Health-related quality of life in children with objectively diagnosed staple food allergy assessed with a disease-specific questionnaire.

AIM: Among Swedish children of 0-12 years old, we investigated various food allergy-related exposures associated with health-related quality of life using a food allergy-specific questionnaire among children allergic to the staple foods cow's milk, hen's egg and/or wheat, and contextualised worse food allergy-associated health-related quality of life using a generic questionnaire versus controls. METHODS: In total, 85 children with objectively diagnosed allergy to the staple foods were included as cases, and 94 children matched for age and sex were included as controls. We administered a food allergy-specific parent-completed questionnaire originally developed by EuroPrevall to cases only, and a generic health-related quality of life questionnaire (EuroQol Health Questionnaire, 5 Dimensions; EQ 5-D); to both cases and controls. RESULTS: Hen's egg was the most common offending staple food, affecting 76% of cases. Approximately 7% of cases were allergic to all three staple foods. Parent-reported respiratory and cardiovascular symptoms were associated with worse health-related quality of life. Elements of disease severity [previous anaphylaxis (p < 0.001); epinephrine autoinjector prescription (p < 0.003)] were negatively associated with health-related quality of life. Cases had worse health-related quality of life measured by the EQ-5D compared to controls (p < 0.01). CONCLUSION: The use of a disease-specific questionnaire revealed that disease severity in children with objectively diagnosed allergy to the staple foods cow's milk, hen's egg and/or wheat is associated with worse health-related quality of life. The use of a generic questionnaire confirmed that cases have worse health-related quality of life than controls.

Socioeconomic evaluation of well-characterized allergy to staple foods in adults.

BACKGROUND: The aim of the present study was to evaluate if total, direct, indirect, and intangible costs differ between a cohort of adults with well-characterized allergy to staple foods ('cases') and controls. METHODS: Swedish adults with objectively diagnosed food allergy to cow's milk, hen's egg, and/or wheat were recruited at an outpatient allergy clinic. Controls age- and sex-matched to cases were recruited from the same geographic area. For assessing the household costs of food allergy, a disease-specific socioeconomic questionnaire, developed within EuroPrevall, was utilized. RESULTS: Overall annual total costs at the household level were significantly higher among adults with food allergy compared with controls (the difference amounted to 8164 €), whereas direct costs did not differ between cases and controls. However, household healthcare costs and costs for medicines were significantly higher for cases vs controls. Furthermore, indirect costs were significantly higher for households with food-allergic adults vs households without food-allergic adults. Specifically, more time was spent on performing domestic tasks due to a family member's food-allergy-related illness, as well as shopping and preparing food, and seeking food-allergy-related information. Presence of food allergy also affected intangible costs. Adults with food allergy experienced overall lower health status compared with controls. CONCLUSIONS: Swedish adults with allergy to staple foods have higher total costs determined as direct, indirect, and intangible costs using the disease-specific socioeconomic questionnaire. Thus, total costs were 8164 € higher per year in households with at least one adult allergic to staple foods compared with controls.

Assessment of the clinical and economic outcomes of pharmacy interventions in drug-related problems.

