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Melin EO, Wanby P, Neumark T, Holmberg S, Neumark ASN, Johansson K, Landin-Olsson M, Thulesius H, Hillman M, Thunander M. Depression was associated with younger age, female sex, obesity, smoking, and physical inactivity, in 1027 patients with newly diagnosed type 2 diabetes: a Swedish multicentre cross-sectional study. BMC Endocr Disord 2022; 22:273. [PMID: 36348470 PMCID: PMC9644465 DOI: 10.1186/s12902-022-01184-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 10/21/2022] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Depression is a risk factor for type 2 diabetes (T2D) and cardiovascular disease (CVD). The aims were to explore the prevalence of depression, anxiety, antidepressant use, obesity, Hemoglobin A1c > 64 mmol/mol, life-style factors, pre-existing CVD, in patients with newly diagnosed T2D; to explore associations with depression; and to compare with Swedish general population data. METHODS Multicentre, cross-sectional study. INCLUSION CRITERIA adults with serologically verified newly diagnosed T2D. Included variables: age, sex, current depression and anxiety (Hospital Anxiety and Depression Scale), previous depression, antidepressant use, obesity (BMI ≥ 30 and ≥ 40 kg/m2), Hemoglobin A1c, pre-existing CVD. Logistic regression analyses were performed. RESULTS In 1027 T2D patients, aged 18-94 years, depression was associated with age (per year) (inversely) (odds ratio (OR) 0.97), anxiety (OR 12.2), previous depression (OR 7.1), antidepressant use (OR 4.2), BMI ≥ 30 kg/m2 (OR 1.7), BMI ≥ 40 kg/m2 (OR 2.3), smoking (OR 1.9), physical inactivity (OR 1.8), and women (OR 1.6) (all p ≤ 0.013). Younger women (n = 113), ≤ 59 years, compared to younger men (n = 217) had higher prevalence of current depression (31% vs 12%), previous depression (43 vs 19%), anxiety (42% vs 25%), antidepressant use (37% vs 12%), BMI ≥ 30 kg/m2 (73% vs 60%) and BMI ≥ 40 kg/m2) (18% vs 9%), and smoking (26% vs 16%) (all p ≤ 0.029). Older women (n = 297), ≥ 60 years, compared to older men (n = 400) had higher prevalence of previous depression (45% vs 12%), anxiety (18% vs 10%), antidepressant use (20% vs 8%), BMI ≥ 30 kg/m2 (55% vs 47%), BMI ≥ 40 kg/m2 (7% vs 3%) (all p ≤ 0.048), but not of current depression (both 9%). Compared to the Swedish general population (depression (women 11.2%, men 12.3%) and antidepressant use (women 9.8%, men 5.3%)), the younger women had higher prevalence of current depression, and all patients had higher prevalence of antidepressant use. CONCLUSIONS In patients with newly diagnosed T2D, the younger women had the highest prevalence of depression, anxiety, and obesity. The prevalence of depression in young women and antidepressant use in all patients were higher than in the Swedish general population. Three risk factors for CVD, obesity, smoking, and physical inactivity, were associated with depression.
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Affiliation(s)
- Eva O Melin
- Department of Clinical Sciences, Diabetology and Endocrinology, Lund University, Lund, Sweden.
- Diabetes Research Laboratory, Biomedical Centre, Lund University, Lund, Sweden.
- Department of Research and Development, Region Kronoberg, Box 1223, 351 12, Växjö, Sweden.
- Region Kronoberg, Primary Care, Växjö, Sweden.
