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  • 1. Andersson, M
    et al.
    Ekdahl, K
    Mölstad, Sigvard
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, General Practice.
    Hansson, HB
    Persson, K
    Giesecke, J
    Modelling the spread of penicillin-resistant Streptococcus pneumoniae in day-care and evaluation of intervention2005In: Statistics in Medicine, ISSN 0277-6715, E-ISSN 1097-0258, Vol. 24, p. 3593-607Article in journal (Refereed)
  • 2.
    Andre, M.
    et al.
    André, M., Centre for Clinical Research, Dalarna, Nissers väg 3, 791 82 Falun, Sweden.
    Hedin, K.
    Unit of RandD, Kronoberg County Council, Växjö, Sweden, Department of Clinical Science in Malmö - General Practice/Family Medicine, Lund University, Malmö, Sweden.
    Hakansson, A.
    Håkansson, A., Department of Clinical Science in Malmö - General Practice/Family Medicine, Lund University, Malmö, Sweden.
    Mölstad, Sigvard
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, General Practice.
    Rodhe, N.
    Centre for Clinical Research, Dalarna, Nissers väg 3, 791 82 Falun, Sweden.
    Petersson, C.
    Unit of RandD, Kronoberg County Council, Växjö, Sweden.
    More physician consultations and antibiotic prescriptions in families with high concern about infectious illness - Adequate response to infection-prone child or self-fulfilling prophecy?2007In: Family Practice, ISSN 0263-2136, E-ISSN 1460-2229, Vol. 24, no 4, p. 302-307Article in journal (Refereed)
    Abstract [en]

    Background. Respiratory tract infections (RTI) in children is the most common cause of prescription of antibiotics. It is important to describe and analyse non-medical factors in order to develop more rational use of antibiotics. Objectives. To compare families with high and low concern about infectious illness with regard to social variables, perception of infection proneness and beliefs in antibiotics and to relate the concern for infectious illness to reported morbidity, physician consultations and antibiotic prescriptions for the 18-month-old child in the family. Methods. A prospective, population-based survey was performed. During 1 month, all infectious symptoms, physician consultations and antibiotic treatments for 18-month-old children were noted. The 818 families also answered questions about their socio-economic situation, illness perception and concern about infectious illness. Results. High concern about infectious illness was associated with more frequent physicians consultations and more prescriptions of antibiotics. There was no significant difference in reported days with symptoms of RTI, but the parents more often experienced their children with RTI without fever as being ill. The variables of infection proneness in the child, inadequate beliefs in antibiotics and the factor of being the only child were important explanatory factors for concern about infectious illness. Conclusions. High concern about infectious illness is an important determining factor for physician consultations and antibiotic prescription for small children. An adequate consultation, where the doctor deals with the parents' worries and gives appropriate information about symptoms and disease, might contribute to less antibiotic prescribing with preserved parental satisfaction. © Published by Oxford University Press.

  • 3.
    André, Malin
    et al.
    Linköping University, Department of Medicine and Health Sciences. Linköping University, Faculty of Health Sciences.
    Borgquist, Lars
    Linköping University, Department of Medicine and Health Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in the West of Östergötland, Unit of Research and Development in Local Health Care, County of Östergötland.
    Foldevi, Mats
    Linköping University, Department of Medicine and Health Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Central County Primary Health Care.
    Mölstad, Sigvard
    Linköping University, Department of Medicine and Health Sciences. Linköping University, Faculty of Health Sciences.
    Asking for ’rules of thumb’: a way to discover tacit knowledge in general practice2002In: Family Practice, ISSN 0263-2136, Vol. 19, no 6, p. 617-622Article in journal (Refereed)
    Abstract [en]

    Background. Research in decision-making has identified heuristics (rules of thumb) as shortcuts to simplify search and choice.

    Objective. To find out if GPs recognize the use of rules of thumb and if they could describe what they looked like.

    Methods. An explorative and descriptive study was set up using focus group interviews. The interview guide contained the questions: Do you recognize the use of rules of thumb? Are you able to give some examples? What are the benefits and dangers in using rules of thumb? Where do they come from? The interviews were transcribed and analysed using the templates in the interview guide, and the examples of rules were classified by editing analysis.

    Results. Four groups with 23 GPs were interviewed. GPs recognized using rules of thumb, producing examples covering different aspects of the consultation. The rules for somatic problems were formulated as axiomatic simplified medical knowledge and taken for granted, while rules for psychosocial problems were formulated as expressions of individual experience and were followed by an explanation. The rules seemed unaffected by the sparse objections given. A GP’s clinical experience was judged a prerequisite for applying the rules. The origin of many rules was via word-of-mouth from a colleague. The GPs acknowledged the benefits of using the rules, thereby simplifying work.

