Neighborhood, family, and childhood and adolescent epilepsy: A nationwide epidemiological study from Sweden.

To examine whether neighborhood deprivation increases the odds of hospital registration for childhood and adolescent epilepsy, after accounting for family- and individual-level sociodemographic characteristics

Prurigo nodularis - vid svårare symtom kan pregabalin övervägas.

Prurigo nodularis is a pruritic condition characterized by skin noduli. Different treatment options have been used with limited success. Pregabalin is a drug licensed for treatment of neuropathic pain in adults. As prurigo nodularis involves suffering for the patients and is difficult to treat, the aim of this case report is to report the effect of pregabalin treatment in seven patients with prurigo nodularis, treated in the dermatology clinic in Malmö, Sweden. Four patients experienced good effect of pregabalin, though two patients had a transient effect. Side effects of pregabalin have been reported. This case report indicates that pregabalin is a treatment option for therapy-resistant prurigo nodularis; even though one must be aware of that the effect may not be permanent and that there are side effects. The aim must be to use the drug for a limited time, taking the patient to a remission state, where the vicious itch-scratch cycle can be inhibited

Longitudinal age-and cohort trends in body mass index in Sweden - a 24-year follow-up study

Background: The aim of this longitudinal study was to analyze whether mean Body Mass Index (BMI), assessed at four occasions, changed within different age groups and birth cohorts over time, i.e., between 1980/81 and 2004/05, after adjustment for possible confounders. Methods: A sample of 2728 men and 2770 women aged 16-71 years at study start were randomly drawn from the Swedish Total Population Register and followed from 1980/81 to 2004/05. The same sample was assessed on four occasions during the 24-year study period (i.e., every eighth year). The outcome variable, BMI, was based on self-reported height and weight. A mixed model, with random intercept and random slope, was used to estimate annual changes in BMI within the different age groups and birth cohorts. Results: Mean BMI increased from 24.1 to 25.5 for men and from 23.1 to 24.3 for women during the 24-year study period. The annual change by age group was highest in the ages of 32-39, 40-47 and 48-55 years among men, and in the ages of 24-31, 32-39, and 40-47 years among women. The highest annual changes were found in the youngest birth cohorts for both men and women, i.e., those born 1958-65, 1966-73, and 1974-81. For each birth cohort, the annual change in BMI increased compared to the previous, i.e., older, birth cohort. In addition, age-by-cohort interaction tests revealed that the increase in BMI by increasing age was higher in the younger birth cohorts (1966-1989) than in the older ones. Conclusions: Public health policies should target those age groups and birth cohorts with the highest increases in BMI. For example, younger birth cohorts had higher annual increases in BMI than older birth cohorts, which means that younger cohorts increased their BMI more than older ones during the study period

Study protocol: a multi-professional team intervention of physical activity referrals in primary care patients with cardiovascular risk factors-the Dalby lifestyle intervention cohort (DALICO) study

Background: The present study protocol describes the trial design of a primary care intervention cohort study, which examines whether an extended, multi-professional physical activity referral (PAR) intervention is more effective in enhancing and maintaining self-reported physical activity than physical activity prescription in usual care. The study targets patients with newly diagnosed hypertension and/or type 2 diabetes. Secondary outcomes include: need of pharmacological therapy; blood pressure/plasma glucose; physical fitness and anthropometric variables; mental health; health related quality of life; and cost-effectiveness. Methods/Design: The study is designed as a long term intervention. Three primary care centres are involved in the study, each constituting one of three treatment groups: 1) Intervention group (IG): multi-professional team intervention with PAR, 2) Control group A (CA): physical activity prescription in usual care and 3) Control group B: treatment as usual (retrospective data collection). The intervention is based on self-determination theory and follows the principles of motivational interviewing. The primary outcome, physical activity, is measured with the International Physical Activity Questionnaire (IPAQ) and expressed as metabolic equivalent of task (MET)-minutes per week. Physical fitness is estimated with the 6-minute walk test in IG only. Variables such as health behaviours; health-related quality of life; motivation to change; mental health; demographics and socioeconomic characteristics are assessed with an electronic study questionnaire that submits all data to a patient database, which automatically provides feed-back to the health-care providers on the patients' health status. Cost-effectiveness of the intervention is evaluated continuously and the intermediate outcomes of the intervention are extrapolated by economic modelling. Discussions: By helping patients to overcome practical, social and cultural obstacles and increase their internal motivation for physical activity we aim to improve their physical health in a long- term perspective. The targeted patients belong to a patient category that is supposed to benefit from increased physical activity in terms of improved physiological values, mental status and quality of life, decreased risk of complications and maybe a decreased need of medication