| | - Pär Wanby
- Department of Medicine and Optometry, Linnaeus University, Kalmar, Sweden
- Department of Medical and Health Sciences, University of Linköping, Linköping, Sweden
- Department of Internal Medicine, Endocrinology, Kalmar County Hospital, Region Kalmar, Sweden
| | - Thomas Neumark
- Regional Executive Office - Coordination of Health Care, Kalmar, Sweden
- Department of Research, Region Kalmar County, Kalmar, Sweden
| | - Sara Holmberg
- Department of Research and Development, Region Kronoberg, Box 1223, 351 12, Växjö, Sweden
- Department of Medicine and Optometry, Linnaeus University, Kalmar, Sweden
- Department of Laboratory Medicine, Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden
| | | | - Karin Johansson
- Department of Research and Development, Region Kronoberg, Box 1223, 351 12, Växjö, Sweden
- Region Kronoberg, Primary Care, Växjö, Sweden
- Department of Health and Caring Sciences, Linnaeus University, Växjö, Sweden
| | - Mona Landin-Olsson
- Department of Clinical Sciences, Diabetology and Endocrinology, Lund University, Lund, Sweden
- Diabetes Research Laboratory, Biomedical Centre, Lund University, Lund, Sweden
- Department of Diabetology and Endocrinology, Skane University Hospital, Lund, Sweden
| | - Hans Thulesius
- Department of Research and Development, Region Kronoberg, Box 1223, 351 12, Växjö, Sweden
- Region Kronoberg, Primary Care, Växjö, Sweden
- Department of Medicine and Optometry, Linnaeus University, Kalmar, Sweden
- Department of Clinical Sciences, Division of Family Medicine, Lund University, Malmö, Sweden
| | - Magnus Hillman
- Department of Clinical Sciences, Diabetology and Endocrinology, Lund University, Lund, Sweden
- Diabetes Research Laboratory, Biomedical Centre, Lund University, Lund, Sweden
| | - Maria Thunander
- Department of Clinical Sciences, Diabetology and Endocrinology, Lund University, Lund, Sweden
- Department of Research and Development, Region Kronoberg, Box 1223, 351 12, Växjö, Sweden
- Department of Internal Medicine, Endocrinology and Diabetes, Växjö Central Hospital, Region Kronoberg, Växjö, Sweden
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Kornfält Isberg H, Hedin K, Melander E, Mölstad S, Cronberg O, Engström S, Lindbäck H, Neumark T, Ekman GS, Beckman A. Different antibiotic regimes in men diagnosed with lower urinary tract infection - a retrospective register-based study. Scand J Prim Health Care 2020; 38:291-299. [PMID: 32686974 PMCID: PMC7470089 DOI: 10.1080/02813432.2020.1794409] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVE To compare the proportion of therapy failure, recurrence and complications within 30 days after consultation between men diagnosed with lower urinary tract infection (UTI) treated with narrow-spectrum antibiotics (nitrofurantoin or pivmecillinam) and broad-spectrum antibiotics (fluoroquinolones or trimethoprim or trimethoprim/sulfamethoxazole). DESIGN A retrospective cohort study based on data derived from electronic medical records between January 2012 and December 2015. SETTING Primary health care and hospital care in five different counties in Sweden. Patients: A total of 16,555 men aged between 18 and 79 years diagnosed with lower UTI. MAIN OUTCOME MEASURES Treatment with narrow-spectrum antibiotics was compared with broad-spectrum antibiotics regarding therapy failure, recurrence and complications within 30 days. RESULTS The median age of included men was 65 IQR (51-72) years. Narrow-spectrum antibiotics were prescribed in 8457 (40%) and broad-spectrum antibiotics in 12,667 (60%) cases, respectively. Therapy failure was registered in 192 (0.9%), recurrence in 1277 (6%) and complications in 121 (0.6%) cases. Therapy failure and recurrence were more common in patients treated with narrow-spectrum antibiotics and trimethoprim (p < 0.001), but no such difference could be detected regarding complications. CONCLUSION There was no difference in incidence of complications within 30 days between men treated with narrow- or broad-spectrum antibiotics. Patients prescribed broad-spectrum antibiotics had lower odds of reconsultation because of therapy failure and recurrence. From current data, treatment with narrow-spectrum antibiotics seems to be an optimal choice regarding preventing complications when treating men with lower UTI. KEY POINTS Complications such as pyelonephritis and sepsis are uncommon in men diagnosed with lower urinary tract infection treated with antibiotics. There was no difference in incidence of complications among men diagnosed with lower urinary tract infection treated with narrow- or broad-spectrum antibiotics. In spite of higher incidence of therapy failure and recurrence, treatment with narrow-spectrum antibiotics seems to be an optimal choice regarding preventing complications when treating men diagnosed with lower UTI.