    Conclusion. GPs recognize the use of rules of thumb as an immediate and semiconscious kind of knowledge that could be called tacit knowledge. Using rules of thumb might explain why practice remains unchanged although educational activities result in more elaborate knowledge.

  • 4.
    André, Malin
    et al.
    Linköping University, Department of Medicine and Health Sciences. Linköping University, Faculty of Health Sciences.
    Borgquist, Lars
    Linköping University, Department of Medicine and Health Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in the West of Östergötland, Unit of Research and Development in Local Health Care, County of Östergötland.
    Mölstad, Sigvard
    Linköping University, Department of Medicine and Health Sciences. Linköping University, Faculty of Health Sciences.
    Use of rules of thumb in the consultation in general practice: an act of balance between the individual and the general perspective2003In: Family Practice, ISSN 0263-2136, Vol. 20, no 5, p. 514-519Article in journal (Refereed)
    Abstract [en]

    Background. Rules of thumb used by GPs could be considered as empirical evidence of intuition and a link between science and practice in general practice.

    Objective. The purpose of the present study was to analyse the description of the application of rules of thumb with regard to different situations in general practice.

    Methods. An explorative and descriptive study was started with focus group interviews. Four groups with 23 GPs were interviewed. The interviews were transcribed and analysed, and the rules and their application were classified by an editing analysis.

    Results. A specific set of rules of thumb was used for rapid assessment, when emergency and psychosocial problems were identified. When the main focus of the problems was identified as somatic or psychosocial, the GPs did not disregard the other aspects but described the use of rules in a simultaneous individualizing and generalizing process. The rules contained probability reasoning and risk assessment.

    Conclusion. Rules of thumb seemed to serve as a link between theoretical knowledge and practical experience and were used by the GPs in an act of balance between the individual and the general perspective.

  • 5.
    André, Malin
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, General Practice.
    Eriksson, M
    Mölstad, Sigvard
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, General Practice.
    Strålby Lundborg, C
    Jacobsson, A
    Odenholt, I
    The management of infections in children in general practice in Sweden: A repeated 1-week diagnosis-prescribing study in 5 counties in 2000 and 20022005In: Scandinavian Journal of Infectious Diseases, ISSN 0036-5548, E-ISSN 1651-1980, Vol. 37, no 11-12, p. 863-869Article in journal (Refereed)
    Abstract [en]

    A diagnosis-prescribing study was performed in 5 Swedish counties during 1 week in November in 2000 and repeated in 2002. The aim of the present study was to analyse data for children 0-15 y of age who consulted a general practitioner with symptoms of an infection. During the 2 weeks studied, 4049 children were consulted. Respiratory tract infections (RTI) were the predominant diagnoses, above all among the youngest children, while the proportion of urinary tract infections and skin infections increased with increasing age. Between the y 2000 and 2002, the proportion of children allocated the diagnosis streptococcal tonsillitis and pneumonia decreased (p<0.01 and p<0.001, respectively) while the proportion of common cold increased (p <0.001). Antibiotic prescribing decreased from 55% to 48% (p <0.001) for respiratory infections between the years studied. The only significant changes in type of antibiotics prescribed were the increase of isoxazolylpenicillins (p<0.001) used for skin infection and the decrease of macrolides (p=0.001). A diagnostic test was used in more than half of the consultations. Of children allocated a RTI diagnosis, 36% were prescribed antibiotics when a C-reactive protein test was performed compared to 58% in those not tested. Further studies are needed in general practice to determine the optimal use of near-patient tests in children with RTI. © 2005 Taylor & Francis.

  • 6.
    André, Malin
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, General Practice.
    Mölstad, Sigvard
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, General Practice.
    Nya riktlinger för urinvägsinfektion hos kvinnor2008In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 105, no 15, p. 1107-1109Article in journal (Refereed)
    Abstract [sv]

      

  • 7.
    André, Malin
    et al.
    Linköping University, Department of Medicine and Health Sciences, Primary Care . Linköping University, Faculty of Health Sciences.
    Mölstad, Sigvard
    Unit of Research and Development in Primary Care, Jönköping, Sweden.
    Stålsby Lundborg, Cecilia
    Department of Public Health Sciences, Division of International Health (IHCAR), Karolinska Instituet Apoteket AB, Stockholm and Nordic School of Health, Gothenburg, Sweden.
    Odenholt, Inga
    Department of Infectious Diseases, University Hospital, MAS, Malmö, Sweden.
    Management of urinary tract infections in primary care: A repeated 1-week diagnosis-prescribing study in five counties in Sweden in 2000 and 20022004In: Scandinavian Journal of Infectious Diseases, ISSN 0036-5548, Vol. 36, no 2, p. 134-138Article in journal (Refereed)
    Abstract [en]

