Jörgen Månsson | Göteborg University (original) (raw)
Papers by Jörgen Månsson
Primary Care Respiratory Journal, 2009
To evaluate the feasibility of a lifestyle program for early intervention in patients with COPD i... more To evaluate the feasibility of a lifestyle program for early intervention in patients with COPD in a primary care population. The study was performed in a Primary Health Care Centre in Western Sweden. During a four-week period, all smokers between 40-70 years of age were invited to answer a questionnaire and to perform spirometry. The intervention program included a specially designed smoking cessation program and programs for physical activity and diet. 84 smokers were included. 42% fulfilled the criteria for COPD. All of the COPD patients were in GOLD stage I and II. Among the COPD subjects, 38% were underweight and 56% had a low fat-free mass - both together indicating malnutrition and the need for nutritional treatment. By the end of the intervention program, 47% of the COPD patients had stopped smoking. The intervention program was feasible and effective with a very high smoking cessation rate.
Scandinavian Journal of Primary Health Care, 2006
To calculate total cost of investigating symptoms related to one of the four most common cancers:... more To calculate total cost of investigating symptoms related to one of the four most common cancers: prostate, breast, colorectal, and pulmonary. Special attention was given to two non-specific and common symptoms: vertigo/dizziness and tiredness/fatigue. Retrospective examination of patient records in a defined population. Primary health care (PHC) and hospital care. Investigation costs of selected ICD codes. In total 6812 patients with 14,541 ICD codes were investigated to a total cost per registered ICD code, with one of the selected diagnostic measures, of SEK 800. Some 50% of the costs were due to X-ray examinations of which colonic X-ray was the most expensive single procedure. Symptoms related to colorectal cancer were the most expensive to investigate with vertigo/dizziness and tiredness/fatigue examined separately. Tiredness/fatigue symptoms cost SEK 395 and vertigo/dizziness SEK 197 per registered code to investigate and none of them yielded a detected malignancy. The incidence of cancer was 0.7%. The average cost of diagnosing one malignancy was SEK 236,700, if all diagnostic activities could be justified only for detection of malignancies. A high cost of diagnosing malignancy can be expected and justified, but many symptoms presented in PHC, such as tiredness/fatigue and vertigo/dizziness, have a relatively high investigation cost but detected no case of cancer in this study.
Scandinavian Journal of Primary Health Care, 2007
To investigate quality of life, measured by the SF-36 scales, in a population-based sample of wom... more 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. A representative cohort of women was observed over 24 years with regard to cancer prevalence, incidence, and quality of life. Gothenburg, Sweden. A total of 1462 women aged 38-60 years at baseline. 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. 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. 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.
Scandinavian Journal of Primary Health Care, 2004
To evaluate prerequisites, practicalities, attitudes and limitations related to the collection of... more 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. Prospective study. Primary health care centres in south-western Sweden. Fourteen participating general practitioners in five primary health care centres. 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. 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. 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.
Scandinavian Journal of Primary Health Care, 2005
Objective. To study symptom panorama in students, to identify undiagnosed iron deficiency, and to... more 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.
Public Health, 2007
To find predictive factors for long-term sick leave (SL) and disability pension (DP) among freque... more To find predictive factors for long-term sick leave (SL) and disability pension (DP) among frequent attenders (FAs) and normal attenders (NAs) in primary health care. A cohort study with follow-up over 5 years. Groups of FAs and NAs were followed over 5 years. Information about background, situation, sociodemography, life events, social support and sense of coherence were gathered at baseline. Multiple logistic regression analysis was used to determine the influence of each variable on long-term SL and receipt of a DP. During the study period, 18.9% of FAs received long-term SL/DP compared with 6% of NAs. Chronic disease was a predictive factor for long-term SL/DP among FAs [odds ratio (OR) 7.0] and NAs (OR 3.4). Among FAs, a life event was also a predictive factor (OR 2.1). Each additional life event increased the ratio of FAs with long-term SL/DP by 110%. Conflicts and losses had the greatest negative effects on FAs. FAs are a high-risk group for long-term SL/DP. Besides chronic disease, a life event was the only predictive factor for long-term SL/DP among FAs. These findings indicate that FAs are a vulnerable group for stressful events. Consequently, healthcare personnel should take more notice of life events among FAs.
