Anders Håkansson

Smoking during pregnancy: comparison of self-reports and cotinine levels in 496 women

Objective. To validate self‐reported smoking habits in smoking pregnant women and estimate the prevalence of substantial exposure to passive smoking in non‐smoking pregnant women.

Which women stop smoking?, A population-based study of 403 pregnant smokers

OBJECTIVE To describe, in detail, the smoking cessation process during pregnancy, and to find out which women are most and least successful at reducing or giving up smoking. DESIGN Prospective, population-based study. SETTING All antenatal clinics in Kronoberg County in southern Sweden. SUBJECTS Four hundred and three women, smoking at the time of conception, and registered for antenatal care in the period June 1993 to September 1994. MAIN OUTCOME MEASURES Self-reported number of cigarettes smoked per day and percentage of smoking women in different weeks of pregnancy. Noted by midwives on special forms. RESULTS At the time of registration at the antenatal clinic, the proportion of smoking women had fallen from 100% to 76%, and at the postpartum check-up, the proportion had fallen further to 56%. For the women still smoking, the mean number of smoked cigarettes per day fell from 14.1 before the pregnancy, to 8.6 in week 12, and 6.3 in week 40, and then rose to 9.5 after the pregnancy. Heavy smokers and women with smoking partners continued smoking to a greater extent, as did multiparae and women in unqualified jobs. CONCLUSION The individual anti-smoking advice given during pregnancy should be aimed primarily at these risk groups, and the partner should be involved in the womans attempt to cease smoking. There is much left to be done at the antenatal clinic, as more than half of the women were still smoking a few months after pregnancy.

Benign Paroxysmal Positional Vertigo among Elderly Patients in Primary Health Care

Background:Dizziness influences well-being in old age, and benign paroxysmal positional vertigo (BPPV) is a common cause. The condition is diagnosed using the Hallpike maneuver and treated by the particle-repositioning maneuver or habituation exercises. Objective:To identify patients with BPPV among a variety of diagnoses represented by the ICD-10 diagnosis R42 in people 65 aged years and older who visited primary health care because of vertigo and dizziness. Methods:Searches were performed in the computerized medical records of 6 different health care centers over the period of 1 year for the ICD-10 diagnosis R42 and the age group 65 years and older. Letters were sent to the patients identified with an invitation for assessment and physical examination by a physiotherapist. Thirty-eight patients responded to the letter and were included in the study. All patients were assessed by physical examination including the Hallpike maneuver. Results: The study group included 13 men and 25 women, 65–94 (median 83) years of age. After physical examination, 15 patients were found to have BPPV (confidence interval 24–55%). Conclusion:In this study, 2 of 5 of the patients with ICD-10 diagnosis R42 (dizziness and giddiness) had BPPV. BPPV is probably an underestimated cause of dizziness/vertigo among elderly patients in primary health care.

Wound management for 287 patients with chronic leg ulcers demands 12 full-time nurses Leg ulcer epidemiology and care in a well-defined population in southern Sweden

Objective - To study the prevalence, aetiology and treatment of chronic leg and foot ulcers, and to estimate the nurses time in wound management. Design - A structured questionnaire with 19 questions about chronic ulcers and wound management was sent to all district and community nurses in the county during 1 week in March 1998. A similar questionnaire has been administered regularly since 1986. Setting - Primary and community care in the county of Blekinge, Sweden, with a population of 151 610. Patients - 287 patients with chronic leg and foot ulcers were identified during the week studied. Main outcome measures - Prevalence of leg and foot ulcers, ulcer aetiology, treatment of ulcers and wound management time. Results - The estimated prevalence of chronic leg and foot ulcers was 0.19%. Venous ulcers were the most common (38%), of which 87% were treated with some form of compression therapy. Seven percent of the nurses workload was devoted to ulcer care. During the period 1986 to 1998, ulcers with missing or unknown aetiology decreased from 31% to 6% and ulcers with a duration of more than 2 years from 44% to 27%, while treatment time per ulcer decreased from 2.1 to 1.7 hours/week. Conclusion ? Monitoring standards for ulcer aetiology through repeated questionnaires seems to ensure more accurate diagnoses. Thorough and detailed information about treatment time documents the workload for wound management.

Deceased, disabled or depressed--a population-based 6-year follow-up study of elderly people with depression.

Abstract.The prognosis of depression in elderly people is reported as poor, with high mortality and high rate of non-recovery. The aim of this study was to investigate the outcome after 6 years in a broader perspective. In addition to the risk of dying, we also estimated the risk of moving to long-term care, and having a depression in a re-screening event after 6 years.In 1993, a screening event for depressive symptoms using the Hopkins Symptom Checklist (HSCL-25) was carried out on 1215 subjects aged 65 years and older living in a health care district in Karlstad, Sweden. The study population was divided into a high score, a low score and a dropout group. A re-screening of the same population was carried out in 1999. Logistic regression analysis was used for calculating odds ratios for the selected end-points adjusted for age, gender, civil status and occurrence of physical illness. The adjusted odds ratios for dying for the high score group were 2.5 (95% CI 1.5–4.4) and for any of the end-points 6.1 (95% CI 3.5–10.8) compared with the low score group. Nearly three-quarters of the subjects in the high score group were deceased, depressed or had moved to long-term care after 6 years.The prognosis was poor for depressed elderly people despite not having more physical illness. It is believed that the poor outcome is due to an additive effect of depression on the total medical disease burden.