    A diagnosis-antibiotic prescribing study was performed in 5 counties in Sweden during 1week in November in the y 2000 and 2002, respectively. As part of the study, the characteristics and clinical management of patients who received diagnoses of urinary tract infections (UTIs) (n=1564) in primary care, were analysed. 85% of the visits were by women, and 74% of all consultations were diagnosed as lower UTIs. One or more diagnostic tests were performed in 98% of the women with suspected lower or recurrent UTIs and 95% were prescribed an antibiotic. The most commonly prescribed antibiotics for lower UTIs were trimethoprim followed by pivmecillinam and a quinolone. The study indicated a change in antibiotic prescribing with improved adherence to the national recommendations. There was an increase of prescribed nitrofurantoin and a decrease of prescribed quinolones to women with lower UTIs between the studied y. Furthermore, 3-d treatment with trimethoprim increased although the prescribed duration was mostly 7 d. In contrast to the guidelines, few urine cultures were performed. The study highlights the necessity of updating the guidelines for the management of lower UTIs in general practice.

  • 8.
    André, Malin
    et al.
    Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Health Sciences.
    Odenholt, Inga
    Schwan, Åke
    Axelsson, I.
    Eriksson, M.
    Hoffman, M.
    Mölstad, Sigvard
    Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Health Sciences.
    Runehagen, A.
    Lundborg, CS.
    Wahlström, R.
    Upper respiratory tract infections in general practice: diagnosis, antibiotic prescribing, duration of symptoms and use of diagnostic tests2002In: Scandinavian Journal of Infectious Diseases, ISSN 2374-4235, Vol. 34, no 12, p. 880-886Article in journal (Refereed)
    Abstract [en]

    A diagnosis/antibiotic prescribing study was performed in 5 counties in Sweden for 1 week in November 2000. As part of this study, the characteristics and clinical management of patients with upper respiratory tract infections (n = 2899) in primary care were analyzed. Almost half of the patients were aged < 15 y and one-fifth of the patients consulted out of hours. Of all patients seeking primary care for upper respiratory tract infections, 56.0% were prescribed an antibiotic. Almost all patients who were given the diagnoses streptococcal tonsillitis, acute otitis media or acute sinusitis were prescribed antibiotics, compared to 10% of patients with common cold or acute pharyngitis. The most frequently prescribed antibiotic was penicillin V (79.2%) and this was even more pronounced out of hours, when the diagnoses otitis media and streptococcal tonsillitis were more frequently used. In patients with common cold and acute pharyngitis, the percentage who received antibiotics increased with increasing length of symptoms and increasing CRP levels. In patients with acute pharyngitis or streptococcal tonsillitis, antibiotics were prescribed less frequently provided streptococcal tests were performed. The management of patients with upper respiratory tract infections in general practice seems to be in good agreement with current Swedish guidelines. However, the study indicates some areas for improvement. The diagnosis of acute sinusitis seems to have been overestimated and used only to justify antibiotic treatment.

  • 9.
    André, Malin
    et al.
    Linköping University, Department of Medicine and Health Sciences. Linköping University, Faculty of Health Sciences.
    Schwan, Åke
    Department of Public Health and Caring Sciences/Family Medicine, Uppsala University, Uppsala.
    Odenholt, Inga
    Department of Infectious Diseases, University Hospital, Malmö.
    Axelsson, I.
    Eriksson, M.
    Mölstad, Sigvard
    Linköping University, Department of Medicine and Health Sciences. Linköping University, Faculty of Health Sciences.
    Runehagen, A.
    Lundborg, CS.
    The Use of CRP Tests in Patients with Respiratory Tract Infections in Primary Care in Sweden Can Be Questioned2004In: Scandinavian Journal of Infectious Diseases, ISSN 0036-5548, Vol. 36, no 3, p. 192-197Article in journal (Refereed)
    Abstract [en]

    A diagnosis-antibiotic prescribing study was performed in 5 counties in Sweden during 1 week in November in 2000 and 2002 respectively. As a part of the study, the use and results of C-reactive protein (CRP) tests in relation to duration of symptoms and antibiotic prescribing in 6778 patients assigned a diagnosis of respiratory tract infections were analysed. In almost half (42%) of the patients, a CRP test was performed. The majority of CRP tests (69%) were performed in patients assigned diagnosis upper respiratory tract infection, where the test is not recommended. Overall, there was a minor decrease in antibiotic prescribing when CRP was used (41%), in comparison to 44% of the patients where no CRP was performed (p<0.01). Patients assigned diagnoses implying a bacterial aetiology were prescribed antibiotics irrespective of result of CRP or length of symptoms before consultation. For patients assigned viral diagnoses, antibiotic prescribing increased with increasing duration of symptoms and increasing value of CRP. The use of CRP decreased antibiotic prescribing in patients assigned to viral diagnoses and with longstanding symptoms (p<0.001). However, 59% of the patients assigned viral diagnoses with CRP≥25 received antibiotics, which seems to indicate a misinterpretation of CRP and a non-optimal use of antibiotics.