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Affiliation(s)
- Helena Kornfält Isberg
- Department of Clinical Sciences, Family Medicine Malmö, Lund University, Malmö, Sweden
- CONTACT Helena Kornfält Isberg Department of Clinical Sciences, Family Medicine Malmö, Lund University, Malmö, Sweden
| | - Katarina Hedin
- Department of Clinical Sciences, Family Medicine Malmö, Lund University, Malmö, Sweden
- Futurum, Region Jönköping County and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Eva Melander
- Regional Center for Communicable Disease Control, Malmö, Sweden
- Department of Translational Medicine, Lund University, Malmö, Sweden
| | - Sigvard Mölstad
- Department of Clinical Sciences, Family Medicine Malmö, Lund University, Malmö, Sweden
| | - Olof Cronberg
- Department of Clinical Sciences, Family Medicine Malmö, Lund University, Malmö, Sweden
- Department of Research and Development, Region Kronoberg, Växjö, Sweden
| | - Sven Engström
- Futurum, Region Jönköping County and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Heidi Lindbäck
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Thomas Neumark
- Regional Executive Officer's Staff – Coordination of Health Care, Kalmar, Sweden
| | | | - Anders Beckman
- Department of Clinical Sciences, Family Medicine Malmö, Lund University, Malmö, Sweden
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Vik I, Mdala I, Bollestad M, Cordoba GC, Bjerrum L, Neumark T, Damsgaard E, Bærheim A, Grude N, Lindbaek M. Predicting the use of antibiotics after initial symptomatic treatment of an uncomplicated urinary tract infection: analyses performed after a randomised controlled trial. BMJ Open 2020; 10:e035074. [PMID: 32868350 PMCID: PMC7462246 DOI: 10.1136/bmjopen-2019-035074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To predict antibiotic use after initial treatment with ibuprofen using data from a randomised controlled trial comparing ibuprofen to pivmecillinam in the treatment of women with symptoms of an uncomplicated urinary tract infection (UTI). SETTING 16 sites in a primary care setting in Norway, Sweden and Denmark. PARTICIPANTS Data from 181 non-pregnant women aged 18-60 presenting with symptoms of uncomplicated UTI, initially treated with ibuprofen. METHODS Using the least absolute shrinkage and selection operator logistic regression model, we conducted analyses to see if baseline information could help us predict which women could be treated with ibuprofen without risking treatment failure and which women should be recommended antibiotics. RESULTS Of the 143 women included in the final analysis, 77 (53.8%) recovered without antibiotics and 66 (46.2 %) were subsequently prescribed antibiotics. In the unadjusted binary logistic regression, the number of days with symptoms before inclusion (<3 days) and feeling moderately unwell or worse (≥4 on a scale of 0-6) were significant predictors for subsequent antibiotic use. In the adjusted model, no predictors were significantly associated with subsequent antibiotic use. The area under the curve of the final model was 0.66 (95% CI: 0.57 to 0.74). CONCLUSION We did not find any baseline information that significantly predicted the use of antibiotic treatment. Identifying women who need antibiotic treatment to manage their uncomplicated UTI is still challenging. Larger data sets are needed to develop models that are more accurate. TRIAL REGISTRATION NUMBER ClinicalTrials.gov (NCT01849926).
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Affiliation(s)
- Ingvild Vik
- Department of General Practice, Antibiotic Centre for Primary Care, Institute of Health and Society, University of Oslo, Oslo, Norway
- Department of Emergency General Practice, City of Oslo Health Agency, Oslo Accident and Emergency Outpatient Clinic, Oslo, Norway
| | - Ibrahimu Mdala
- General Practice Research Unit (AFE), Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Marianne Bollestad
- Department of General Practice, Antibiotic Centre for Primary Care, Institute of Health and Society, University of Oslo, Oslo, Norway
- Medicine, Helse Stavanger HF, Stavanger, Norway
| | - Gloria Cristina Cordoba
- Section of General Practice and Research Unit of General Practice, Department of Public Health, University of Copenhagen, København, Denmark
| | - Lars Bjerrum
- Section of General Practice and Research Unit of General Practice, Department of Public Health, University of Copenhagen, København, Denmark
| | - Thomas Neumark
- Primary Health Care and Planning Division, Kalmar County Council, Kalmar, Sweden
| | - Eivind Damsgaard
- Bergen Accident and Emergency Department, Bergen Kommune, Bergen, Norway
| | - Anders Bærheim
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Hordaland, Norway
| | - Nils Grude
- Department of General Practice, Antibiotic Centre for Primary Care, Institute of Health and Society, University of Oslo, Oslo, Norway
- Department of Medical Microbiology, Vestfold Hospital Trust, Tønsberg, Norway
| | - Morten Lindbaek
- Department of General Practice, Antibiotic Centre for Primary Care, Institute of Health and Society, University of Oslo, Oslo, Norway