Från evidensbaserad medicin till kliniskt kunskapsstöd

Allmänmedicin är ett brett område som spänner över många sjukdomstillstånd, med fokus på patientcentrering. Inom många områden sker en snabb kunskapsutveckling och rekommendationer för utrednings- och behandlingsstrategier uppdateras hela tiden. För en allmänläkare kan det vara svårt att hålla sig uppdaterad och tidsbrist begränsar möjligheterna att leta kunskap i det dagliga kliniska arbetet. Digitalisering och ökande tillgång till information via internet gör att patienter är alltmer pålästa och förberedda. Detta ger dock inte bara adekvat kunskap utan även information som ligger långt från vetenskap och beprövad erfarenhet. Även medarbetaren inom sjukvården riskerar att ta till sig information som inte är faktagranskad. För att kunna förklara för patienten vilken information som är pålitlig, är det av stort värde att kunna hänvisa till information som är kvalitetssäkrad utifrån evidens

Obesity and cardiovascular disease. Aspects of methods and susceptibility.

The aim of this thesis was to study the morbidity and mortality of cardiovascular disease (CVD) in obese individuals, as measured by different obesity measurements, and to explore how the CVD risk related to obesity was modified by other biologic and socio-demographic circumstances. Data from two population-based cohort studies was used. The Malmö Preventive Project included 22 444 middle-aged men, with a mean follow-up of 17.7 years. In a subcohort of 6193 men, information on inflammatory proteins was available. The Malmö Diet and Cancer Study included 28 098 men and women, with a mean follow-up of 7.6 years. National and local registers were used to follow the incidence of coronary events (CE), stroke and mortality. Body mass index (BMI) was an independent risk factor for CE and mortality in men. However, the risk associated with obesity was increased by exposure to other atherosclerotic risk factors (smoking, hypertension, diabetes mellitus and hyperlipidemia), of which smoking seemed to be the most important. Obesity was more prevalent in men with manual work and in men living alone, than in men with non-manual work and in cohabiting men. Adjusted for lifestyle and biological risk factors, the increased risk of CE and death for obese men with manual jobs was applicable only to those who were single. There was a positive interaction between obesity and living alone for incidence of CE. Increased BMI was related to plasma levels of inflammation-sensitive proteins (ISP) in men. The CVD risk varied widely between obese or overweight men with high and low ISP. Body fat percentage (BF%), measured by bioelectrical impedance method, was an independent risk factor for cardiovascular morbidity and mortality in men and women. BF% was a stronger CVD risk factor in women than in men. The raised CVD risk associated with high BF% was reduced by physical activity. Body fat distribution as measured by waist hip ratio (WHR) was associated with increased CVD risk. WHR added to the CVD risk in women at all levels of BMI and in men with normal weight. It is concluded that the susceptibility to CVD in obese people differs substantially according to subsets of other biologic and socio-demographic circumstances

Follow-up and screening for type-2 diabetes mellitus in women with previous gestational diabetes in primary care