  • 10.
    André, Malin
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, General Practice.
    Vernby, Åsa
    KI .
    Odenholt, Inga
    Lund univ .
    Stålby Lundborg, Cecilia
    KI .
    Axelsson, Inge
    Oslo .
    Eriksson, Margareta
    Karolinska univ sjukhuset .
    Rundhagen, Arne
    Växjö sjukhus .
    Schwan, Åke
    Uppsala univ .
    Mölstad, Sigvard
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, General Practice.
    Diagnosis-prescribing surveys in 2000, 2002 and 2005 in Swedish general practice: Consultations, diagnosis, diagnostics and treatment choices2008In: Scandinavian Journal of Infectious Diseases, ISSN 0036-5548, E-ISSN 1651-1980, Vol. 40, no 8, p. 648-654Article in journal (Refereed)
    Abstract [en]

    The aim of this study is to present diagnostic patterns, diagnostics used and antibiotic treatment in relation to guidelines in 3 repeated diagnosis-prescription studies conducted simultaneously in general practice in 5 Swedish counties, during 1 week in November 2000, 2002 and 2005. General practitioners (GPs) at the participating health centres were asked to complete a form for all patients with symptoms of an infectious disease. During the studied periods a total of 15,371 consultations was registered. Consultations with GPs diagnosed as respiratory tract infection (RTI), especially consultations for sore throat, decreased considerably between y 2000 and 2005. The percentage of patients allocated an RTI diagnosis and prescribed an antibiotic declined significantly from 54% to 49% and the decline was most pronounced among children. Penicillin V remained the dominant antibiotic prescribed throughout the study periods. For lower urinary tract infections there was a significant change in choice of prescribed antibiotics with an increase for pivmecillinam and nitrofurantoin and a decrease for trimethoprim, in accordance with recommendations. The results indicate a quite close adherence to current guidelines, with changes in the pattern of consultations as well as in the management of infectious diseases in general practice in Sweden.

  • 11.
    André, Malin
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, General Practice.
    Vernby, Åsa
    KI .
    Odenholt, Inga
    Malmö univ .
    Stålsby Lundborg, Cecilia
    KI .
    Axelsson, Inge
    Östersunds sjukhus .
    Eriksson, Margareta
    Stockholm .
    Runehagen, Arne
    Centrallasarettet Växjö .
    Schwan, Åke
    Uppsala univ .
    Mölstad, Sigvard
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, General Practice.
    Allmänläkare förskrev mindre antibiotika men utnyttjade CRP-test mer. Diagnos-förskrivningsstudier för åren 2000-20052008In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 105, no 41, p. 2851-2854Article in journal (Refereed)
    Abstract [sv]

      

  • 12.
    Barabas, G
    et al.
    Rosenlunds Health Care Centre, Jönköping.
    Mölstad, Sigvard
    Unit of Research and Development in Primary Care, Jönköping.
    No association between elevated post-void residual volume and bacteriuria in residents of nursing homes2005In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 23, no 1, p. 52-56Article in journal (Refereed)
    Abstract [en]

    Objective To evaluate the concept that increased post-void residual urine volume (PVR) is a risk factor for bacteriuria. Design Cross-sectional study. Setting Three nursing homes in Jönköping, southern Sweden. Subjects A total of 147 elderly residents in municipal nursing homes. Main outcome values PVR volumes measured with a portable ultrasonic bladder scan, urine specimen, and questionnaire data on incontinence, immobility, impaired cognition, neurological diseases, and medications. Results Mean age was 86 years and 78% were women. The prevalence of a PVR for the four chosen cut-off values (30, 50, 100, and 150 ml) was 51%, 39%, 20%, and 7%, respectively. The prevalence of bacteriuria was 42%, 46% for women and 28% for men. Elevated PVR was not associated with bacteriuria, incontinence, immobility, impaired cognition or neurological disease (stroke, Parkinson's disease). Conclusion Bacteriuria and elevated PVR are common among elderly residents in nursing homes. The study could not confirm that elevated PVR predisposes to bacteriuria in elderly residents in nursing homes.