BACKGROUND AND OBJECTIVE: Due to drug-related problems (DRPs) that cause both unnecessary suffering and huge costs to society, many patients do not receive the intended beneficial effects of their treatment. Pharmacy practitioners have a key responsibility to respond to these problems, but more knowledge about the expected outcomes of their interventions is needed. The objective of the study was to assess the clinical and economic outcomes of community pharmacy interventions in patient DRPs. METHODS: Drug-related problems in 13 different patient groups were identified and classified, according to the Westerlund System, by pharmacy practitioners from 89 Swedish pharmacies in 2006. The cases were documented in the pharmacy software and transferred to the national DRP database. An assessment model was developed and applied by the researchers (a pharmacist and a physician). This assessment was used to conduct a retrospective review by analysing the DRP and intervention documentation, in particular case descriptions from free text fields. Expected clinical patient outcomes of pharmacy interventions were judged in terms of improved therapeutic effects and prevented or relieved adverse drug reactions (ADRs). The review also assessed the expected patient outcomes with regard to initiated or avoided primary care contacts or avoided hospitalisations. The resulting hypothetically avoided direct societal costs and the estimated pharmacy personnel costs were calculated for the study and extrapolated to the Swedish nationwide level on an annual basis, to demonstrate the potential of national cost savings by pharmacy DRP-interventions. RESULTS AND DISCUSSION: In 358 cases (68%), the pharmacy interventions were judged to have produced an improved therapeutic effect in the patient, and in 172 cases (32%) to have prevented or relieved ADRs. Primary care contacts were initiated for 151 patients (29%), and pharmacy interventions were assessed to have saved 68 (13%) primary care contacts and 16 (3%) future hospitalisations. The potential societal cost savings extrapolated to Sweden at the national level were estimated at euro 358 million. This is 37 times the expected pharmacy personnel costs for identifying and responding to the DRPs. CONCLUSION: Our study demonstrates that community pharmacy interventions in patient DRPs are most likely to lead to favourable clinical and economic outcomes. The convincing cost-benefit ratio should be presented to health care politicians and decision makers to encourage appropriate remuneration for these services.

Social physique anxiety and sociocultural attitudes toward appearance impact on orthorexia test in fitness participants.

This study investigates how scores on the Social Physique Anxiety Scale (SPAS) and the Sociocultural Attitudes Towards Appearance Questionnaire (SATAQ) relate to Bratman's orthorexia test (BOT) scores with regard to age, sex, and self-reported exercise frequency and duration in a sample of Swedish participants in fitness center activities. A total of 251 participants (166 women and 85 men) completed the SPAS, the SATAQ, and a questionnaire focusing on exercise frequency and duration. The results indicated that the SATAQ subdomain internalization could itself explain the variation in BOT results. In women, the results indicated that exercise frequency, followed by SPAS score and the SATAQ subdomains internalization and awareness, could together explain the variation in BOT results. Fitness centers could make a point of emphasizing that some physical ideals are neither healthy nor realistic, thus strengthening member self-image and preventing social physique anxiety, eating disorders, and negative attitudes toward appearance.

Computer-supported telephone nurse triage: an evaluation of medical quality and costs.

AIM: To evaluate a telephone nurse triage model in terms of appropriateness of referrals to the appropriate level of care, patient's compliance with given advice and costs. BACKGROUND: A key concern in each telephonic consultation is to evaluate if appropriate. METHOD: An evaluative design in primary health care with consecutive patients (N = 362) calling telephone nurse triage between November 2002 and February 2003. RESULTS: The advice was considered adequate in 325 (97.6%) cases. The patients' compliance with self-care was 81.3%, to primary health care 91.1% and to Accident and Emergency department 100%. The nurses referred self-care cases (64.7%) and Accident and Emergency cases (29.6%) from a less adequate to an appropriate level of care. The cost saving per call leading to a recommendation of self-care was euro 70.3, to primary health care euro 24.3 and to Accident and Emergency department euro 22.2. CONCLUSIONS: The telephone nurse triage model showed adequate guidance for the patients concerning level of care and released resources for the benefit of both patients and the health care system.

Life events, social support and sense of coherence among frequent attenders in primary health care.

OBJECTIVES: The aim of this survey was to compare stressful life events, social support and sense of coherence (SOC) between frequent attenders (FAs) and normal attenders (controls) in primary health care. STUDY DESIGN: A cross-sectional study was conducted in a primary healthcare centre in the south-west of Sweden. METHODS: A postal questionnaire was sent to 263 frequent attenders and 703 normal attenders. The questionnaire comprised sociodemographic variables and scales of stressful life events, social support and SOC. The results from the questionnaire were compared between the groups, and the significance of the variables in terms of attendance was tested in a multiple regression analysis. RESULTS: More of the FAs were secondarily single, they had more chronic diseases and were more often living on a sickness/disablement pension than the controls. FAs did not report more stressful life events than the controls nor was their experience of events more negative. Social support was as strong among FAs as among controls, and it had no significant effect on their frequent attendance. FAs had a significantly weaker SOC compared with controls. The variables that significantly influenced frequent attendance were high age [odds ratio (OR) = 1.02], chronic disease (OR = 3.08), sickness/disablement pension (OR = 2.46) and SOC (OR = 0.97). CONCLUSIONS: SOC had a significant influence on frequent attendance in primary health care, but stressful life events and social support did not. FAs did not report more stressful life events. However, due to an inadequate coping strategy, indicated by a weak SOC, the life events probably caused them more symptoms and diseases, and thereby a higher consulting frequency.