Primary Health Care Research & Development, 2008
Background: Statistics from primary health care in Sweden, as well as from other Nordic countries... more Background: Statistics from primary health care in Sweden, as well as from other Nordic countries, have been sparse. The electronic patient records (EPR) will be an increasingly important source of clinical information. The aim of this ...
Patient Education and Counseling, 1999
Avoiding patient's and doctor's delay is important for the detection of cancer. I... more Avoiding patient's and doctor's delay is important for the detection of cancer. In order to study the possibilities for shortening the delay, without causing anxiety, an educational programme for early detection of cancer (EPEDC) was worked out, aimed to be evaluated at the community level. A community with 77,100 inhabitants, was informed about cancer symptoms in a letter. Participants who observed the cancer symptoms, described in the letter, were invited to visit the health centres, where they were interviewed and examined according to a specially designed schedule. Guidelines for taking care of these participants were also worked out. Fifteen previously unknown cancers were detected. By means of a telephone interview and a questionnaire the reactions to the EPEDC were studied. The results indicate that it is possible to inform and educate the population about cancer symptoms without causing anxiety on condition that there is an organisation which can be contacted without delay by subjects with potential cancer symptoms.
Palliative and Supportive Care, 2014
Breathlessness is a subjective symptom, which makes it difficult to define and understand. The ai... more Breathlessness is a subjective symptom, which makes it difficult to define and understand. The aim of the present study was to illuminate how patients suffering from breathlessness experience their everyday life. The study was a qualitative study, and the focus of the analysis was the patients' descriptions of their experiences of breathlessness using a diary with two unstructured questions for a period of 7 consecutive days. Sixteen participants: 7 men, mean age 65 ± 7 (range 55-73 years old), and 9 women, mean age 65 ± 9 (range 50-72 years old) participated in the study. Two themes emerged from the analysis: 1) Impaired quality of life and 2) symptom tolerance and adaptation. The theme "impaired quality of life" included the categories limited physical ability, psychological burdens, and social life barriers. The theme "symptom tolerance and adaptation" included importance of health care, social support, hobbies and leisure activities, and coping strategies. The findings in our study showed that patients, in spite of considerable difficulties with shortness of breath, found relief in several types of activities, in addition to drug therapy. The result indicates that the "biopsychosocial model" is an appealing approach that should be discussed further to gain a better understanding of breathlessness.
Musculoskeletal Care, 2007
To evaluate a new multidisciplinary structured home training programme for patients with lateral ... more To evaluate a new multidisciplinary structured home training programme for patients with lateral epicondylitis compared to conventional attendance. This study utilized a prospective non-randomized design to compare the effect of a home exercise programme against a pragmatic approach to managing patients with lateral epicondylitis in a primary care setting in Sweden. A total of 78 patients, presenting to their general practitioner with lateral epicondylitis were recruited from two separate geographical areas. The patients were divided into two group, 51 entered the intervention group and 27 entered the control group. The intervention group was treated with a specific home training programme, ergonomic advice and when necessary wrist and/or night bandages. The control group was treated with conventional treatment, e.g. corticosteroid injections, stretching or no intervention. Pain and function were evaluated by the PRFEQ. An electronic hand-power gauge measured strength and stamina. Sick-leave absence was collected via the regional Social Insurance Office. After four weeks the intervention group experienced less sick-leave, less pain, better function and returned to work earlier than the control group. After 16 weeks the intervention group still had significantly better function than the control group and were taking less sick-leave. Pain decreased more in the intervention group but this was not significant. There was no difference in grip strength between the two groups. A structured home training programme can improve function and reduce sick leave in patients with lateral epicondylitis.
Lung Cancer, 1994
IIldcellIlmg-,themlio-modalityi8chemotherapy, unnbii with early thoracic radiation therapy for pa... more IIldcellIlmg-,themlio-modalityi8chemotherapy, unnbii with early thoracic radiation therapy for patients with limited diseasee. The precocity of the rwponse after initiating multimodality beatment is the mia prognosis tbctor. Patients with very limited small cell lung cancer (TNM stage I and II) can be managed by surgery. Association with colony stimulating factors can I-the severity of oeutmpenicandinfectiousepiscdee. Themleofmaintenancetherapyby alpha interfemo in cliically disease tiw patients is suggwted. Recent adv-in diagnosis and treatment of small ceil and nonsmnllcelllungcancar Sorensen JB, Hansen HH. Oncol 1994;6: 162-70.
Journal of Rehabilitation Medicine, 2005
Objective: To identify predictive factors for work capacity in patients with musculoskeletal diso... more 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 patient's 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.