Prescribing, prescription costs and adherence to formulary committee recommendations: long-term differences between physicians in public and private care

Abstract. Background: In southern Sweden, many general practitioners (GPs) participate in an extensive postgraduate drug education programme, and many health centres are also fed back crude local drug statistics from pharmacists in the area. Private physicians and hospital physicians have not participated in these programmes. Objective: The drug prescribing habits and costs of GPs, hospital physicians and private physicians were compared. Methods: Each March, from 1990 to 1997, all prescriptions dispensed at the eight pharmacies in Växjö, a city and municipality in southern Sweden, were registered, specifying drug(s) prescribed, price, patients age, sex and area of residence, and prescribers place of work and category. Results: Overall, the costs of prescribed drugs increased with time, even in 1997 when the prescribing volume was reduced due to changes in the reimbursement system. The cost increase was caused by increased prescribing of newer, more expensive drug alternatives. However, within each of the eleven major drug groups, the drugs prescribed by GPs were less expensive than those prescribed by hospital physicians and, particularly, private physicians. Moreover, even though GPs prescribed more and a wider range of drugs, they also had a higher degree of adherence to the recommendations by the formulary committee. Conclusion: GPs prescribed less expensive drugs and had a higher degree of adherence to the recommendations by the formulary committee than other categories of physicians. One reason for these differences may be that the GPs participated in regional and local educational activities aimed at the rationalisation of drug prescribing.

Pinch grafting of chronic leg ulcers in primary care: Fourteen years' experience

Pinch grafting for treatment of chronic leg ulcers has been evaluated mainly in hospitalized and immobilized patients. This study describes the results of 199 pinch graft operations of 126 chronic leg and foot ulcers in 85 patients in primary care between 1987 and 2001. The aetiology of the ulcers was venous insufficiency in 43% and multi-factorial in 25% (77% with venous insufficiency as the main determinant). The mean ulcer size was 13.5 cm2 and the mean ulcer duration was 15.9 months. The overall healing rate within 3 months was 33%, ranging from 19% for multi-factorial or combined venous and arterial ulcers to 48% for venous ulcers. Within 12 months the overall healing rate was 60%, with 67% healed venous ulcers. The results from our study suggest that pinch grafting is suitable for treating chronic leg ulcers, especially venous ulcers, in primary care.

Pinch grafting of leg ulcers in primary care

Treatment of chronic leg ulcers consumes considerable primary care resources. For the patient, it often entails restrictions in everyday life. This study describes the results of 84 skin transplantations on 45 patients with 55 ulcerated limbs, using the pinch graft technique, performed in primary care from 1987-1993. The healing rate after 12 weeks for venous ulcers was 45%, and for neuropathic ulcers 44%. Venous ulcers represented 56% of all the ulcers, while 16% were neuropathic. One year postoperatively, 47% (19/40) of examined ulcers remained healed. The results from our study suggest that venous and neuropathic ulcers may be particularly well suited for skin transplantation, which can easily be performed in primary care.

Characteristics of primary amphetamine users in Sweden: a criminal justice population examined with the Addiction Severity Index.

Background/Aims: Characteristics of primary amphetamine, heroin and cocaine users were compared in a criminal justice population. Methods: 7,085 clients with suspected or reported substance use were studied using the Addiction Severity Index. Variables separating amphetamine, heroin and cocaine users were analyzed in stepwise logistic regression. Results: There were considerably more primary amphetamine users (n = 1,396) than heroin (n = 392) and cocaine (n = 119) users. Amphetamine users were older, a more rural population, and less likely to be non-Nordic immigrants. Compared with heroin, amphetamine use was associated with older age, Nordic origin, nonurban residence, memory/concentration problems, parental alcohol problems, and less history of other opioid use, overdose and detoxification. Compared with cocaine, amphetamine use was associated with older age, Nordic origin, nonurban residence, injecting, tobacco and institution treatment. Overlap of drug use between groups was relatively uncommon. Conclusion: This pattern of amphetamine use, common among Swedish criminals, has relatively distinct boundaries from heroin and cocaine use, commonly involves injecting, and differs from other countries. Psychiatric problems and alcohol heredity were common, and evidence-based treatment for amphetamine users is needed. The connection between amphetamine use and criminal behavior is insufficiently understood and should be further addressed.

Post-traumatic stress associated with low self-rated well-being in primary care attenders

In this study, we assessed the prevalence of self-rated post-traumatic stress in relation to reported trauma in an unselected primary care population. A total of 1113 out of 1378 consecutive attenders (response rate 81%) to 10 health centres completed the self-report instruments Impact of Event Scale (IES), and Post Traumatic Symptom Scale (PTSS-10). A horizontal visual analogue scale (VAS; 0–100 mm) resembling the EuroQoL (quality of life) health barometer was used for evaluating well-being. Trauma was reported by 325 attenders (29.2%) when applying DSM-IV trauma criteria. Prevalence of possible post-traumatic stress disorder (PTSD) was 6.5% (n=72) using cut-off scores of >35 for IES and >5 for PTSS-10. The two most common traumas in the PTSD group were accidents (2.0%, n=22), followed by cancer (1.3%, n=15). When excluding diseases and unspecified death as trauma, the rate of possible PTSD was 3.5% (n=39). Mean VAS–QoL score was 39.6 mm in the PTSD group (n=72), and 64.7 mm in the non-PTSD group with a reported trauma (n=253). In a multiple logistic regression analysis low self-rated well-being showed the strongest association with possible PTSD, followed by sexual assault, female gender, immigrant status and less than 2 years since trauma.