Cardiovascular mortality focusing on socio-economic influence: the low-risk population of Halland compared to the population of Sweden as a whole.

The aim of the study was to investigate the relationship between mortality from cardiovascular diseases (CVD) and socio-economic status (SES) in Sweden and to estimate to what extent the difference between a province with low mortality and the rest of Sweden was dependent on socio-economic factors. A population-based retrospective study with a historical prospective approach was performed covering a 10-y period in the province of Halland, Sweden, as well as Sweden as a whole. Altogether 1,654,744 men and 1,592,467 women were included, of whom 45,394 men and 43,403 women were from Halland, distributed according to SES. Multivariate analysis with Poisson regression was used. Relative risks with 95% confidence intervals were calculated. Both men and women with a low SES showed a significantly higher risk of death from CVD in Sweden as a whole. The risk was 23% higher for male blue-collar workers and 44% higher for female blue-collar workers when compared to their white-collar counterparts. The level of mortality in Halland was 14% lower compared to the country as a whole when only age was taken into account. When the socio-economic variable was also included, this figure was 8%. The results show the substantial significance of social differences with respect to CVD mortality. The effect of SES seems to be more important than that of geographical conditions when the latter are isolated from socio-economic influence.

Evaluation of a new screening method for detecting peripheral arterial disease in a primary health care population of patients with diabetes mellitus.

AIMS: To compare the ability to detect peripheral arterial disease between the traditional ankle Doppler technique for measuring ankle blood pressure and a new pulse oximetric method for measuring systolic toe pressure, in an unselected primary health care population with diabetes mellitus. METHODS: The total population with the diagnosis diabetes mellitus in two primary health care districts was studied. The population was investigated by means of pulse palpation, ankle Doppler pressure, systolic toe pressure using a pulse oximetric method, arm blood pressures, neuropathy screening and laboratory tests. RESULTS: A total of 126 patients were included in the study. In these patients, 250 extremities were investigated. Systolic ankle Doppler pressure and ankle/arm pressure indices were found to be significantly higher than the pressures and indices achieved with the pulse oximetric method (158 +/- 44 vs. 117 +/- 33 mmHg, P < 0.0001, and 1.02 +/- 0.24 vs. 0.76 +/- 0.22, P < 0.0001). Thirty-one extremities with a systolic toe pressure < 80 mmHg were found. Twenty-one of these lacked a palpable pulse in the dorsal pedial or posterior tibial artery. The pulse oximetric method gave significantly more pathological indices (Doppler index < or = 0.8, pulse oximeter index < or = 0.6) (Doppler 36/250, pulse oximeter 58/250, P = 0.003). However, the Doppler method gave significantly more indices above 1.3 compared with the pulse oximetric method (33/250 vs. 2/250, P = 0.003). CONCLUSION: This study demonstrates that ankle Doppler pressure measurements overestimate peripheral arterial pressure in a typical primary health care population. In the screening situation, this new pulse oximetric toe pressure method seems to be valuable since it can be performed in out-patient clinics and handle large numbers of patients in a short time and avoid the problem of media sclerosis.

Trends in the misuse of androgenic anabolic steroids among boys 16-17 years old in a primary health care area in Sweden.

OBJECTIVE: To evaluate the effects of an appearance programme in preventing the misuse of androgenic anabolic steroids among male adolescents in a primary health care area in Sweden. METHODS: Attitudes to steroid hormones among 16-17 years old male and female adolescents are discussed. A well-established anonymous multiple-choice questionnaire was answered by 921 adolescents and statistically analysed. RESULTS: The misuse of androgenic anabolic steroids tended to decrease after the intervention. CONCLUSIONS: The misuse of androgenic anabolic steroids did not increase, and even tended to decrease, after the intervention, indicating that drug-abuse among male adolescents can be decreased through discussions about appearance and attitudes. Repeat and prospective studies have to be done before this intervention programme can be generalised.

