Aase Aamland | Uni Research (original) (raw)

Papers by Aase Aamland

Research paper thumbnail of Patients with persistent medically unexplained physical symptoms: a descriptive study from Norwegian general practice

BMC Family Practice, 2014

Background: Further research on effective interventions for patients with peristent Medically Une... more Background: Further research on effective interventions for patients with peristent Medically Unexplained Physical Symptoms (MUPS) in general practice is needed. Prevalence estimates of such patients are conflicting, and other descriptive knowledge is needed for development and evaluation of effective future interventions. In this study, we aimed to estimate the consultation prevalence of patients with persistent MUPS in general practice, including patients' characteristics and symptom pattern, employment status and use of social benefits, and the general practitioners' (GPs) management strategy. Method: During a four-week period the participating Norwegian GPs (n = 84) registered all consultations with patients who met a strict definition of MUPS (>3 months duration and function loss), using a questionnaire with simple tick-off questions. Analyses were performed with descriptive statistics for all variables and split analysis on gender and age.

Research paper thumbnail of Explaining symptoms after negative tests: towards a rational explanation

Journal of the Royal Society of Medicine, Jan 11, 2014

Research paper thumbnail of Salt restriction among hypertensive patients: Modest blood pressure effect and no adverse effects

Scandinavian Journal of Primary Health Care, 2009

Objective. Previous studies, mainly evaluating short-term very low salt diets, suggest that salt ... more Objective. Previous studies, mainly evaluating short-term very low salt diets, suggest that salt restriction may influence glucose and insulin metabolism, catecholamines, renin, aldosterone, and lipid levels adversely. The authors wanted to explore whether sodium restriction for eight weeks influenced insulin secretion unfavourably, and evaluate the efficacy and safety of such treatment also in terms of other parameters important in the management of hypertensive patients. Design. A double-blind randomized controlled parallel group designed trial. All participants received dietary advice aimed at a moderate salt-restricted diet. Half of the participants received salt capsules, the others received identical placebo capsules. Setting. General practice. Subjects. Forty-six hypertensive patients inadequately controlled by drug treatment. Main outcome measures. Fasting serum insulin C-peptide and glucose and levels of these measures after oral glucose, blood pressure, serum aldosterone and lipids, peripheral resistance, and skin conductance. Results. Salt restriction did not influence glucose and insulin metabolism, aldosterone, or lipid levels adversely. We observed better blood pressure regulation in the low salt group than in the high salt group, with a systolic and diastolic blood pressure difference of 5/5 mmHg after eight weeks. The difference was only statistically significant for diastolic blood pressure, p 0.02. Conclusion. This study revealed a modest diastolic blood pressure reducing effect of moderate sodium restriction. This reduction was obtained without any apparent unfavourable side effects such as increased insulin secretion, impaired glucose tolerance or dyslipidaemia.

Research paper thumbnail of Sickness absence, marginality, and medically unexplained physical symptoms: A focus-group study of patients’ experiences

Scandinavian Journal of Primary Health Care, 2013

Purpose . Medically unexplained physical symptoms (MUPS) form a major cause of sickness absence. ... more Purpose . Medically unexplained physical symptoms (MUPS) form a major cause of sickness absence. The purpose of this study was to explore factors which may infl uence further marginalization among patients with MUPS on long-term sickness absence. Methods . Two focus-group discussions were conducted with a purposive sample of 12 participants, six men and six women, aged 24 -59 years. Their average duration of sickness absence was 10.5 months. Participants were invited to share stories about experiences from the process leading to the ongoing sickness absence, with a focus on the causes being medically unexplained. Systematic text condensation was applied for analysis. Inspired by theories of marginalization and coping, the authors searched for knowledge of how patients ' positive resources can be mobilized to counteract processes of marginality. Results . Analysis revealed how invisible symptoms and lack of objective fi ndings were perceived as an additional burden to the sickness absence itself. Factors that could counteract further marginalization were a supportive social network, positive coping strategies such as keeping to the daily schedule and physical activity, and positive attention and confi dence from professionals. Conclusions . Confi dence from both personal and professional contacts is crucial. GPs have an important and appreciated role in this aspect.

Research paper thumbnail of Phenomena associated with sick leave among primary care patients with Medically Unexplained Physical Symptoms: A systematic review

Scandinavian Journal of Primary Health Care, 2012

To explore and synthesize the literature on phenomena associated with sick leave among patients w... more To explore and synthesize the literature on phenomena associated with sick leave among patients with Medically Unexplained Physical Symptoms (MUPS). A systematic review of the literature was undertaken in three phases: (1) a search of the following databases: Medline, Embase, Psych Info, Cochrane Collaboration Library, Digital Dissertations, DiVA, SweMed +, NORART, and ISI Web of Science, (2) selection of studies based on pre-specified inclusion criteria was undertaken, extracting study design and results, (3) quality assessment was undertaken independently by two reviewers. Due to heterogeneity in study designs, populations, interventions, and outcome measures, a mixed research synthesis approach was used. Results were assessed in a pragmatic and descriptive way; textual and numerical data were extracted from the included studies, and classified into patient- and doctor-related factors. Sixteen studies were included. With regard to patients, an association was found between sick leave and psychiatric comorbidity as well as total symptom burden. With regard to doctors, knowledge of the patient, sympathy, and trust appeared to increase the probability of the patient being sick-listed. None of the interventions in the educational programmes aiming to improve doctors' management of MUPS patients succeeded in lowering sick leave. Despite MUPS being a leading cause of sickness absence, the review identified only a small number of studies concerning phenomena associated with sick leave. The authors did not identify any studies regarding the impact of the working conditions on sick leave among MUPS patients. This is an important area for further studies.

