Håkan Bergh

Characteristics of frequent attenders in different age and sex groups in primary health care.

Little is known about the characteristics of frequent attenders within different age bands and sex groups. Frequent attenders have an age and sex-specific morbidity. They have a higher consulting frequency for most medical problems and a significantly higher consumption of antibiotics than other patients. Objective r - r To compare frequent attenders in different age and sex groups with a control group according to characteristics and use of primary health care. Design r - r Descriptive study of medical records. Setting r - r Primary health care centre. Subjects r - r 341 frequent attenders, divided by age and sex, were compared with 1025 controls from the same area. Main outcome measures r - r Consultation rate, diagnoses, prescribed medicine, referrals and certificates of illness during one year. Results r - r Frequent attenders constituted 3.3% of the population but accounted for 25% of all visits to the GP and 44% of all illness certificates allocated. They were given more antibiotic prescriptions and consulted the GP more often for most medical problems. Frequent attenders had a morbidity, with a preponderance of infections at a young age, musculoskeletal and respiratory problems in middle age, and, among the oldest, circulatory, endocrine and musculoskeletal diseases. Conclusion r - r Frequent attenders had a morbidity within different ages similar to that of the controls, but also a higher consulting frequency for most medical problems and a significantly higher consumption of antibiotics. Are frequent attenders more vulnerable individuals and more prone to all kinds of diseases, or do they just consult more often for the usual medical problems?

Impact of a six-month empowerment-based exercise intervention programme in non-physically active adolescent Swedish girls

Objective: This study evaluated changes in self-efficacy in non-physically active adolescent girls (13–19 years old) who participated in a six-month, empowerment-based exercise intervention programme (EIP). Design: The study used a pre- and post-test randomized group design and included one pre- and one post-test (at six months) and non-physically active adolescent girls (N = 110) were assigned to an intervention group (n = 54) or a comparison group (n = 56). Setting: Two upper secondary schools and five secondary schools, located in the low socio-economic areas of two communities in southern Sweden were involved in the study. Method: The Swedish version of a 10-item General Self-efficacy Scale (GSES) and the Social Barriers to Exercise Self-efficacy Questionnaire (SPBESQ) were used. In addition, BMI and results from a physical fitness test were measured. For statistical analysis, the Mann-Whitney U-test and the Wilcoxon’s matched-pairs signed-rank test were used. Results: Analysis showed a statistically significant difference in GSES scores (p = 0.037) between the groups after the EIP was implemented. Girls in the intervention group had increased their levels of general perceived self-efficacy (p = 0.004). Both groups increased their level of physical fitness (intervention, p = 0.06 and control, p = 0.013). BMI increased in the control group (p = 0.031). Conclusions: The EIP had an impact on adolescent girls’ general perceived self-efficacy and can be regarded as an outcome of empowerment that indicates the development of the adolescent girls’ ability to effectively deal with a variety of stressful situations in general.

Sublingual varices in relation to smoking and cardiovascular diseases

The purpose of this study was to investigate the relation between sublingual varices, cardiovascular disease (CVD), and smoking. We studied 281 patients over 40 years old in this observational clinical study. During a dental check up visit, sublingual varices were sought on the lateral border of the tongue. Results were classified into two groups: grade 0 (few or none) and grade 1 (moderate or severe). Information about CVD and smoking was obtained from the patients and recorded. Multiple logistic regression analysis was used to assess the influence of particular variables on the incidence of sublingual varices. The presence and number of varices increased with increasing age, and the overall incidence was 98/281 (35%). Fifty-one of the patients were smokers (18%) and 45 (16%) had CVD, usually hypertension. Sublingual varices were significantly associated with age (odds ratio (OR) 1.1), smoking (OR 2.4), and CVD (OR 2.7).