Nonprescription drug-related problems and pharmacy interventions.

OBJECTIVE: To document the number and types of drug-related problems (DRPs) identified in customers purchasing nonprescription products in Swedish pharmacies; describe the distribution of DRPs by customer's gender, age, underlying ailment, and class of drug; determine whether problems are identified to the same extent in pharmacies with staffed nonprescription self-service departments as in pharmacies with over-the-counter sales; and document the number and types of pharmacy interventions to prevent or resolve DRPs, including reasons for drug switches and referrals to physicians. METHODS: A computerized instrument for documentation of DRPs and pharmacy interventions was developed. The study was conducted in 45 volunteer pharmacies in Sweden during 10 weeks in late 1999. RESULTS: A total of 1,425 problems and 2,040 interventions were recorded by 308 pharmacy practitioners. Relatively fewer DRPs were documented in pharmacies with self-service departments. The most common DRPs were uncertainty about the indication for the drug (33.5%) and therapy failure (19.5%). Dyspepsia was the most frequently specified symptom (11.4%). Consumers of dermatologic products had significantly higher rates of problems than expected in relation to sales volume. The most common ways of responding to a problem were with consumer drug counseling (61.1%), switching of drugs (43.9%), and referral to a physician (27.5%). CONCLUSIONS: The study has demonstrated a need for more professional attention and intervention by pharmacy staff to prevent and rectify DRPs in nonprescription consumers. It seems especially important to make sure that consumers receive the appropriate drugs for their current ailments.

The prevalence of the use of androgenic anabolic steroids by adolescents in a county of Sweden.

BACKGROUND: The prevalence of the use of androgenic anabolic steroids has been poorly studied in Europe. This study was undertaken to examine the prevalence of the misuse--the non-medical use--of androgenic anabolic steroids among adolescents in a county of Sweden. METHODS: The total population of 16 and 17 year old male and female adolescents in a county on the south-west coast of Sweden was studied. The investigation was done by an anonymous multiple-choice questionnaire. The questionnaire was completed by 5,827 pupils and statistically analysed. The participation rate was 95%. RESULTS: Among male adolescents 16 and 17 years old, 3.6% and 2.8% had misused androgenic anabolic steroids, respectively. These male adolescents had also misused alcohol, growth hormones and narcotic drugs more than the steroid hormone non-users. Among female adolescents there was no recorded misuse of these drugs (0.0%). CONCLUSIONS: The misuse of androgenic anabolic steroids is a reality in both small and large municipalities in Sweden. The prevalence figures are higher among 16 year old compared to 17 year old male adolescents. There is an association between this drug misuse and other substance misuse such as narcotic drugs. Female adolescents do not misuse steroid hormones. The findings indicate the need for preventive work among male adolescents in order to induce adolescents not to start misusing androgenic anabolic steroids.

The association between socio-economic status and chest pain, focusing on self-rated health in a primary health care area of Sweden.

STUDY OBJECTIVE: The study objective was to determine, first, the association between men's and women's chest pain and their socio-economic status (occupation, smoking) and, secondly, the association between their socio-economic status and self-rated health, in a primary health care area. DESIGN AND SETTING: A population-based cross-sectional survey was made in a primary health care area of Sweden. Primarily based on occupation according to Swedish standards, 4,238 men and women were divided into two socio-economic groups; blue-collar and white-collar workers. METHODS: Odds ratios with 95% CI were calculated by multivariate logistic regression, controlling for the variable age as confounding factor. Student's t-test was used to compare self-rated health, and the chi 2-test to determine any difference in smoking habits between the two groups. MAIN RESULTS: Both male and female blue-collar workers showed significantly more chest pain when excited than white-collar workers. In six of eight health indices, they also reported significantly worse self-rated health than the white-collar workers. CONCLUSIONS: These findings show that there are socio-economic inequalities in self-reported chest pain. Furthermore, socio-economic status has a major influence on self-rated health, acting across the working life of both sexes.

Prevalence of non-healed and healed chronic leg ulcers in an elderly rural population.

