriatric patients--a randomised study.

The present study was designed to evaluate to the effect of dietary supplements on clinical outcome and nutritional status in a large group of geriatric patients (n = 501). The patients were randomised into an experimental group which received nutritional supplementation (400 kcal) as well as a standard hospital diet, and a control group on hospital diet alone. The nutritional state was measured on admission and after 8 and 26 weeks by anthropometry, serum protein analysis and a delayed hypersensitivity skin test. Protein energy malnutrition was defined as the presence of three or more abnormal parameters. 28.5% of patients showed evidence of malnutrition on admission. Hospitalisation itself resulted in a gradual deterioration in nutritional status. Nutritional supplementation generally improved nutritional state. Among those patients who were well nourished on admission, and subsequently receiving dietary supplementation, 8.3% fulfilled malnutrition criteria after 26 weeks, while 21.1% were considered malnourished in the control group (p < 0.05). The improvement observed in transport proteins was probably related to nutritional support and not just to the reversal of inflammation. In the initially well nourished group of more than 300 patients, the mortality rate was 8.6% in those given nutritional support compared to 18.6% in the control group (p < 0.02).

Journal Article↗

PubMed1990

The correlation between anergy, malnutrition and clinical outcome in an elderly hospital population.

The nutritional state of 482 out of 501 newly admitted elderly patients was assessed by anthropometry, serum protein analyses and the delayed hypersensitivity skin test (DH) on admission and after 8 and 26 weeks. The mean age of the women was 81.3 +/- 7.7 and of the men 77.9 +/- 9.3. Protein-energy malnutrition (PEM) was initially defined as three or more subnormal criteria, one in each of the three categories of measurement. The data was then reanalysed excluding anergy and using the two other criteria only. The prevalence of PEM on the first assessment was 28.5% and was 10% higher when anergy was excluded as a criterion. PEM was more common in women and increased with age. The anergic patients had lower mean values in serum protein and anthropometry than those with normal reactivity. Anergic patients had a higher mortality rate and more pressure sores than the reactive group. Nutritional supplementation was associated with an increase in skin reactivity.

Journal Article↗

PubMed1990

Overall functioning and criteria of progress in rehabilitation of alcohol abusers: longitudinal analyses of changes.

The aim was to compare alcohol consumption and vocational adjustment as criteria of rehabilitation progress of alcoholics, with regard to links to concomitant changes in functioning in other life areas. Thirty-four advanced alcohol abusers in rehabilitation were examined twice with an interval of 2 years between each examination. Change scores in alcohol consumption and work capacity were correlated with change scores in social network, activities, life-satisfaction, psychological well-being, psychiatric symptoms, and biomedical functioning. Improved drinking habits were connected with some changes in overall functioning, however not solely in a favorable direction. Negative mood changes were especially noteworthy. Improvements in vocational adjustment, on the other hand, appeared to be somewhat more unequivocally and encompassingly associated with amelioration in the wider range of functioning. The results indicate that drinking measures alone are not sufficient indicators of progress in rehabilitation and underscores the need of more global criteria of general adjustment.

Activities of Daily Living↗

PubMed1990

Audit of decision-making regarding female genitourinary infections in outpatient practice.

Patient data, diagnosis, work-up measures, and prescriptions were collected from 63 consultations by general practitioners (GPs) to study day-to-day management of women with complaints suggestive of genitourinary (GU) infections. The collected patient data were thereafter presented to a panel of 9 specialist physicians for their individual recommendations. On drug prescriptions, the panel supported 81% of the decisions, did not support 14%, and remained undecided on 5% of the cases. In all but one of the unsupported cases, the GP had prescribed antibiotics. On diagnoses, the panel supported 62% of the decisions, did not support 13%, and was undecided on 25% of the cases. The most frequent discordance concerned diagnosis of urethritis. On collection of medical data by history and physical examination, the panel found 22% of the consultations unsatisfactory. Discordance in both diagnosis and drug prescription were related to remarks about data collection. The results suggest that the body of knowledge available for GPs for management of female GU infections in outpatient practice is incomplete.

Adolescent↗

PubMed1989

The semantics of diagnosis and management of genitourinary infections: a cross-specialty study.

To investigate agreement between physicians about diagnosis and management concepts of genitourinary infection, data from 63 symptomatic women was collected and distributed to a panel consisting of three general practitioners, three urologists and three nephrologists. Using double-blind methods, the panel was asked individually to give a preliminary diagnosis and a management recommendation for each case. Pairwise comparison of the evaluations showed 66% agreement for diagnosis and 79% agreement for prescription of antibiotics. Adjusting for chance agreement, the kappa index was 0.43 for prescription of antibiotics, 0.31 for diagnosis of cystitis, 0.20 for vulvovaginitis, 0.21 for pyelonephritis and 0.09 for urethritis. The specialist groups ordered significantly more laboratory investigations, resulting in a 75-95% more expensive work-up compared with general practitioners. The findings imply a need for more distinct use of the concept of 'urethritis' and are consistent with previously demonstrated differences in resource use between general practitioners and specialist physicians.