  • 13. Bronzwaer, S
    et al.
    Cars, O
    Buchholz, U
    Mölstad, Sigvard
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, General Practice.
    Goettsch, W
    Veldhuijzen, I
    Kool, J
    Sprenger, M
    Degener, J
    The Relationship between Antimicrobial Use and Antimicrobial Resestance in Europe2002In: Emerging Infectious Diseases, ISSN 1080-6040, E-ISSN 1080-6059, Vol. 8, p. 278-282Article in journal (Refereed)
  • 14.
    Butler, C.C.
    et al.
    Cardiff University.
    Kelly, M.J.
    Cardiff University.
    Hood, K.
    Cardiff University.
    Schaberg, T.
    Deaconess Hospital Rotenburg.
    Melbye, H.
    University of Tromso.
    Serra-Prat, M.
    Hospital Mataro.
    Blasi, F.
    University of Milan.
    Little, P.
    University of Southampton.
    Verheij, T.
    University Medical Centre Utrecht.
    Mölstad, Sigvard
    Linköping University, Department of Medical and Health Sciences, General Practice. Linköping University, Faculty of Health Sciences.
    Godycki-Cwirko, M.
    Medical University of Lodz.
    Edwards, P.
    Ely Bridge Surgery.
    Almirall, J.
    Hospital Mataro.
    Torres, A.
    University Barcelona.
    Rautakorpi, U-M.
    Natl Institute Hlth and Welf THL.
    Nuttall, J.
    Cardiff University.
    Goossens, H.
    University of Antwerp.
    Coenen, S.
    University of Antwerp.
    Antibiotic prescribing for discoloured sputum in acute cough/lower respiratory tract infection2011In: European Respiratory Journal, ISSN 0903-1936, E-ISSN 1399-3003, Vol. 38, no 1, p. 119-125Article in journal (Refereed)
    Abstract [en]

    We investigated whether discoloured sputum and feeling unwell were associated with antibiotic prescription and benefit from antibiotic treatment for acute cough/lower respiratory tract infection (LTRI) in a prospective study of 3,402 adults in 13 countries. A two-level model investigated the association between producing discoloured sputum or feeling generally unwell and an antibiotic prescription. A three-level model investigated the association between an antibiotic prescription and symptom resolution. Patients producing discoloured sputum were prescribed antibiotics more frequently than those not producing sputum (OR 3.2, 95% CI 2.1-5.0), unlike those producing clear/white sputum (OR 0.95, 95% CI 0.61-1.48). Antibiotic prescription was not associated with a greater rate or magnitude of symptom score resolution (as measured by a 13-item questionnaire completed by patients each day) among those who: produced yellow (coefficient 0.00; p=0.68) or green (coefficient -0.01; p=0.11) sputum; reported any of three categories of feeling unwell; or produced discoloured sputum and felt generally unwell (coefficient -0.01; p=0.19). Adults with acute cough/LRTI presenting in primary care settings with discoloured sputum were prescribed antibiotics more often compared to those not producing sputum. Sputum colour, alone or together with feeling generally unwell, was not associated with recovery or benefit from antibiotic treatment.

  • 15.
    Butler, Christopher C
    et al.
    Cardiff University.
    Kelly, Mark J
    Cardiff University.
    Goossens, Herman
    University of Antwerp.
    Verheij, Theo
    University Medical Centre Utrecht.
    Little, Paul
    University of Southampton.
    Melbye, Hasse
    University of Tromso.
    Torres, Antoni
    University of Barcelona.
    Mölstad, Sigvard
    Linköping University, Department of Medicine and Health Sciences, General Practice. Linköping University, Faculty of Health Sciences.
    Godycki-Cwirko, Maciek
    Medical University Lodz.
    Almirall, Jordi
    Hospital Mataro.
    Blasi, Francesco
    University of Milan.
    Schaberg, Tom
    Deaconess Hospital Rotenburg.
    Edwards, Peter
    Ely Bridge Surg, Cardiff.
    Rautakorpi, Ulla-Maija
    Tampere Off.
    Hupkova, Helena
    Comenius University.
    Wood, Joseph
    Cardiff University.
    Nuttall, Jacqui
    Cardiff University.
    Coenen, Samuel
    University of Antwerp.
    Treatment of acute cough/lower respiratory tract infection by antibiotic class and associated outcomes: a 13 European country observational study in primary care2010In: JOURNAL OF ANTIMICROBIAL CHEMOTHERAPY, ISSN 0305-7453, Vol. 65, no 11, p. 2472-2478Article in journal (Refereed)
    Abstract [en]