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Vik I, Bollestad M, Grude N, Bærheim A, Damsgaard E, Neumark T, Bjerrum L, Cordoba G, Olsen IC, Lindbæk M. Ibuprofen versus pivmecillinam for uncomplicated urinary tract infection in women-A double-blind, randomized non-inferiority trial. PLoS Med 2018; 15:e1002569. [PMID: 29763434 PMCID: PMC5953442 DOI: 10.1371/journal.pmed.1002569] [Citation(s) in RCA: 73] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Accepted: 04/16/2018] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Although uncomplicated urinary tract infections (UTIs) are often self-limiting, most patients will be prescribed antibiotic treatment. We assessed whether treatment with ibuprofen was non-inferior to pivmecillinam in achieving symptomatic resolution by day 4, with a non-inferiority margin of 10%. METHODS AND FINDINGS This was a randomized, controlled, double-blind non-inferiority trial. We recruited patients from 16 sites in a general practice setting in Norway, Sweden, and Denmark. Non-pregnant women aged 18-60 years presenting with symptoms of uncomplicated UTI were screened for eligibility from 11 April 2013 to 22 April 2016. Patients with informed consent were randomized (1:1 ratio) to treatment with either 600 mg ibuprofen or 200 mg pivmecillinam 3 times a day for 3 days. The patient, treating physician, and study personnel were blinded to treatment allocation. The primary outcome was the proportion of patients who felt cured by day 4, as assessed from a patient diary. Secondary outcomes included the proportion of patients in need of secondary treatment with antibiotics and cases of pyelonephritis. A total of 383 women were randomly assigned to treatment with either ibuprofen (n = 194, 181 analyzed) or pivmecillinam (n = 189, 178 analyzed). By day 4, 38.7% of the patients in the ibuprofen group felt cured versus 73.6% in the pivmecillinam group. The adjusted risk difference with 90% confidence interval was 35% (27% to 43%) in favor of pivmecillinam, which crossed the prespecified non-inferiority margin. Secondary endpoints were generally in favor of pivmecillinam. After 4 weeks' follow-up, 53% of patients in the ibuprofen group recovered without antibiotic treatment. Seven cases of pyelonephritis occurred, all in the ibuprofen group, giving a number needed to harm of 26 (95% CI 13 to 103). Five of these patients were hospitalized and classified as having serious adverse events; 2 recovered as outpatients. A limitation of the study was the extensive list of exclusion criteria, eliminating almost half of the patients screened. We did not register symptoms in the screening process; hence, we do not know the symptom burden for those who declined to participate. This might make our results less generalizable. CONCLUSIONS Ibuprofen was inferior to pivmecillinam for treating uncomplicated UTIs. More than half of the women in the ibuprofen group recovered without antibiotics. However, pyelonephritis occurred in 7 out of 181 women using ibuprofen. Until we can identify those women who will develop complications, we cannot recommend ibuprofen alone as initial treatment to women with uncomplicated UTIs. TRIAL REGISTRATION ClinicalTrials.gov NCT01849926 EU Clinical Trials Register (EU-CTR), EudraCT Number 2012-002776-14.
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Affiliation(s)
- Ingvild Vik
- Department of Emergency General Practice, Oslo Accident and Emergency Outpatient Clinic, Oslo, Norway
- Antibiotic Centre of Primary Care, Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
- * E-mail:
| | - Marianne Bollestad
- Antibiotic Centre of Primary Care, Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
- Division of Medicine, Stavanger University Hospital, Stavanger, Norway
| | - Nils Grude
- Antibiotic Centre of Primary Care, Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
- Department of Medical Microbiology, Vestfold Hospital Trust, Tønsberg, Norway
| | - Anders Bærheim
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Eivind Damsgaard
- Bergen Accident and Emergency Department, Bergen City Council, Bergen, Norway
| | - Thomas Neumark
- Primary Health Care and Planning Division, Kalmar County Council, Kalmar, Sweden
| | - Lars Bjerrum
- Section of General Practice and Research Unit of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Gloria Cordoba
- Section of General Practice and Research Unit of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | | | - Morten Lindbæk
- Antibiotic Centre of Primary Care, Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
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Neumark ASN, Brudin L, Neumark T. Adherence to national diabetes guidelines through monitoring quality indicators--A comparison of three types of care for the elderly with special emphasis on HbA1c. Prim Care Diabetes 2015; 9:253-260. [PMID: 25865853 DOI: 10.1016/j.pcd.2015.03.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Revised: 01/27/2015] [Accepted: 03/11/2015] [Indexed: 11/26/2022]
Abstract
AIM To compare adherence to Swedish guidelines for diabetes care between elderly people living at home with or without home health care, and residents of nursing homes. METHODS Medical records of 277 elderly people aged 80 and older, with known diabetes in a Swedish municipality, were monitored using quality indicators to evaluate processes and outcomes. RESULTS Monitoring, in accordance to diabetes guidelines, of HbA1c, lipids, blood pressure and foot examinations was lower among residents of nursing homes (p < 0.001). The HbA1c value of ≤ 6.9% (52 mmol/mol) was achieved for 48% of those in nursing homes with medication, 35% and 39%, for those living at home with or without home health care, respectively. Insulin was used to a greater extent in nursing homes. Metformin was frequently used, even at reduced e-GFR. Systolic BP ≤ 140 mmHg was achieved by 71% vs 80% and 85% of those living at home, those with home health care and residents of nursing homes in the respective groups. CONCLUSIONS Adherence to guidelines was deficient particularly in nursing homes. Clearer guidelines and interventions aimed at the improvement of quality in diabetes care in elderly people and sustainable coordination between health care providers is needed.