OBJECTIVE: To estimate the prevalence of non-healed and healed chronic leg ulcers in an elderly rural population. DESIGN: All persons 70 years or older were asked about present and previous leg ulcers. SETTING: A rural village in mid-west Sweden with 4000 inhabitants. PARTICIPANTS: 541 persons aged 70 years and above. OUTCOME MEASURES: The prevalence of healed or non-healed chronic leg ulcers in the population aged > or = 70. RESULTS: Healed or non-healed leg ulcers were reported by 53 persons (9.8%). Examination of these patients and also 100 individuals who had negated present or previous leg ulceration, giving the total prevalence of 12.6%. CONCLUSION: The result indicates a certain risk for overestimation of prevalence, as well as underestimation and decreased reliability when basing the figures only on telephone interviews or posted questionnaires.

Evolution and clonal traits of Mycobacterium tuberculosis complex in Guinea-Bissau.

Two hundred twenty-nine consecutive isolates of Mycobacterium tuberculosis complex from patients with pulmonary tuberculosis in Guinea-Bissau, which is located in West Africa, were analyzed for clonal origin by biochemical typing and DNA fingerprinting. By using four biochemical tests (resistance to thiophene-2-carboxylic acid hydrazide, niacin production, nitrate reductase test, and pyrazinamidase test), the isolates could be assigned to five different biovars. The characteristics of four strains conformed fully with the biochemical criteria for M. bovis, while those of 85 isolates agreed with the biochemical criteria for M. tuberculosis. The remaining 140 isolates could be allocated into one of three biovars (biovars 2 to 4) representing a spectrum between the classical bovine (biovar 1) and human (biovar 5) tubercle bacilli. By using two genotyping methods, restriction fragment length polymorphism analysis with IS6110 (IS6110 RFLP analysis) and spoligotyping, the isolates could be separated into three groups (groups A to C) of the M. tuberculosis complex. Group A (n = 95), which contained the majority of classical human M. tuberculosis isolates, had large numbers of copies of IS6110 elements (mean number of copies, 9) and a distinctive spoligotyping pattern that lacked spacers 33 to 36. Isolates of the major group, group B (n = 119), had fewer IS6110 copies (mean copy number, 5) and a spoligotyping pattern that lacked spacers 7 to 9 and 39 and mainly comprised isolates of biovars 1 to 4. Group C isolates (n = 15) had one to three IS6110 copies, had a spoligotyping pattern that lacked spacers 29 to 34, and represented biovar 3 to 5 isolates. Four isolates whose biochemical characteristics conformed with those of M. bovis clustered with the group B isolates and had spoligotype patterns that differed from those previously reported for M. bovis, in that they possessed spacers 40 to 43. Interestingly, isolates of group B and, to a certain extent, also isolates of group C showed a high degree of variability in biochemical traits, despite genotypic identity in terms of IS6110 RFLP and spoligotype patterns. We hypothesize that isolates of groups B and C have their evolutionary origin in West Africa, while group A isolates are of European descent.

Promoting medical self-care: evaluation of a family intervention implemented in the primary health care by pharmacies.

BACKGROUND: Medical self-care is the range of behaviours undertaken by people to promote or restore health when dealing with a medical problem. OBJECTIVES: The aim of the study was to evaluate medical self-care effects of a family intervention implemented in primary health care by pharmacies, in terms of non-professional and professional involvement. METHODS: The intervention was implemented in one of two primary health care areas during a 4-month period and involved consecutive families acting as an intervention (IG, n = 94) or a control (CG, n = 93) group. Eight telephone interviews were conducted with each family. The families were asked about complaints of illness, how long they prevailed and how they were treated. RESULTS: The results showed (P < 0.05-0.0001) that the IG had more medical problems (931 versus 621) compared with the CG, were less hospitalized (4 versus 10), stayed at home more to take care of sick children (84 versus 40), read more medical brochures (121 versus 31), tried more non-medical treatments (228 versus 116), and had fewer visits to the department of paediatrics but more visits to primary health care (69 and 98 versus 90 and 68). CONCLUSIONS: Due to the non-randomization procedure, some caution with regard to generalization of the results must be taken, but they are in concordance with established knowledge of the usefulness of medical self-care. The results indicate that a brief intervention for families can change the use of health authorities. It therefore seems meaningful to implement the intervention in a more comprehensive way in the primary health care setting, while at the same time trying to implement it as a large-scale randomized experimental study, comprising aspects such as the individual's need for care, the use of the right organization level and the assessment of economic costs and savings.