In the shadow of the welfare society ill-health and symptoms, psychological exposure and lifestyle habits among social security recipients: a national survey study

BackgroundIn Sweden social security is a means-tested financial allowance. The Social Services Act states that an individual is entitled to financial support when his/her needs are not met in any other way. The aim of the present study was to analyse the prevalence and impact of various illness factors and symptoms in social security recipients compared to non-recipients in a welfare state, in this case Sweden.MethodsA simple random sample of 20 100 individuals was selected from a national survey that covered all individuals in the 18–84 year age group in Sweden. A postal survey was thereafter conducted. Multiple logistic regression was employed as a statistical test. Odds ratio (OR) and a 95% confidence interval (CI) was used.ResultsSocial security recipients were found to have a significantly higher risk in most of the studied variables. Reduced psychological wellbeing measured by means of the GHQ12 was significantly higher in this group compared to the rest of the population (OR 1.41 CI 1.03–1.94) and their lack of trust was greater (OR 1.96, CI 1.45–2.66). They reported more sleep disturbances (OR 2.16, CI 1.58–2.94) and suffered from anxiety (OR 1.74, CI 1.28–2.36). Their dental health was worse (OR 2.44, CI 1.82–3.28) and they had more pain in their hands and legs (OR 1.57, CI 1.16–2.12). Social security recipients were more often humiliated (OR 1.79, CI 1.31–2.44) and exposed to threat (OR 1.69, CI 1.09–2.61). They were less physically active (OR 1.56, CI 1.17–2.08), had a poorer diet (OR 1.95, CI 1.45–2.63) and were more often smokers (OR 3.20, CI 2.37–4.33).ImplicationThe challenge for the welfare state consists of recognising the significance of both structural and lifestyle factors as a means of reducing the health gap.

The outcome of two-step blood pressure screening in dental healthcare

Aim: The purpose of this study was to evaluate a two-step screening method for hypertension in dentistry regarding the number needed to screen (NNS) and positive predictive value (PPV) and to risk-classify those with newly diagnosed hypertension. Methods: In connection with their regular dental care check-up, 2025 subjects aged 40–75 years were screened for high blood pressure. Via a health questionnaire, data were collected concerning risk factors. Blood pressure was screened comprehensively in two steps, which included screening in a dental clinic and home measurements for one week. Recently discovered hypertensive participants were assessed for 10-year risk of cardiovascular mortality according to the guidelines of the European Society of Hypertension (ESH) and the European Society of Cardiology (ESC). Results: A total of 170 new hypertensive participants were found (NNS = 12; 95% confidence interval (CI): 11–13). The method yielded a PPV of 0.73 (95% CI: 0.68–0.78) and eliminated 84.8% of the false-positive participants. The results also showed that based on ESH/ESC risk estimation, 76.5% of those newly diagnosed hypertensive participants had a moderate or high risk of cardiovascular mortality within 10 years. Conclusions: The study shows that a two-step method for blood pressure screening in a dental setting including home measurement resulted in a high PPV and eliminated most of those with a false high blood pressure reading. The findings also show that two-step screening for hypertension is feasible in a larger population with more screening providers involved.

A home-based method for the detection of impaired glucose tolerance in hypertensive primary care patients.

Abstract Objective. The aim of this project was to compare an oral glucose tolerance test (OGTT) partly performed in the patients home (OGTTh) with a clinic-obtained OGTT with regard to the ability of the tests to identify patients with impaired glucose tolerance (IGT) and type 2 diabetes mellitus (DM-2). Design. A method comparison. Setting. The study was completed at two primary health care centres. Subjects. Fifty-one patients with hypertension aged 50–79 years completed both OGTT tests. Main outcome measures. Values for capillary P-glucose obtained two hours after a glucose load were compared between the two OGTT tests. Fasting plasma glucose (fP-glucose) and HbA1c were also measured. Results. Thirty-seven patients were classified in the same group (normal/IGT/DM-2) by the two tests. The index of validity based on the tests ability to identify normal or pathological values (≥ 8.9 mmol/l) was 0.75. The value for kappa was 0.66 with a sensitivity of 0.54 and a specificity of 0.82. Conclusion. OGTTh may be a useful screening method for IGT in risk groups such as hypertensive patients.