Research paper thumbnail of Patients with persistent medically unexplained physical symptoms: a descriptive study from Norwegian general practice

BMC Family Practice, 2014

Background: Further research on effective interventions for patients with peristent Medically Une... more Background: Further research on effective interventions for patients with peristent Medically Unexplained Physical Symptoms (MUPS) in general practice is needed. Prevalence estimates of such patients are conflicting, and other descriptive knowledge is needed for development and evaluation of effective future interventions. In this study, we aimed to estimate the consultation prevalence of patients with persistent MUPS in general practice, including patients' characteristics and symptom pattern, employment status and use of social benefits, and the general practitioners' (GPs) management strategy. Method: During a four-week period the participating Norwegian GPs (n = 84) registered all consultations with patients who met a strict definition of MUPS (>3 months duration and function loss), using a questionnaire with simple tick-off questions. Analyses were performed with descriptive statistics for all variables and split analysis on gender and age.

Research paper thumbnail of Explaining symptoms after negative tests: towards a rational explanation

Journal of the Royal Society of Medicine, Jan 11, 2014

Research paper thumbnail of Salt restriction among hypertensive patients: Modest blood pressure effect and no adverse effects

Scandinavian Journal of Primary Health Care, 2009

Objective. Previous studies, mainly evaluating short-term very low salt diets, suggest that salt ... more Objective. Previous studies, mainly evaluating short-term very low salt diets, suggest that salt restriction may influence glucose and insulin metabolism, catecholamines, renin, aldosterone, and lipid levels adversely. The authors wanted to explore whether sodium restriction for eight weeks influenced insulin secretion unfavourably, and evaluate the efficacy and safety of such treatment also in terms of other parameters important in the management of hypertensive patients. Design. A double-blind randomized controlled parallel group designed trial. All participants received dietary advice aimed at a moderate salt-restricted diet. Half of the participants received salt capsules, the others received identical placebo capsules. Setting. General practice. Subjects. Forty-six hypertensive patients inadequately controlled by drug treatment. Main outcome measures. Fasting serum insulin C-peptide and glucose and levels of these measures after oral glucose, blood pressure, serum aldosterone and lipids, peripheral resistance, and skin conductance. Results. Salt restriction did not influence glucose and insulin metabolism, aldosterone, or lipid levels adversely. We observed better blood pressure regulation in the low salt group than in the high salt group, with a systolic and diastolic blood pressure difference of 5/5 mmHg after eight weeks. The difference was only statistically significant for diastolic blood pressure, p 0.02. Conclusion. This study revealed a modest diastolic blood pressure reducing effect of moderate sodium restriction. This reduction was obtained without any apparent unfavourable side effects such as increased insulin secretion, impaired glucose tolerance or dyslipidaemia.

Research paper thumbnail of Sickness absence, marginality, and medically unexplained physical symptoms: A focus-group study of patients’ experiences

Scandinavian Journal of Primary Health Care, 2013

Purpose . Medically unexplained physical symptoms (MUPS) form a major cause of sickness absence. ... more Purpose . Medically unexplained physical symptoms (MUPS) form a major cause of sickness absence. The purpose of this study was to explore factors which may infl uence further marginalization among patients with MUPS on long-term sickness absence. Methods . Two focus-group discussions were conducted with a purposive sample of 12 participants, six men and six women, aged 24 -59 years. Their average duration of sickness absence was 10.5 months. Participants were invited to share stories about experiences from the process leading to the ongoing sickness absence, with a focus on the causes being medically unexplained. Systematic text condensation was applied for analysis. Inspired by theories of marginalization and coping, the authors searched for knowledge of how patients ' positive resources can be mobilized to counteract processes of marginality. Results . Analysis revealed how invisible symptoms and lack of objective fi ndings were perceived as an additional burden to the sickness absence itself. Factors that could counteract further marginalization were a supportive social network, positive coping strategies such as keeping to the daily schedule and physical activity, and positive attention and confi dence from professionals. Conclusions . Confi dence from both personal and professional contacts is crucial. GPs have an important and appreciated role in this aspect.

Research paper thumbnail of Phenomena associated with sick leave among primary care patients with Medically Unexplained Physical Symptoms: A systematic review

Scandinavian Journal of Primary Health Care, 2012

To explore and synthesize the literature on phenomena associated with sick leave among patients w... more To explore and synthesize the literature on phenomena associated with sick leave among patients with Medically Unexplained Physical Symptoms (MUPS). A systematic review of the literature was undertaken in three phases: (1) a search of the following databases: Medline, Embase, Psych Info, Cochrane Collaboration Library, Digital Dissertations, DiVA, SweMed +, NORART, and ISI Web of Science, (2) selection of studies based on pre-specified inclusion criteria was undertaken, extracting study design and results, (3) quality assessment was undertaken independently by two reviewers. Due to heterogeneity in study designs, populations, interventions, and outcome measures, a mixed research synthesis approach was used. Results were assessed in a pragmatic and descriptive way; textual and numerical data were extracted from the included studies, and classified into patient- and doctor-related factors. Sixteen studies were included. With regard to patients, an association was found between sick leave and psychiatric comorbidity as well as total symptom burden. With regard to doctors, knowledge of the patient, sympathy, and trust appeared to increase the probability of the patient being sick-listed. None of the interventions in the educational programmes aiming to improve doctors' management of MUPS patients succeeded in lowering sick leave. Despite MUPS being a leading cause of sickness absence, the review identified only a small number of studies concerning phenomena associated with sick leave. The authors did not identify any studies regarding the impact of the working conditions on sick leave among MUPS patients. This is an important area for further studies.