ObjectiveGestational diabetes mellitus (GDM) is an established risk factor for developing type 2 diabetes mellitus (T2DM) that is possible to prevent by systematic follow-up and preventive measures. The aim of this study was to examine whether women with previous GDM were offered follow-up in primary care, according to Swedish national guidelines.DesignRetrospective review of electronic medical records.SettingPrimary care in southern Sweden, Skåne county.SubjectsWomen who received a GDM diagnosis in 2018 at the Endocrinology department, Skåne University Hospital in Lund. The study population consisted of a total number of 161 patients, whereof 83 patients were included.Main outcome measuresWhether primary care offered follow-up for T2DM after GDM and if any communication took place between secondary and primary care. Furthermore, it was examined whether the quality of the follow-up was in accordance with the national guidelines.ResultsOf the study population, a total of 29% (n = 24) had been followed-up by primary care. In 55% (n = 46) of the cases, there was no communication between secondary and primary care. Plasma glucose was checked in all (n = 20) cases where follow-up could be evaluated. Conversations about lifestyle habits took place in 70% (n = 14) of the cases. Weight and risk factors for cardiovascular disease were controlled in less than half (n = 9) of the patients. Lifestyle advice was offered in two cases and in 24% (n = 20) of the cases an annual check-up was planned.ConclusionsThe follow-up of women with previous GDM in primary care in southern Sweden was lacking in seven out of 10 cases and showed great potential for improvement.Key PointsGestational diabetes is an established risk factor for developing type 2 diabetes.Earlier research has recognized that risk reduction is possible by systematic follow-up and preventive measures, but the extent of follow-up in primary care in southern Sweden remains unknown.This study demonstrates a lack of follow-up according to national guidelines for women with previous gestational diabetes in primary care in southern Sweden.There is great potential to improve the care of these patients with relatively simple means

Primary care physicians’ knowledge, attitudes and concerns about bariatric surgery and the association with referral patterns : a Swedish survey study

Background: Obesity prevalence is increasing globally. Bariatric surgery is an effective treatment for severe and complex obesity resulting in significant and sustained weight loss. In Sweden, most bariatric surgery patients are referred by primary care physicians. We aimed to explore barriers for physicians to refer patients with severe and complex obesity for bariatric surgery. Methods: A questionnaire survey was in 2019 emailed to 1100 primary care physicians in the Skåne and Kronoberg regions in south Sweden. The survey focused on referral patterns, knowledge and attitudes towards bariatric surgery and concerns about postoperative complications. We created different statistical indices for referral patterns, knowledge, attitudes and concerns about bariatric surgery. To analyze the correlation between these indices, we did Spearman’s correlations and regression analyses. Results: Of 1100 email respondents, we received 157 (14%) completed surveys. Among 157 physician respondents, 73% answered that they had good knowledge about the referral criteria for bariatric surgery, whereas 55 and 60% answered correctly to two items on criteria for bariatric surgery. A majority of respondents (84%) stated that their patients initiated referral to bariatric surgery. Half of the respondents had concerns about postoperative medical and surgical complications, but another half had a positive attitude to bariatric surgery as a treatment for obesity comorbidities. Almost half of the respondents (44%) answered that they needed to learn more about bariatric surgery. We found significant positive correlations between high knowledge and referral patterns (r = 0.292, p < 0.001) and positive attitudes (r = 0.235, p < 0.001) respectively. We found significant reverse correlations between concerns and referral patterns (r = − 0.355, p < 0.001) and between positive attitudes and concerns (r = − 0.294, p < 0.001). In logistic regression high levels of concerns explained low willingness to refer for bariatric surgery (Odds Ratio 0.2, 95% confidence interval 0.1–0.7). Conclusion: According to this Swedish survey among primary care physicians, high levels of concerns about bariatric surgery among physicians seemed to be a barrier to refer patients with severe and complex obesity for bariatric surgery. Since high knowledge about obesity and bariatric surgery correlated negatively to concerns and positively to favorable attitudes to bariatric surgery, more knowledge about obesity and bariatric surgery is warranted