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MESH Headings
- Aged, 80 and over
- Biomarkers/blood
- Blood Glucose/drug effects
- Blood Glucose/metabolism
- Cross-Sectional Studies
- Diabetes Mellitus, Type 1/blood
- Diabetes Mellitus, Type 1/diagnosis
- Diabetes Mellitus, Type 1/drug therapy
- Diabetes Mellitus, Type 1/epidemiology
- Diabetes Mellitus, Type 2/blood
- Diabetes Mellitus, Type 2/diagnosis
- Diabetes Mellitus, Type 2/drug therapy
- Diabetes Mellitus, Type 2/epidemiology
- Female
- Glycated Hemoglobin/metabolism
- Guideline Adherence/standards
- Health Services for the Aged/standards
- Home Care Services
- Homes for the Aged
- Humans
- Hypoglycemic Agents/adverse effects
- Hypoglycemic Agents/therapeutic use
- Independent Living
- Male
- Nursing Homes
- Practice Guidelines as Topic/standards
- Practice Patterns, Physicians'/standards
- Prevalence
- Process Assessment, Health Care/standards
- Quality Indicators, Health Care/standards
- Sweden/epidemiology
- Treatment Outcome
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Affiliation(s)
| | - Lars Brudin
- Department of Clinical Physiology, Kalmar County Hospital, Kalmar, Sweden
| | - Thomas Neumark
- Primary Health Centre Lindsdal, Kalmar, Sweden; Planning Division, Kalmar County Council, Kalmar, Sweden
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Abstract
BACKGROUND Studies of antibiotic prescribing related to diagnosis comparing prescribers trained abroad with those trained in Sweden are lacking. OBJECTIVES To determine whether general practices (GPs) and GP residents trained abroad had different prescribing patterns for antibiotics for common infections than those trained in Sweden using retrospective data from electronic patient records from primary health care in Kalmar County, Sweden. METHODS Consultations with an infection diagnosis, both with and without the prescription of antibiotics to 67 GPs and residents trained in Western Europe outside Sweden and other countries, were compared with a matched control group trained in Sweden. RESULTS For 1 year, 44101 consultations of patients with an infection diagnosis and 16276 prescriptions of antibiotics were registered. Foreign-trained physicians had 20% more visits compared with physicians trained in Sweden. The prescription of antibiotics per visit and physician in the respective groups, and independent of diagnosis, did not significantly differ between groups, when scaled down from number of consultations to number of prescribing physicians. CONCLUSIONS There were minor and non-significant differences in antibiotic prescribing comparing GPs and residents trained abroad and in Sweden, most likely the result of an adaptation to Swedish conditions. Nevertheless, no group prescribed antibiotics in accordance to national guidelines. The results suggest that interventions are needed to reduce irrational antibiotic prescribing patterns, targeting all physicians working in Swedish primary health care.
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Affiliation(s)
- Thomas Neumark
- Primary Health Centre, Lindsdal, Kalmar, Department of Planning, Division of Pharmacotherapy, Kalmar County Council, Kalmar,
| | - Lars Brudin
- Department of Clinical Physiology, Kalmar County Hospital, Kalmar and
| | - Sigvard Mölstad
- Department of Clinical Sciences, General Practice, Lund University, Malmö, Sweden
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Wågström P, Bengnér M, Dahle C, Nilsdotter-Augustinsson Å, Neumark T, Brudin L, Björkander J. Does the frequency of respiratory tract infections help to identify humoral immunodeficiencies in a primary health-care cohort? Infect Dis (Lond) 2014; 47:13-9. [PMID: 25378084 DOI: 10.3109/00365548.2014.956330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Primary immune deficiency (PID) due to humoral defects is associated with recurrent respiratory tract infections (RTIs). Reliable clinical warning signs of PID would facilitate early diagnosis and thereby reduce long-term complications. The aim of the present study was to evaluate the accuracy of the warning sign, 'four or more antibiotic-treated RTIs annually for 3 or more consecutive years,' for detecting PID among adults in a primary health-care setting. METHODS Fifty-three cases with 'four or more antibiotic-treated RTIs annually for 3 or more consecutive years' were selected from a Swedish primary health-care registry of RTIs. In addition, 66 age- and sex-matched controls were selected having a maximum of one antibiotic-treated RTI during the period covered by the study. Levels of immunoglobulin (Ig) IgG, IgA, IgM, IgG subclasses, and IgG antibodies against Haemophilus influenzae and Streptococcus pneumoniae as well as the inflammatory markers, C-reactive protein, interleukin (IL)-6 and IL-8 were determined. RESULTS IgG subclass deficiencies (IgGsd) were found in 5/53 (9.4%) of the cases and in 7/66 (10.6%) controls. The most frequent deficiency was IgG3sd and this was found in three participants in the case group and seven in the control group. The mean level of IgG3 was lower in the control group (p = 0.02). The mean level of IL-8 was lower in the case group (p = 0.02). CONCLUSION The results show that physicians working in primary health care cannot solely rely on the frequency of antibiotic-treated RTIs as a warning sign for the detection of common humoral immune deficiencies.