European Journal of General Practice, 2011
To investigate reasons for encounters, investigations, referrals, diagnoses and treatments in eve... more 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. Four Swedish primary care centres using EPR participated. Distributions of symptoms, investigations, diagnoses and prescribed drugs were registered. 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. 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.
Disability and Rehabilitation, 2011
The main aim of this study was to describe the thoughts and feelings of future working life relat... more The main aim of this study was to describe the thoughts and feelings of future working life related to return to work (RTW) in sick-listed persons due to musculoskeletal disorders (MSD). Further aim was to compare these descriptions with the person's actual working situation 1, 5 and 10 years after a rehabilitation period. This study consisted of two parts. The first part had an explorative design, and qualitative content analysis was chosen in order to analyse the response to an open question regarding future working life answered before, persons sick-listed due to MSD (n = 320), took part in a rehabilitation programme 10 years ago. The second part had a prospective design and quantitative analysis was used to compare the results of the qualitative analysis with RTW and the working situation 1, 5 and 10 years after baseline. Three categories emerged from the data with a total of nine subcategories. In the categories Motivation and optimism and Limitations to overcome, there were significantly more persons who had RTW 1 year after baseline when compared with the category Hindrance and hesitation. There were also some significant differences between the subcategories. The question, regarding thoughts and feelings of future working life, may be a simple screening method to predict RTW in persons sick-listed with MSD. This will guide the rehabilitation team to adjust the rehabilitation to each person's needs and facilitating RTW.
Disability and Rehabilitation, 2011
The aim of this study was to compare psychosocial factors between healthy persons and sick-listed... more 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. 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. 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. 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 person's physical condition and workplace related problems, as well as psychosocial factors, is of great importance for the person and for society.
The Canadian Journal of Hospital Pharmacy, 2012
Acute exacerbation of chronic obstructive pulmonary disease (COPD) is associated with an accelera... more Acute exacerbation of chronic obstructive pulmonary disease (COPD) is associated with an accelerated decline in lung function and a significant decrease in health status. Maintenance therapy with respiratory medications can reduce the risk of such exacerbations. To determine whether respiratory maintenance medications were being prescribed in accordance with the 2007 COPD guidelines of the Canadian Thoracic Society for patients admitted to hospital for acute exacerbation of COPD. A chart review was conducted for admissions to the Centre hospitalier universitaire de Sherbrooke, in Sherbrooke, Quebec, for acute exacerbation of COPD (according to diagnostic codes in the International Statistical Classification of Diseases and Related Health Problems, 10th revision) between January 1, 2008, and January 31, 2011. Data were extracted from patients' medical charts concerning respiratory medications prescribed before the admission, during the hospital stay, and at discharge. A total of 846 hospital admissions involving 561 patients were reviewed. In almost 70% of admissions for which data were available on respiratory medications prescribed before the admission, during the hospital stay, and at discharge (238/341 [69.8%]), a combination of 3 medications was prescribed at discharge: tiotropium, a long-acting ß(2) agonist, and an inhaled corticosteroid. For more than 80% of the admissions, a prescription for at least one inhaled long-acting bronchodilator was documented both on admission and at discharge. Few patients had a prescription for inhaled corticosteroid without long-acting ß(2) agonist, but the number of admissions with a prescription for regular use of systemic corticosteroids increased at discharge. Respiratory medications were generally prescribed in accordance with Canadian COPD guidelines, but improvements could be made regarding use of the combination of tiotropium, long-acting ß(2)agonist, and inhaled corticosteroid, as well as long-term use of systemic corticosteroids.
