Jörgen Månsson

Cerebrospinal fluid monoamine metabolites in 114 healthy individuals 18–88 years of age

Concentrations of the monoamine metabolites homovanillic acid (HVA), 5-hydroxy-indoleacetic acid (5-HIAA) and 4-hydroxy-3-methoxyphenylglycol (HMPG) were determined in lumbar cerebrospinal fluid (CSF) of 114 healthy individuals, 18-88 years of age, without histories, symptoms or signs of central nervous system dysfunction. The mean values (+/- SD) were 253 +/- 109 nmol/l for HVA, 125 +/- 54 nmol/l for 5-HIAA, 47 +/- 10 nmol/l for HMPG, and 2.10 +/- 0.52 for the HVA/5-HIAA ratio. Analyses of confounding factors revealed that all metabolites correlated negatively with body height, the values being lower in taller than in shorter individuals. This is probably attributable to a larger surface area for monoamine metabolite transport from the subarachnoid space in taller than in shorter individuals. These correlations make statistical adjustment for body height important in analyses of monoamine metabolite levels. Without considering body height, all monoamine metabolites showed a positive correlation with age, and higher levels of HVA and 5-HIAA were found in women than men. After statistical adjustment for the influence of body height, no differences in CSF monoamine metabolites levels were found between the sexes, and only 5-HIAA showed a positive correlation with age. There were no significant seasonal variations for any of the monoamine metabolites.

PREDICTIVE FACTORS FOR WORK CAPACITY IN PATIENTS WITH MUSCULOSKELETAL DISORDERS

OBJECTIVE To identify predictive factors for work capacity in patients with musculoskeletal disorders. DESIGN A descriptive, evaluative, quantitative study. SUBJECTS/PATIENTS The study was based on 385 patients who participated in a rehabilitation programme. METHODS Patients were divided into 2 groups depending on their ability to work. The groups were compared with each other with regard to sociodemographic factors, diagnoses, disability pension and number of sick days. The patients level of exercise habits, ability to undertake activities, physical capacity, pain and quality of life were compared further using logistic regression analysis. RESULTS Predictive factors for work capacity, such as ability to undertake activities, quality of life and fitness on exercise, were identified as important independent factors. Other well-known factors, i.e. gender, age, education, pain and earlier sickness certification periods, were also identified. Factors that were not significantly different between the groups were employment status, profession, diagnosis and levels of exercise habits. CONCLUSION Identifying predictors for ability to return to work is an essential task for deciding on suitable individual rehabilitation. This study identified new predictive factors, such as ability to undertake activities, quality of life and fitness on exercise.

Collection and retrieval of structured clinical data from electronic patient records in general practice. A first-phase study to create a health care database for research and quality assessment.

Objective To evaluate prerequisites, practicalities, attitudes and limitations related to the collection of structured clinical data in everyday general practice for use in the future establishment of a national registration network. Design Prospective study. Setting Primary health care centres in south-western Sweden. Subjects Fourteen participating general practitioners in five primary health care centres. Main outcome measures Feasibility and workload involved in structured data entry and in the retrieval of data from different record systems. The accuracy of clinical data in terms of clinical variables, correctness and representativeness. Results All four record systems could deliver basic data on the patient population. One centre had to be excluded from further data retrieval because of limitations in the data retrieval export format. Collecting data in everyday practice was feasible with acceptable data accuracy and moderate workload. Conclusion It was feasible to collect, retrieve and store structured clinical data with respect to accuracy and extra workload. Interest in a national registration network and an increasing demand for information about primary health care in order to optimise clinical practices and support research, creates prerequisites for establishing a valid and reliable database. However, developmental work focusing on classification limitations, coding tools and routines for data retrieval is necessary.