    Acute cough/lower respiratory tract infection (LRTI) is one of the commonest reasons for consulting and antibiotic prescribing. There are theoretical reasons why treatment with particular antibiotic classes may aid recovery more than others, but empirical, pragmatic evidence is lacking. We investigated whether treatment with a particular antibiotic class (amoxicillin) was more strongly associated with symptom score resolution and time to patients reporting recovery than each of eight other antibiotic classes or no antibiotic treatment for acute cough/LRTI. Clinicians recorded history, examination findings, symptom severity and antibiotic treatment for 3402 patients in a 13 country prospective observational study of adults presenting in 14 primary care research networks with acute cough/LRTI. 2714 patients completed a symptom score daily for up to 28 days and recorded the day on which they felt recovered. A three-level autoregressive moving average model (1,1) model investigated logged daily symptom scores to analyse symptom resolution. A two-level survival model analysed time to reported recovery. Clinical presentation was controlled for using clinician-recorded symptoms, sputum colour, temperature, age, co-morbidities, smoking status and duration of illness prior to consultation. Compared with amoxicillin, no antibiotic class (and no antibiotic treatment) was associated with clinically relevant improved symptom resolution (all coefficients in the range -0.02 to 0.01 and all P values greater than 0.12). No antibiotic class (and no antibiotic treatment) was associated with faster time to recovery than amoxicillin. Treatment by antibiotic class was not associated with symptom resolution or time to recovery in adults presenting to primary care with acute cough/LRTI.

  • 16.
    Butler, Christopher
    et al.
    Department of Primary Care and Public Health, School of Medicine, Cardiff University, Cardiff CF14 4XN, United Kingdom.
    Hood, Kerry
    South East Wales Trials Unit (SEWTU), School of Medicine, Cardiff University, United Kingdom.
    Verheij, Theo
    Julius Centrum Voor Gezondheidswetenschappen en Eerstelijns Geneeskunde, Universitair Medisch Centrum Utrecht, Utrecht, Netherlands.
    Little, Paul
    University of Southampton, United Kingdom.
    Melbye, Hasse
    Institutt for Samfunnsmedisin, Universitetet Tromsø, Norway.
    Nuttall, Jacqueline
    South East Wales Trials Unit (SEWTU), School of Medicine, Cardiff University, United Kingdom.
    Kelly, Mark
    South East Wales Trials Unit (SEWTU), School of Medicine, Cardiff University, United Kingdom.
    Mölstad, Sigvard
    Linköping University, Department of Medical and Health Sciences, General Practice. Linköping University, Faculty of Health Sciences.
    Godycki-Cwirko, Maciek
    Uniwersytet Medyczny W Lodzi, Lodz, Poland.
    Almirall, Jordi
    Unitat de Cures Intensives, Hospital de Mataró, Barcelona, Spain.
    Torres, Antoni
    Servei de Pneumologia I Allèrgia Respiratoria, Institut Clínic del Tòrax, Hospital Clínic de Barcelona, Spain.
    Gillespie, David
    South East Wales Trials Unit (SEWTU), School of Medicine, Cardiff University, United Kingdom.
    Coenen, Samuel
    Vaccin and Infectieziekten Instituut (VAXINFECTIO), Universiteit Antwerpen, Antwerpen, Belgium.
    Goossens, Herman
    Universiteit Antwerpen, Antwerpen, België.
    Antibiotica voor acute hoest: het voorschrijfgedrag van huisartsen in dertien Europese landen [Antibiotics in case of acute cough: Prescribing habits of general practitioners in 13 European countries]2009In: Huisarts en Wetenschap, ISSN 0018-7070, Vol. 52, no 12, p. 571-575Article in journal (Refereed)
    Abstract [nl]

    Doel Ons doel was in kaart te brengen hoe vaak huisartsen in verschillende Europese landen antibiotica voorschrijven voor acute hoest, en welk effect dit heeft op het ziektebeloop.

    Methode Wij verrichtten een cross-sectioneel prospectief observationeel onderzoek onder volwassen patiënten in 13 Europese landen die met een nieuwe of verergerende hoest bij de huisarts kwamen of bij wie de huisarts een infectie van de lage luchtwegen vermoedde. De huisartsen noteerden bij presentatie de symptomen en welk beleid zij volgden, de patiënten hielden 28 dagen een symptoomdagboek bij. Onze primaire uitkomstmaten waren het voorschrijven van antibiotica en het beloop van de symptomen in de tijd.