BMC Musculoskeletal Disorders, 2008
In Sweden, as well as in Scandinavia, there is no easy way to evaluate patients&a... more In Sweden, as well as in Scandinavia, there is no easy way to evaluate patients' difficulties when they suffer from lateral epicondylitis/epicondylalgia. However, there is a Canadian questionnaire, in English, that could make the evaluation of a patient's pain and functional loss both quick and inexpensive. Therefore, the aim of this study was to translate and cross-culturally adapt the questionnaire "Patient-rated Tennis Elbow Evaluation" into Swedish (PRTEE-S; "Patientskattad Utvärdering av Tennisarmbåge"), and to evaluate the reliability and validity of the test. The Patient-rated Tennis Elbow Evaluation was cross-culturally adapted for the Swedish language according to well-established guidelines. Fifty-four patients with unilateral epicondylitis/epicondylalgia were assessed using the PRTEE-S (Patientskattad Utvärdering av Tennisarmbåge), the Disabilities of Arm, Shoulder, and Hand questionnaire, and the Roles & Maudsley score to establish the validity and reliability of the PRTEE-S. Reliability was determined via calculation of the intra-class correlation coefficient (ICC) the internal consistency was assessed by Cronbach's alpha, and validity was calculated using Spearman's correlation coefficient. The test-retest reliability, using the PRTEE-S (Patientskattad Utvärdering av Tennisarmbåge) intraclass correlation coefficient, was 0.95 and the internal consistency was 0.94. The PRTEE-S correlated well with the Disabilities of the Arm, Shoulder, and Hand questionnaire (r = 0.88) and the Roles & Maudsley score (r = 0.78). The PRTEE-S (Patientskattad Utvärdering av Tennisarmbåge) represents a reliable and valid instrument to evaluate the subjective outcome in Swedish speaking patients with lateral epicondylitis/epicondylalgia, and can be used in both research and clinical settings.
Scandinavian Journal of Occupational Therapy, 2012
To evaluate whether patients with lateral epicondylalgia had less pain or function loss two years... more To evaluate whether patients with lateral epicondylalgia had less pain or function loss two years following treatment by a structured programme and if the number of recurrent episodes and sick leave days differed compared with a control group. All of the patients were diagnosed by a physician with the diagnosis code M77.1 (lateral epicondylitis). The intervention group (n = 103) was treated by a physiotherapist and an occupational therapist with a home training programme that included ergonomic advice. Wrist supports and/or night bandages were also available. Controls (n = 194) were diversely treated by different professionals. In the total study group (n = 297), 54% of the patients experienced pain and 55% experienced function loss after two years. The intervention group had less pain than patients treated with corticosteroid injections (p < 0.0001) or NSAIDs (p = 0.048) and experienced better function than those treated with corticosteroid injections (p = 0.002). The intervention group had a lower recurrence (p < 0.0001) and fewer sick leave days at the time of the visit to the health care centre (p = 0.005). A structured treatment programme was more effective than corticosteroid injections and NSAIDs. Patients did not require additional treatment or sick leave and had learned self-treatment of the disorder.
Primary Care Respiratory Journal, 2009
To evaluate the feasibility of a lifestyle program for early intervention in patients with COPD i... more To evaluate the feasibility of a lifestyle program for early intervention in patients with COPD in a primary care population. The study was performed in a Primary Health Care Centre in Western Sweden. During a four-week period, all smokers between 40-70 years of age were invited to answer a questionnaire and to perform spirometry. The intervention program included a specially designed smoking cessation program and programs for physical activity and diet. 84 smokers were included. 42% fulfilled the criteria for COPD. All of the COPD patients were in GOLD stage I and II. Among the COPD subjects, 38% were underweight and 56% had a low fat-free mass - both together indicating malnutrition and the need for nutritional treatment. By the end of the intervention program, 47% of the COPD patients had stopped smoking. The intervention program was feasible and effective with a very high smoking cessation rate.
Scandinavian Journal of Primary Health Care, 2006
To calculate total cost of investigating symptoms related to one of the four most common cancers:... more To calculate total cost of investigating symptoms related to one of the four most common cancers: prostate, breast, colorectal, and pulmonary. Special attention was given to two non-specific and common symptoms: vertigo/dizziness and tiredness/fatigue. Retrospective examination of patient records in a defined population. Primary health care (PHC) and hospital care. Investigation costs of selected ICD codes. In total 6812 patients with 14,541 ICD codes were investigated to a total cost per registered ICD code, with one of the selected diagnostic measures, of SEK 800. Some 50% of the costs were due to X-ray examinations of which colonic X-ray was the most expensive single procedure. Symptoms related to colorectal cancer were the most expensive to investigate with vertigo/dizziness and tiredness/fatigue examined separately. Tiredness/fatigue symptoms cost SEK 395 and vertigo/dizziness SEK 197 per registered code to investigate and none of them yielded a detected malignancy. The incidence of cancer was 0.7%. The average cost of diagnosing one malignancy was SEK 236,700, if all diagnostic activities could be justified only for detection of malignancies. A high cost of diagnosing malignancy can be expected and justified, but many symptoms presented in PHC, such as tiredness/fatigue and vertigo/dizziness, have a relatively high investigation cost but detected no case of cancer in this study.