Quality of life in cancer survivors as observed in a population study of Swedish women

Objective. To investigate quality of life, measured by the SF-36 scales, in a population-based sample of women who have survived cancer at any site and, specifically, breast cancer. Design. A representative cohort of women was observed over 24 years with regard to cancer prevalence, incidence, and quality of life. Setting. Gothenburg, Sweden. Subjects. A total of 1462 women aged 38–60 years at baseline. Main outcome measures. Differences in quality of life between cancer survivors and cancer-free controls measured by the SF-36 Short Form Health Survey, with adjustment for age and additionally for social status, and history of major disease (diabetes, stroke, and myocardial infarction) at follow-up in 1992–93. Results. In women who had survived cancer, a lower feeling of general health was the only score found to be significantly associated with having had cancer. Similar analysis was conducted separately for breast cancer cases. Survivors of breast cancer reported lower vitality and when controlled for major disease also lower general health compared with women who had not had cancer. All other results were independent when adjusted for social status, and also for history of major disease. Conclusions. Women who have survived cancer report lowered general health, and breast cancer cases lowered vitality, but considering the non-significant results for the other scores and summary scales it can be concluded that the well-being of women who have survived a cancer on the whole did not differ profoundly from that of other women.

Management of chronic obstructive pulmonary disease (COPD) in primary care: a questionnaire survey in western Sweden

AIM To assess the primary care management of chronic obstructive pulmonary disease (COPD) in relation to COPD guidelines. METHOD A postal questionnaire was sent out to all Primary Health Care Centres (PHCCs) in western Sweden (n=232). The response rate was 75%. RESULTS A majority of the PHCCs had a nurse and physician responsible for COPD care. They used spirometry equipment regularly, but only 50% reported that they calibrated it at least weekly. Less than 30% of the PHCCs reported access to a dietician, occupational therapist or physiotherapist. There was a structured smoking cessation program in 50% of the PHCCs. Larger PHCCs were more likely to use spirometry equipment regularly and to have specific personnel for COPD care. CONCLUSION There is a need to establish structured programs for COPD care including smoking cessation programs for COPD patients with special trained staff. Larger PHCCs have a better infrastructure for providing guideline-defined COPD care.

Reasons for encounters, investigations, referrals, diagnoses and treatments in general practice in Sweden—a multicentre pilot study using electronic patient records

Abstract Objective: To investigate reasons for encounters, investigations, referrals, diagnoses and treatments in everyday general practice, using electronic patient records (EPR), and possible related differences concerning gender, socio-economic status (SES) and practice location. Method: Four Swedish primary care centres using EPR participated. Distributions of symptoms, investigations, diagnoses and prescribed drugs were registered. Results: In 1055 encounters, the mean patient age was 53; 59% were women. The most common reasons for the encounter were musculoskeletal (21.5%) and respiratory (15.2%) symptoms. A total of 1534 diagnoses were coded, on average 1.5 per encounter. The predominant diagnostic groups, i.e. ICD-10 chapters, were musculoskeletal (17.2%) and respiratory (12.4%). The most common specific diagnoses were essential hypertension (8.1%) and acute upper respiratory infections (3.7%). A total of 1687 prescriptions were issued, on average 1.6 per encounter. The most frequent pharmaceutical groups were nervous (17.7%), respiratory system (16.2%), and cardiovascular (15.7%). The most frequent drugs were phenoxymethyl penicillin (3.7%), diclofenac (2.9%) and acetylsalicylic acid (2.5%). An average of 1.3 laboratory tests was performed per encounter. In 7.5% of encounters, radiology referrals were made; in 12.3% referrals were made to other specialists/therapists, while sick-list certificates were written in 11.7%. There were significant differences concerning symptoms, diagnoses and investigations between female and male patients, urban and rural practices and SES. Conclusion: The musculoskeletal, respiratory and circulatory systems predominated, both as reasons for the encounter and in the diagnoses, but with significant differences concerning gender, SES and practice location.