    Resultaten Aan het onderzoek namen 384 huisartsen deel, die 3402 patiënten includeerden. Van 3296 (97%) patiënten ontvingen de onderzoekers een volledig registratieformulier en van 2560 (75%) patiënten een compleet symptoomdagboek. De ernst van de symptomen bij presentatie (gescoord door de huisarts op een schaal van 0 tot 100) varieerde van 19 in Spanje en Italië tot 38 in Zweden. In gemiddeld 53% van de episoden schreven de artsen antibiotica voor, maar dit varieerde per land van 20% tot bijna 90% (België 25,9%, Nederland 41,5%). Ook na correctie voor klinische presentatie en demografische kenmerken bleven de verschillen aanzienlijk. Noorse huisartsen schreven het minst vaak antibiotica voor (OR 0,18; 95%-BI 0,11 tot 0,30), Slowaakse het vaakst (OR 11,2; 95%-BI 6,20 tot 20,27). Ook het soort antibioticum varieerde sterk. Amoxicilline, het meest voorgeschreven middel, werd in Noorwegen het minst vaak gegeven (3% van de voorgeschreven antibiotica), in Engeland het vaakst (83%). Fluorochinolonen werden in sommige landen helemaal niet voorgeschreven, maar in Italië aan 18% van de patiënten. Patiënten die geen antibiotica kregen, herstelden nagenoeg even snel als patiënten die wel antibiotica kregen.

    Conclusie De variatie in de klinische presentatie biedt geen verklaring voor de grote verschillen in het voorschrijven van antibiotica bij lageluchtweginfecties en/of hoest in Europa. Antibiotica hebben nauwelijks invloed op het herstel van de hoestklachten.

  • 17. Cars, Otto
    et al.
    Mölstad, Sigvard
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, General Practice.
    Melander, Arne
    Variation in antibiotic use in the European Union2001In: The Lancet, ISSN 0140-6736, E-ISSN 1474-547X, Vol. 357, p. 1851-1853Article in journal (Refereed)
  • 18.
    Engström, Sven
    et al.
    Linköping University, Department of Medicine and Health Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Central County Primary Health Care.
    Mölstad, Sigvard
    Linköping University, Department of Medicine and Health Sciences. Linköping University, Faculty of Health Sciences.
    Lindström, Kjell
    Östergötlands Läns Landsting, Local Health Care Services in the West of Östergötland, Unit of Research and Development in Local Health Care, County of Östergötland.
    Nilsson, Gunnar
    Department of Clinical Science, Family Medicine Stockholm, Karolinska Institute, Stockholm.
    Borgquist, Lars
    Linköping University, Department of Medicine and Health Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in the West of Östergötland, Unit of Research and Development in Local Health Care, County of Östergötland.
    Excessive use of rapid tests in respiratory tract infections in Swedish primary health care2004In: Scandinavian Journal of Infectious Diseases, ISSN 0036-5548, Vol. 36, no 3, p. 213-218Article in journal (Refereed)
    Abstract [en]

    A 1-y retrospective study of problem oriented electronic patient records, for encounters concerning respiratory tract infection, was performed. The aim was to analyse the management of respiratory tract infections in primary health care in terms of diagnostic coding, tests and antibiotic treatment using data from electronic patient records. 12 primary health care centres with a registered population of 102,050 residents in 3 counties in southeast Sweden participated. Data were retrieved electronically from records of patient encounters concerning respiratory tract infections. The data were: patient age and gender, date of contact, diagnostic code, CRP and GABHS tests and results, as well as antibiotic prescriptions. In a total of 19,965 encounters, the most frequent diagnoses were common cold (40%), acute tonsillitis (18%), and acute bronchitis (15%). A total of 4445 GABHS tests (in 22% of encounters) and 6141 CRP tests (31%) were performed, and both tests were done in 1910 encounters (10%). A total of 7934 antibiotic prescriptions were registered. The proportion of patients tested and prescribed an antibiotic varied greatly between centres. We found an excessive, and much varying, use of rapid tests in encounters for respiratory tract infections. Data retrieval from electronic patient record systems was a feasible method to study the use of laboratory tests in relation to pharmacological treatment.

  • 19.
    Engström, Sven
    et al.
    Linköping University, Department of Medicine and Health Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Central County Primary Health Care.
    Mölstad, Sigvard
    Linköping University, Department of Medicine and Health Sciences. Linköping University, Faculty of Health Sciences.
    Nilsson, Gunnar
    Department of Clinical Science, Family Medicine Stockholm, Karolinska Institute, Stockholm, Sweden.
    Lindström, Kjell
    Östergötlands Läns Landsting, Local Health Care Services in the West of Östergötland, Unit of Research and Development in Local Health Care, County of Östergötland.
    Borgquist, Lars
    Linköping University, Department of Medicine and Health Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in the West of Östergötland, Unit of Research and Development in Local Health Care, County of Östergötland.
    Data from electronic patient records are suitable for surveillance of antibiotic prescriptions for respiratory tract infections in primary health care2004In: Scandinavian Journal of Infectious Diseases, ISSN 0036-5548, Vol. 36, no 2, p. 139-143Article in journal (Refereed)
    Abstract [en]