Scandinavian Journal of Primary Health Care, 2007
To investigate quality of life, measured by the SF-36 scales, in a population-based sample of wom... more 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. A representative cohort of women was observed over 24 years with regard to cancer prevalence, incidence, and quality of life. Gothenburg, Sweden. A total of 1462 women aged 38-60 years at baseline. 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. 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. 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.
Scandinavian Journal of Primary Health Care, 2004
To evaluate prerequisites, practicalities, attitudes and limitations related to the collection of... more 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. Prospective study. Primary health care centres in south-western Sweden. Fourteen participating general practitioners in five primary health care centres. 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. 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. 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.
Scandinavian Journal of Primary Health Care, 2005
Objective. To study symptom panorama in students, to identify undiagnosed iron deficiency, and to... more 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.
Public Health, 2007
To find predictive factors for long-term sick leave (SL) and disability pension (DP) among freque... more To find predictive factors for long-term sick leave (SL) and disability pension (DP) among frequent attenders (FAs) and normal attenders (NAs) in primary health care. A cohort study with follow-up over 5 years. Groups of FAs and NAs were followed over 5 years. Information about background, situation, sociodemography, life events, social support and sense of coherence were gathered at baseline. Multiple logistic regression analysis was used to determine the influence of each variable on long-term SL and receipt of a DP. During the study period, 18.9% of FAs received long-term SL/DP compared with 6% of NAs. Chronic disease was a predictive factor for long-term SL/DP among FAs [odds ratio (OR) 7.0] and NAs (OR 3.4). Among FAs, a life event was also a predictive factor (OR 2.1). Each additional life event increased the ratio of FAs with long-term SL/DP by 110%. Conflicts and losses had the greatest negative effects on FAs. FAs are a high-risk group for long-term SL/DP. Besides chronic disease, a life event was the only predictive factor for long-term SL/DP among FAs. These findings indicate that FAs are a vulnerable group for stressful events. Consequently, healthcare personnel should take more notice of life events among FAs.
Primary Health Care Research & Development, 2008
Background: Statistics from primary health care in Sweden, as well as from other Nordic countries... more Background: Statistics from primary health care in Sweden, as well as from other Nordic countries, have been sparse. The electronic patient records (EPR) will be an increasingly important source of clinical information. The aim of this ...
Patient Education and Counseling, 1999
Avoiding patient's and doctor's delay is important for the detection of cancer. I... more Avoiding patient's and doctor's delay is important for the detection of cancer. In order to study the possibilities for shortening the delay, without causing anxiety, an educational programme for early detection of cancer (EPEDC) was worked out, aimed to be evaluated at the community level. A community with 77,100 inhabitants, was informed about cancer symptoms in a letter. Participants who observed the cancer symptoms, described in the letter, were invited to visit the health centres, where they were interviewed and examined according to a specially designed schedule. Guidelines for taking care of these participants were also worked out. Fifteen previously unknown cancers were detected. By means of a telephone interview and a questionnaire the reactions to the EPEDC were studied. The results indicate that it is possible to inform and educate the population about cancer symptoms without causing anxiety on condition that there is an organisation which can be contacted without delay by subjects with potential cancer symptoms.
Palliative and Supportive Care, 2014
Breathlessness is a subjective symptom, which makes it difficult to define and understand. The ai... more Breathlessness is a subjective symptom, which makes it difficult to define and understand. The aim of the present study was to illuminate how patients suffering from breathlessness experience their everyday life. The study was a qualitative study, and the focus of the analysis was the patients' descriptions of their experiences of breathlessness using a diary with two unstructured questions for a period of 7 consecutive days. Sixteen participants: 7 men, mean age 65 ± 7 (range 55-73 years old), and 9 women, mean age 65 ± 9 (range 50-72 years old) participated in the study. Two themes emerged from the analysis: 1) Impaired quality of life and 2) symptom tolerance and adaptation. The theme "impaired quality of life" included the categories limited physical ability, psychological burdens, and social life barriers. The theme "symptom tolerance and adaptation" included importance of health care, social support, hobbies and leisure activities, and coping strategies. The findings in our study showed that patients, in spite of considerable difficulties with shortness of breath, found relief in several types of activities, in addition to drug therapy. The result indicates that the "biopsychosocial model" is an appealing approach that should be discussed further to gain a better understanding of breathlessness.