Anti-Bacterial Agents↗

PubMed1989

The modified Norton scale and the nutritional state.

The Norton scale was devised in 1960 as an additive scale to facilitate the prediction and prevention of pressure sore development. The scale has been used both in the original version and in modified versions both in practice and as an instrument in nursing research. In a previous study the reliability had been analysed. The present investigation comprises 501 patients who were examined weekly by registered nurses with regard to the variables in a modified Norton scale and on admission with regard to the nutritional status. There are significant correlations between the variables establishing the modified Norton scale and the different criteria included in the nutritional assessment form.

Aged↗

PubMed1989

Information needs and information seeking behaviour in primary health care.

A questionnaire survey of 186 general practitioners in Sweden showed that 67% saw the overall supply of medical information as less satisfactory or unsatisfactory, and that 80% experienced major hindrances in seeking relevant information. The most frequent need for information concerned general medicine, with respect to both diagnosis and choice of therapy. Of situations which required additional information, only every second was completely resolved. These results imply a need for a reorganization of the supply of information to general practitioners. As they cannot depend on conventional medical libraries for day-to-day information, personal libraries should be improved and updated regularly, and be readily to hand. Computer technology should be considered for communication between health care providers, and as support for differential diagnosis in general medicine.

Consumer Behavior↗

PubMed1988

Health careers--a method of health education at school for adolescents.

An innovative health education curriculum, "Health Careers", intended for adolescents leaving school, was evaluated using a quasi-experimental pre-/post control group design. The objective of the project was the modification of knowledge, attitudes and behaviour in relation to health. Attempts were made to counteract factors restricting the effect of traditional health education at school. Changes were estimated using questionnaires. Two types of schools were studied, schools A and B, student age averaged 17.3 years and 15.5 years, respectively. The number of students in the experimental groups was 220 and 112, respectively. At school B, in addition, 35 parents participated voluntarily in evening courses arranged by the project staff. Significant improvement was shown in two variables of a possible 60 at school A and in four variables at school B. Analysis by subgroups, however, demonstrated improvements in merely one variable at school B. It is evident that the innovative curriculum did not induce significant behavioural improvement in relation to health. Frame factors of the school--obligatory student participation and teacher role perception--may explain this outcome.

Adolescent↗

PubMed1988

Pregnant women's attitudes and knowledge in relation to access to serum-alpha-fetoprotein test.

Serum-Alpha-Fetoprotein (se-AFP) screening is a controversial issue in Sweden. In some areas the test has never been offered, in others it is routinely offered to all pregnant women and there are areas where the se-AFP test has been offered but is no longer available but for very special indications. This pseudoexperimental situation was used to analyze the effects of different information environments on attitudes to and knowledge of testing procedures at the antenatal clinics, especially the se-AFP test, and anxiety of malformations. Consecutive series of pregnant women in these three areas filled in questionnaires at their first visit, in the 22nd to 24th, and the 32nd to 35th weeks of pregnancy, and after delivery. The attitudes to prenatal screening were most positive in the routine screening area and most negative in the area which previously but no longer offers the test. The level of knowledge was somewhat higher in the routine screening area at the first visit to the clinic and increased substantially, especially in the routine screening area.

Anxiety↗

PubMed1988

Pregnant women's attitudes for accepting or declining a serum-alpha-fetoprotein test.

This study analyzes attitudes which influence women in their decisions to accept or decline a serum-Alpha-FetoProtein (se-AFP) test. The survey covers all women who have visited antenatal clinics offering the se-AFP test in a given area during a specified period. All in all, the pregnant women answered four questionnaires: three before and one after delivery. 19% of the women declined the se-AFP test. During pregnancy, the women who did not take the se-AFP test said that the reason was anxiety about the results of the test. Many of the women who took the test said that they wanted assurance that the child was healthy. This entails obvious ethical problems when the test is positive. The test-routine does not have a major influence in the decision-making process. A change in routines to shorten the waiting time, and a different cut-off line might influence some of the declining women to accept the test.

Anxiety↗

PubMed1988

Prognosis in alcoholic rehabilitation: the relative significance of social, psychological, and medical factors.

The aim was to elucidate the relative importance of a wide range of patient characteristics (social, psychological, and medical factors) in prediction of alcoholic posttreatment functioning. The development of working capacity was recorded for 34 advanced alcoholics during 2 years subsequent to rehabilitation. The results indicated that external social characteristics, psychiatric symptoms, and alcohol-related medical symptoms were almost insignificant as predictors. However, two groups of significant psychological factors emerged (loneliness-low self-esteem, together with indolence-lassitude). The few social predictors indicated that the way of using alcohol (more extraverted and observable) was associated with a negative prognosis.

Adaptation, Psychological↗

PubMed1987