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Affiliation(s)
- Per Wågström
- From the Department of Infectious Diseases, Ryhov County Hospital Ryhov , Jönköping
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Neumark T, Ekblom M, Brudin L, Groth A, Eliasson I, Mölstad S, Petersson AC, Törngren A. Spontaneously draining acute otitis media in children: an observational study of clinical findings, microbiology and clinical course. ACTA ACUST UNITED AC 2011; 43:891-8. [PMID: 21736512 DOI: 10.3109/00365548.2011.591820] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES To study the outcome of acute otitis media (AOM) with otorrhoea in children managed initially without antibiotics, in relation to bacterial and clinical findings, and to identify those who may benefit from antibiotics. METHODS Otherwise healthy, not otitis prone children aged 2-16 y, presenting with AOM with spontaneous otorrhoea, were recruited from primary care and followed at selected ear, nose and throat (ENT) clinics. Specimens for bacterial investigations were obtained; symptoms were registered on a daily basis. The main outcomes measured were the frequency of children treated with antibiotics due to persisting AOM within 9 days in relation to clinical and bacteriological findings, and new AOM within 3 months. RESULTS Twelve of 71 children who completed the trial received antibiotics during the first 9 days due to lack of improvement. One received antibiotics after 16 days due to relapsing AOM and 6 received antibiotics after 30 days due to new AOM. At 2-4 days following inclusion, over 70% of children showed normalized eardrum status and markedly reduced secretion. Alloiococcus otitidis was found in 23 samples, Streptococcus pneumoniae in 12, Streptococcus pyogenes in 6, and Fusobacterium nucleatum in 5. Mycoplasma pneumoniae, Chlamydia pneumoniae, and Fusobacterium necrophorum were not detected. Antibiotics were prescribed more extensively to children with a pulsating eardrum and abundant purulent secretion. All children with S. pyogenes received antibiotics, whereas children with only A. otitidis did not. CONCLUSIONS The results suggest that antibiotics are indicated in AOM with otorrhoea and the presence of abundant purulent secretion, a pulsating eardrum, or the presence of S. pyogenes. The presence of only A. otitidis was not associated with a more prolonged course or the need for antibiotics.
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Neumark T, Brudin L, Mölstad S. Use of rapid diagnostic tests and choice of antibiotics in respiratory tract infections in primary healthcare--a 6-y follow-up study. ACTA ACUST UNITED AC 2010; 42:90-6. [PMID: 19902992 DOI: 10.3109/00365540903352932] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The aim of this retrospective study of electronic patient records in primary health care in Kalmar County, Sweden, was to describe consultations for respiratory tract infections (RTIs) in relation to age, choice of antibiotics and the use of rapid diagnostic tests. During the period 1999-2005, 240,445 visits for RTI were recorded. Children aged <2 y and especially those aged 2-16 y with acute otitis media (AOM), showed decreasing consultations between 2000 and 2005. The consultations for sore throat declined during the study period in all age groups and in 65% of these, antibiotics were prescribed, primarily penicillin V (82%). In sore throat, a positive Strep-A test result was followed by antibiotic prescription in about 92% of cases; when negative, the antibiotic prescription rate was 40%. C-reactive protein (CRP) was analyzed in 36% of all consultations for RTI. In common cold and acute bronchitis, the prescription rates of antibiotics rose with rising CRP. The results show that near-patient tests were used extensively, but often not in accordance with the guidelines. Antibiotic use decreased mainly as a consequence of declined visiting frequencies. This indicates that the new guidelines for AOM and sore throat may have influenced patient consultation habits more than physician prescribing habits.
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Affiliation(s)
- Thomas Neumark
- Lindsdals Primary Health Centre, Förlösavägen 4, Kalmar, Sweden.