Musculoskeletal Care, 2007
To evaluate a new multidisciplinary structured home training programme for patients with lateral ... more To evaluate a new multidisciplinary structured home training programme for patients with lateral epicondylitis compared to conventional attendance. This study utilized a prospective non-randomized design to compare the effect of a home exercise programme against a pragmatic approach to managing patients with lateral epicondylitis in a primary care setting in Sweden. A total of 78 patients, presenting to their general practitioner with lateral epicondylitis were recruited from two separate geographical areas. The patients were divided into two group, 51 entered the intervention group and 27 entered the control group. The intervention group was treated with a specific home training programme, ergonomic advice and when necessary wrist and/or night bandages. The control group was treated with conventional treatment, e.g. corticosteroid injections, stretching or no intervention. Pain and function were evaluated by the PRFEQ. An electronic hand-power gauge measured strength and stamina. Sick-leave absence was collected via the regional Social Insurance Office. After four weeks the intervention group experienced less sick-leave, less pain, better function and returned to work earlier than the control group. After 16 weeks the intervention group still had significantly better function than the control group and were taking less sick-leave. Pain decreased more in the intervention group but this was not significant. There was no difference in grip strength between the two groups. A structured home training programme can improve function and reduce sick leave in patients with lateral epicondylitis.
Lung Cancer, 1994
IIldcellIlmg-,themlio-modalityi8chemotherapy, unnbii with early thoracic radiation therapy for pa... more IIldcellIlmg-,themlio-modalityi8chemotherapy, unnbii with early thoracic radiation therapy for patients with limited diseasee. The precocity of the rwponse after initiating multimodality beatment is the mia prognosis tbctor. Patients with very limited small cell lung cancer (TNM stage I and II) can be managed by surgery. Association with colony stimulating factors can I-the severity of oeutmpenicandinfectiousepiscdee. Themleofmaintenancetherapyby alpha interfemo in cliically disease tiw patients is suggwted. Recent adv-in diagnosis and treatment of small ceil and nonsmnllcelllungcancar Sorensen JB, Hansen HH. Oncol 1994;6: 162-70.
Journal of Rehabilitation Medicine, 2005
Objective: To identify predictive factors for work capacity in patients with musculoskeletal diso... more 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 patient's 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.
European Journal of General Practice, 2011
To investigate reasons for encounters, investigations, referrals, diagnoses and treatments in eve... more 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. Four Swedish primary care centres using EPR participated. Distributions of symptoms, investigations, diagnoses and prescribed drugs were registered. 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. 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.
Disability and Rehabilitation, 2011
The main aim of this study was to describe the thoughts and feelings of future working life relat... more The main aim of this study was to describe the thoughts and feelings of future working life related to return to work (RTW) in sick-listed persons due to musculoskeletal disorders (MSD). Further aim was to compare these descriptions with the person's actual working situation 1, 5 and 10 years after a rehabilitation period. This study consisted of two parts. The first part had an explorative design, and qualitative content analysis was chosen in order to analyse the response to an open question regarding future working life answered before, persons sick-listed due to MSD (n = 320), took part in a rehabilitation programme 10 years ago. The second part had a prospective design and quantitative analysis was used to compare the results of the qualitative analysis with RTW and the working situation 1, 5 and 10 years after baseline. Three categories emerged from the data with a total of nine subcategories. In the categories Motivation and optimism and Limitations to overcome, there were significantly more persons who had RTW 1 year after baseline when compared with the category Hindrance and hesitation. There were also some significant differences between the subcategories. The question, regarding thoughts and feelings of future working life, may be a simple screening method to predict RTW in persons sick-listed with MSD. This will guide the rehabilitation team to adjust the rehabilitation to each person's needs and facilitating RTW.
Disability and Rehabilitation, 2011
The aim of this study was to compare psychosocial factors between healthy persons and sick-listed... more 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. 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. 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. 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 person's physical condition and workplace related problems, as well as psychosocial factors, is of great importance for the person and for society.