How often is the diagnosis bronchial asthma correct?

BACKGROUND: There are studies indicating that bronchial asthma is often underdiagnosed, while only a little research has been conducted as concerns overdiagnosing asthma. OBJECTIVE: We aimed to estimate the number of patients who have been given the wrong diagnosis of asthma. METHODS: All patients aged above 18 years who had visited two GPs during 1994 or 1995, with the diagnosis of bronchial asthma confirmed in the medical register, were examined by a specialist in allergies. RESULTS: One hundred and twenty-three patients fulfilled the criteria for being included in the study. Eighty-six patients (70%) attended the examination. Of these, 51 (59%) had bronchial asthma, six (7%) asthma in combination with chronic obstructive pulmonary disease (COPD) and 29 (34%) no asthmatic disease. CONCLUSION: The study indicates that more accuracy is needed when diagnosing bronchial asthma.

Evaluation of an educational programme for the early detection of cancer.

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.

Site-directed mutagenesis and virulence assessment of the katG gene of Mycobacterium intracellulare.

Mycobacterial catalases have been suggested as acting as virulence factors by protecting intracellular mycobacteria from reactive oxidative metabolites produced by host phagocytes. Mycobacterium intracellulare, like many other mycobacteria, produces two proteins with catalase activity: a heat-stable catalase (KatE) and an inducible, heat-labile catalase peroxidase (KatG). The M. intracellulare katG gene was cloned, and a plasmid derivative with a 4 bp insertion in the katG coding sequence was constructed and used for site-directed mutagenesis of M. intracellulare 1403 (ATCC 35761). The resulting katG mutant was highly resistant to isoniazid (INH), showed an increased sensitivity to H2O2 and had lost peroxidase and heat-sensitive catalase activity but retained heat-stable catalase activity. The plasmid carrying the katG frameshift allele was also used for mutagenesis of the mouse virulent M. intracellulare isolate D673. After intravenous injection into BALB/c mice, D673 and the isogenic katG mutant showed the same growth kinetics in the spleen, liver and lungs of the infected mice. Our results demonstrate that the KatG catalase peroxidase mediates resistance to H2O2 and susceptibility to INH but is not an essential virulence factor for the survival and growth of M. intracellulare in the mouse.

Site-directed mutagenesis of the 19-kilodalton lipoprotein antigen reveals No essential role for the protein in the growth and virulence of Mycobacterium intracellulare.

The mycobacterial 19-kilodalton antigen (19Ag) is a highly expressed, surface-associated glycolipoprotein which is immunodominant in infected patients and has little homology with other known proteins. To investigate the pathogenic significance of the 19Ag, site-directed mutagenesis of the Mycobacterium intracellulare 19Ag gene was carried out by using a suicide vector-based strategy. Allelic replacement of the 19Ag gene of a mouse-avirulent M. intracellulare strain, 1403, was achieved by double-crossover homologous recombination with a gentamicin resistance gene-mutated allele. Unfortunately, an isogenic 19Ag was not achievable in the mouse-virulent strain, D673. However, a 19Ag mutant was successfully constructed in M. intracellulare FM1, a chemically mutagenized derivative of strain D673. FM1 was more amenable to genetic manipulation and susceptible to site-directed mutagenesis of the 19Ag gene yet retained the virulent phenotype of the parental strain. No deleterious effects of 19Ag gene mutation were observed during in vitro growth of M. intracellulare. Virulence assessment of the isogenic 19Ag mutants in a mouse infection model demonstrated that the antigen plays no essential role in the growth of M. intracellulare in vivo. Site-directed mutagenesis of the 19Ag gene demonstrated that it plays no essential role in growth and pathogenicity of M. intracellulare; however, the exact nature of its biological function remains unknown.