Return or no return – psychosocial factors related to sick leave in persons with musculoskeletal disorders: a prospective cohort study

Purpose. The aim of this study was to compare psychosocial factors between healthy persons and sick-listed persons with musculoskeletal disorders (MSD); both groups with MSD 10 years ago. Methods. This cohort study was prospective and 385 persons participated in a rehabilitation program 10 years ago, and 354 persons took part in the follow-up. Of these, 243 persons completed a questionnaire. Two groups were included in the study: a healthy group (not sick-listed) (n = 112) and a sick-listed group (n = 74). Psychosocial factors related to sick leave were compared between the groups. Results. In the 10-year follow-up, the healthy group showed a significantly higher quality of life, more control over the working situation, better sense of coherence and unexpectedly more life events. There was no significant difference in social integration and emotional support between the groups. Conclusions. Using the knowledge about the characteristics of the healthy group, adequate rehabilitation for every sick-listed person with a musculoskeletal disorder can be given and therefore facilitate the returning to work process. A multidimensional approach taking into account a persons physical condition and workplace related problems, as well as psychosocial factors, is of great importance for the person and for society.

Symptom panorama in upper secondary school students and symptoms related to iron deficiency Screening with laboratory tests, questionnaire and interventional treatment with iron

Objective To study symptom panorama in students, to identify undiagnosed iron deficiency, and to evaluate any changes in symptoms and laboratory test results after treatment with iron supplementation. Design Descriptive and prospective, interventional study. Setting Healthcare in upper secondary school. Intervention Treatment with iron supplementation for a period of 3 months. Subjects Students in the first grade of one upper secondary school. Main outcome measures Frequency of iron deficiency related to symptoms measured by a questionnaire (30 questions) on symptoms related to quality of life and 9 questions about diet and exercise. Results Iron deficiency was diagnosed in 12% of the students (two or more abnormal laboratory tests) and in 61% of the students one or more laboratory tests were abnormal. Symptoms of vertigo/dizziness were significantly more common in students with iron deficiency. After iron supplementation there was a significant increase in s-ferritin levels and a decrease in s-transferrin levels, with an accompanying significant reduction of the symptom scores of vertigo/dizziness, irritability, depressive symptoms, and indisposition. Conclusions Symptoms of vertigo/dizziness were significantly more common in students with iron deficiency. Iron supplementation reduced the symptoms of vertigo/dizziness, irritability, depressive symptoms, and indisposition.

Pulmonary cancer from the general practitioner's point of view: Experience from the health centre area of Kungsbacka, Sweden

OBJECTIVE To study the incidence of pulmonary cancer in a community with special reference to the diagnostic process and the role of the general practitioner. DESIGN Study of the records of all patients within the community with pulmonary cancer reported to the Swedish Cancer Registry during the years 1980-1984. SETTING The community of Kungsbacka in southwestern Sweden with about 48,000 inhabitants. PARTICIPANTS 40 subjects with pulmonary cancer. OUTCOME MEASURES Incidence, main symptoms, level of care, doctor delay, survival rate. RESULTS The incidence was 16 per 100,000 per year. Most patients first visited a general practitioner. Most common initial symptom was cough. Mean doctor delay was 12.5 weeks. The five-year mortality rate was 95%. CONCLUSION The high mortality emphasizes the importance of an early diagnosis. The general practitioners are very important in the diagnostic process.

The diagnosis of colorectal cancer--experiences from the community of Kungsbacka, Sweden.

In the community of Kungsbacka, Sweden, with about 48,000 inhabitants, all subjects with colorectal cancer were studied during a three-year period. The incidence was 30 per 100,000 inhabitants per year. In all there were 42 cases. Blood in the stools, anaemia, tiredness, and dizziness were common initial signs and symptoms. Diarrhoea and constipation were also rather frequent. Positive test for faecal occult blood was observed in 40%, negative tests in 12% while in 48% no such test had been performed. The majority of the subjects (64%) first visited a general practitioner (GP). Mean doctors delay was five months. More than half the cancers were located in the rectal or sigmoid area. Subjects in whom no metastases were observed had a favourable prognosis, compared with those with distant metastases. Since most patients with colorectal cancer first visit a GP for their symptoms, the GP has an important role in the diagnosis of colorectal cancer.