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Neumark T, Brudin L, Engstrom S, Molstad S. Trends in number of consultations and antibiotic prescriptions for respiratory tract infections between 1999 and 2005 in primary healthcare in Kalmar County, Southern Sweden. Scand J Prim Health Care 2009; 27:18-24. [PMID: 19085427 PMCID: PMC3410472 DOI: 10.1080/02813430802610784] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2008] [Indexed: 10/21/2022] Open
Abstract
UNLABELLED BACKGROUND. Respiratory tract infections (RTIs) comprise the most common indication for consulting a general practitioner and obtaining an antibiotic prescription. OBJECTIVE To study changes in the number of visits, diagnoses, and antibiotic prescriptions for RTI in primary healthcare during the period 1999-2005. DESIGN A retrospective, descriptive, population-based study of electronic patient records. Setting. County of Kalmar in southeastern Sweden. PATIENTS Patients visiting primary healthcare units in Kalmar County for an RTI between 1 July 1999 and 31 December 2005. MAIN OUTCOME MEASURES RTI diagnoses, antibiotic prescriptions, age groups. RESULTS A total of 240 447 visits for RTI made between 1999 and 2005 were analysed. The yearly consultation rates for the diagnoses acute tonsillitis and AOM decreased by 12% and 10%, respectively (p = 0.001). Of all patients consulting for an RTI diagnosis, 45% received antibiotics. Of all prescribed antibiotics, 60% were for phenoxymethylpenicillin (PcV) and 18% doxycycline. Amoxicillin or amoxicillin + clavulanic acid was prescribed to a lesser extent. The proportion of patients obtaining an antibiotic prescription was almost constant over time (44-46%). The prescriptions of doxycycline showed increasing values (NS). The prescriptions of remaining antibiotics decreased significantly especially for patients up to middle age. CONCLUSION This large population study, comprising more than six years of observations, showed the number of primary healthcare patients receiving an RTI diagnosis decreased during the period 1999-2005, but the proportion of patients receiving an antibiotic prescription remained the same. The large seasonal variations indicate a need for further interventions to decrease antibiotic use for RTIs.
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Affiliation(s)
- Thomas Neumark
- Lindsdals Primary Health Centre, Förlösavägen 4, Kalmar, Sweden.
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Neumüller J, Neumark T, Tohidast-Akrad M, Scheirer E, Jantsch S, Partsch G, Eberl G. Beeinflussung des Zellzyklus von rheumatoiden und nichtrheumatoiden Synovial-Zellkulturen durch humane Interferone*. AKTUEL RHEUMATOL 2008. [DOI: 10.1055/s-2008-1047466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Neumark T, Mölstad S, Rosén C, Persson LG, Törngren A, Brudin L, Eliasson I. Evaluation of phenoxymethylpenicillin treatment of acute otitis media in children aged 2-16. Scand J Prim Health Care 2007; 25:166-71. [PMID: 17846935 PMCID: PMC3379776 DOI: 10.1080/02813430701267405] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
OBJECTIVE To study the clinical recovery from acute otitis media (AOM) in children, 2-16 years of age, managed with or without treatment with phenoxymethylpenicillin (PcV). DESIGN An open, prospective randomized trial. Children aged between 2 and 16 years, presenting with one- or double-sided AOM (without perforation) with symptom duration of less than four days, were included. The children were randomized to PcV for five days or to no primary antibiotic treatment. A health score and compliance were registered on a daily basis for seven days. SETTING A total of 32 health centres and 72 GPs in south-east Sweden. Subjects. Children aged 2-16 presenting with earache. MAIN OUTCOME MEASURES Recovery time, symptom duration, frequency of complications (up to three months) and consumption of healthcare services independent of treatment with or without antibiotics. RESULTS A total of 179 patients carried out the trial; 92 were randomized to PcV, 87 to no primary antibiotic treatment. The median recovery time was four days in both groups. Patients who received PcV had less pain (p <0.001) and used fewer analgesics. There were no significant differences in the number of middle-ear effusions or perforations at the final control after three months. Children randomized to PcV treatment consulted less (p <0.001) during the first seven days. CONCLUSIONS Our investigation supports that PcV treatment of AOM does not affect the recovery time or complication rates. PcV provided some symptomatic benefit in the treatment of AOM in otherwise healthy children, aged 2-16 years.
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Abstract
Gastric application of high doses of colloidal bismuth subcitrate (CBS) stimulates mucosal prostaglandin E2 (PGE2) production, which is considered part of the mechanism by which the drug accelerates peptic ulcer healing. Whether therapeutic, orally administered, doses of CBS cause a sustained stimulation of prostaglandin production is not known. We have, therefore, determined gastric luminal release of PGE2 during 'steady-state' perfusion of the stomach with CBS (10 mg/ml; isotonic mannitol 5 ml/min) and 4 h after the last oral dose of the drug (240 mg b.d.) for 2 weeks (isotonic mannitol 5 ml/min) in 8 healthy volunteers. A significant increase in PGE2 concentrations (712 (409-1076) vs. control 334 (252-655) pg/ml; medians with Q50 ranges; P less than 0.02) and PGE2 output (12.5 (7.3-14.3) vs. control 4.8 (4.1-7.3) ng/15 min; P less than 0.02) occurred during gastric perfusion with CBS. A similar increase in PGE2 concentrations (630 (297-1429) pg/ml; P less than 0.02) and PGE2 output (12.6 (6.4-22.2) ng/15 min; P less than 0.02) was observed following treatment with CBS for 2 weeks. These results suggest that therapeutic doses of CBS cause a sustained stimulation of gastric mucosal PGE2 formation.