The Canadian Journal of Hospital Pharmacy, 2012
Acute exacerbation of chronic obstructive pulmonary disease (COPD) is associated with an accelera... more Acute exacerbation of chronic obstructive pulmonary disease (COPD) is associated with an accelerated decline in lung function and a significant decrease in health status. Maintenance therapy with respiratory medications can reduce the risk of such exacerbations. To determine whether respiratory maintenance medications were being prescribed in accordance with the 2007 COPD guidelines of the Canadian Thoracic Society for patients admitted to hospital for acute exacerbation of COPD. A chart review was conducted for admissions to the Centre hospitalier universitaire de Sherbrooke, in Sherbrooke, Quebec, for acute exacerbation of COPD (according to diagnostic codes in the International Statistical Classification of Diseases and Related Health Problems, 10th revision) between January 1, 2008, and January 31, 2011. Data were extracted from patients' medical charts concerning respiratory medications prescribed before the admission, during the hospital stay, and at discharge. A total of 846 hospital admissions involving 561 patients were reviewed. In almost 70% of admissions for which data were available on respiratory medications prescribed before the admission, during the hospital stay, and at discharge (238/341 [69.8%]), a combination of 3 medications was prescribed at discharge: tiotropium, a long-acting ß(2) agonist, and an inhaled corticosteroid. For more than 80% of the admissions, a prescription for at least one inhaled long-acting bronchodilator was documented both on admission and at discharge. Few patients had a prescription for inhaled corticosteroid without long-acting ß(2) agonist, but the number of admissions with a prescription for regular use of systemic corticosteroids increased at discharge. Respiratory medications were generally prescribed in accordance with Canadian COPD guidelines, but improvements could be made regarding use of the combination of tiotropium, long-acting ß(2)agonist, and inhaled corticosteroid, as well as long-term use of systemic corticosteroids.
BMC Musculoskeletal Disorders, 2008
In Sweden, as well as in Scandinavia, there is no easy way to evaluate patients&a... more In Sweden, as well as in Scandinavia, there is no easy way to evaluate patients' difficulties when they suffer from lateral epicondylitis/epicondylalgia. However, there is a Canadian questionnaire, in English, that could make the evaluation of a patient's pain and functional loss both quick and inexpensive. Therefore, the aim of this study was to translate and cross-culturally adapt the questionnaire "Patient-rated Tennis Elbow Evaluation" into Swedish (PRTEE-S; "Patientskattad Utvärdering av Tennisarmbåge"), and to evaluate the reliability and validity of the test. The Patient-rated Tennis Elbow Evaluation was cross-culturally adapted for the Swedish language according to well-established guidelines. Fifty-four patients with unilateral epicondylitis/epicondylalgia were assessed using the PRTEE-S (Patientskattad Utvärdering av Tennisarmbåge), the Disabilities of Arm, Shoulder, and Hand questionnaire, and the Roles & Maudsley score to establish the validity and reliability of the PRTEE-S. Reliability was determined via calculation of the intra-class correlation coefficient (ICC) the internal consistency was assessed by Cronbach's alpha, and validity was calculated using Spearman's correlation coefficient. The test-retest reliability, using the PRTEE-S (Patientskattad Utvärdering av Tennisarmbåge) intraclass correlation coefficient, was 0.95 and the internal consistency was 0.94. The PRTEE-S correlated well with the Disabilities of the Arm, Shoulder, and Hand questionnaire (r = 0.88) and the Roles & Maudsley score (r = 0.78). The PRTEE-S (Patientskattad Utvärdering av Tennisarmbåge) represents a reliable and valid instrument to evaluate the subjective outcome in Swedish speaking patients with lateral epicondylitis/epicondylalgia, and can be used in both research and clinical settings.
Scandinavian Journal of Occupational Therapy, 2012
To evaluate whether patients with lateral epicondylalgia had less pain or function loss two years... more To evaluate whether patients with lateral epicondylalgia had less pain or function loss two years following treatment by a structured programme and if the number of recurrent episodes and sick leave days differed compared with a control group. All of the patients were diagnosed by a physician with the diagnosis code M77.1 (lateral epicondylitis). The intervention group (n = 103) was treated by a physiotherapist and an occupational therapist with a home training programme that included ergonomic advice. Wrist supports and/or night bandages were also available. Controls (n = 194) were diversely treated by different professionals. In the total study group (n = 297), 54% of the patients experienced pain and 55% experienced function loss after two years. The intervention group had less pain than patients treated with corticosteroid injections (p < 0.0001) or NSAIDs (p = 0.048) and experienced better function than those treated with corticosteroid injections (p = 0.002). The intervention group had a lower recurrence (p < 0.0001) and fewer sick leave days at the time of the visit to the health care centre (p = 0.005). A structured treatment programme was more effective than corticosteroid injections and NSAIDs. Patients did not require additional treatment or sick leave and had learned self-treatment of the disorder.