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Affiliation(s)
- A Mertz-Nielsen
- Department of Medicine G, Bispebjerg Hospital, Copenhagen, Denmark
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Bánrévi Z, Vajda K, Tanka D, Kukán F, Neumark T. [Transitional cell Merkel carcinoma]. Morphol Igazsagugyi Orv Sz 1988; 28:241-6. [PMID: 3185572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Bukosza M, Neumark T, Balint GP. Calcium pyrophosphate crystals in intermittent hydrarthrosis. J Rheumatol 1986; 13:967-8. [PMID: 3029370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
A 49-year-old female presented with intermittent hydrarthrosis affecting the right knee. Numerous calcium pyrophosphate crystals were demonstrated in synovial fluid aspirated from the knee.
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Abstract
Combined NMR and the vacuum dehydration method were used to study the state of water in rat muscle. Comparative studies were carried out on muscles of young and old mature white rats. The spin-lattice relaxation time was measured as a function of water content. The single-exponential behaviour of the relaxation process indicates a normal fast-exchange process between the different fractions. The more elaborate analysis demonstrates the failure of the original fast-exchange model. It is proved that structural changes take place in the macromolecule/ion/bound water system of the muscle even at the beginning of dehydration. All the muscle water seems to be necessary to maintain the normal natural state of the muscle's molecular structure.
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Abstract
In a 48-year-old man with dysuria and microscopic haematuria, pyelography, cystoscopy and bimanual bladder palpation showed no definite abnormality. Because of continued symptoms, ultrasound scanning of the abdomen was done three months later. The examination revealed a tumour in close relation to the top of the bladder. Malignant cells were aspirated at ultrasonically guided puncture, and a urachus tumour was suspected. For early diagnosis of urachus tumours, ultrasound investigation of vague bladder symptoms is required.
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Neumark T, Takács J. [Virus-like particles in cultures of rheumatoid synovial cells]. Vopr Virusol 1984; 29:575-82. [PMID: 6516327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Cultures of synovial cells from 8 patients with classical or determined rheumatoid arthritis and 3 patients with non-rheumatoid arthrosis were examined electron microscopically. Cells of the monolayer formed upon prolonged incubation of tissue pieces had the conventional ultrastructure of synovial cells. In 2 out of 8 cultures of rheumatoid synovial cells after 14 days of incubation, budding virus-like particles with the external diameter of 100-120 nm were observed. Morphologically these particles were very similar to retroviruses. Isolated particles had a buoyant density in sucrose of 1.15-1.17 g/cm3.
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Mul'diiarov PI, Neumark T, Nasonova VA, Takacs J, Alekberova ZS. [Ultrastructural signs indicative of possible viral infection in rheumatoid arthritis]. Revmatologiia (Mosk) 1983:11-5. [PMID: 6359337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Kalmár L, Ablonczy E, Müzes G, Neumark T, Répay I, Gergely P. [Simultaneous incidence of systemic lupus erythematosus and gout]. Orv Hetil 1982; 123:1977-81. [PMID: 7145385 DOI: pmid/7145385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Mituszova M, Gáspárdy G, Tanka D, Neumark T, Bély M. [Simultaneous occurrence of gout and rheumatoid arthritis]. Orv Hetil 1981; 122:339-42. [PMID: 7231996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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Hollós I, Neumark T, Novák E, Szécsey G, Penke Z, Köszeghy Z, Villányi P. Australia antigen survey in Hungary. 3. Morphological study of the antigen before and after treatment with Tween 80. Acta Microbiol Acad Sci Hung 1973; 20:89-101. [PMID: 4130012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Neumark T, Hollós I, Farkas K. [Nuclear inclusion bodies and virus-like particles in the synovial membrane in rheumatoid arthritis]. Morphol Igazsagugyi Orv Sz 1971; 11:269-79. [PMID: 5152869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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Neumark T, Hollos I, Farkas K. Electron microscopical investigation of virus-like particles in rheumatoid synovial membrane. Vnitr Lek 1971; 17:625-30. [PMID: 5564640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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