    Diagnoses and antibiotic treatments were analysed in relation to respiratory tract infections (RTI). A 1-y retrospective study was made of electronic patient records (EPR) for encounters concerning RTIs in primary health care in Sweden. The study covered a registered population of 102,050 individuals at 12 primary health care centres in 3 counties. Data were recorded on number of episodes, encounters, diagnostic codes and antibiotic prescriptions. The yearly number of episodes of RTIs was 16,964 or 166 per 1000 inhabitants per y. The total number of encounters was 19,965. The most frequent diagnoses were common cold (40%), acute tonsillitis (18%), and acute bronchitis (15%). The yearly number of antibiotic prescriptions was 7961, accounting for 47% of the episodes or 78 per 1000 inhabitants per y. The most frequently prescribed antibiotics were phenoxymethylpenicillin (61%), tetracyclines (18%) and macrolides 8%). Standard EPRs provide a feasible source of clinical information which, taking limitations into consideration, could be used for the follow-up of trends in antibiotic prescribing and of adherence to guidelines with regard to RTIs.

  • 20.
    Hedin, K.
    et al.
    Unit of R and D, Kronoberg County Council, Växjö, Sweden, Department of Clinical Sciences in Malmö - General Practice/Family Medicine, Lund University, FoU Centrum, Box 1223, S-351 12 Växjö, Sweden.
    Andre, M.
    Centre for Clinical Research, Dalarna, Falun, Sweden.
    Hakansson, A.
    Håkansson, A., Department of Clinical Sciences in Malmö - General Practice/Family Medicine, Lund University.
    Mölstad, Sigvard
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, General Practice.
    Rodhe, N.
    Centre for Clinical Research, Dalarna, Falun, Sweden.
    Petersson, C.
    Unit of R and D, Kronoberg County Council, Växjö, Sweden.
    Physician consultation and antibiotic prescription in Swedish infants: Population-based comparison of group daycare and home care2007In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 96, no 7, p. 1059-1063Article in journal (Refereed)
    Abstract [en]

    Background: Daycare infants have more infectious episodes, see a physician more often, and are prescribed antibiotics more often than home care infants. Aim: To compare physician consultations and antibiotic prescription in daycare children and home care children taking number of symptom days, sociodemographic factors, concern about infectious illness and antibiotic knowledge into account. Methods: For a cohort of Swedish 18-month-old children all infectious symptoms, physician consultation and antibiotic prescriptions were registered during 1 month. Results: 561 infants with daycare outside the home and 278 with daycare at home were included. Of the daycare infants, 23.2% saw a physician and 11.4% were prescribed antibiotics, as compared with 10.8% physician consultations and 5.0% antibiotic prescription for the home care infants. For daycare infants the crude odds ratio for physician consultation were 2.49 (1.63-3.82) and for antibiotic prescription 2.43 (1.34-4.41) compared with home care infants. However, these differences were no longer statistically significant when background data, concern about infectious illness and reported symptoms were taken into account. Conclusion: When background data, concern about infectious illness and reported infectious symptoms were taken into account daycare infants saw a physician and was prescribed antibiotics in the same way as home care infants © 2007 The Author(s).

  • 21.
    Hedin, K.
    et al.
    Unit of R and D, Landstinget Kronoberg, Department of Clinical Sciences in Malmö - General Practice/Family Medicine, Lund University, FoU Centrum Box 1223, SE-351 12 Växjö, Sweden.
    Andre, M.
    Centre for Clinical Research, Dalarna, Falun.
    Mölstad, Sigvard
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, General Practice.
    Rodhe, N.
    Centre for Clinical Research, Dalarna, Falun.
    Petersson, C.
    Unit of R and D, Landstinget Kronoberg.
    Infections in families with small children: Use of social insurance and healthcare2006In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 24, no 2, p. 98-103Article in journal (Refereed)
    Abstract [en]

    Objective. To examine infectious symptoms on a daily basis in families with small children and how often these infections cause people to stay at home or seek healthcare. Design. A population-based prospective study. Setting. Child health clinics in seven municipalities in Sweden. Subjects and main outcome measures. All family members of 835 families who came with an 18-month-old child to a child health clinic were asked to register all infectious symptoms in a diary for a month. They were also asked to indicate whether they had stayed at home from day-care or school, whether social insurance had been used, and whether they had contacted healthcare facilities or seen a physician. Results. In total, 7% of the 18-month-old children and 34% of the parents had no symptoms during the winter month. The most common symptom was a runny nose. The 18-month-old children had 1.6 symptom episodes with an average duration of 5.6 days. Of the symptom episodes 13% led to contact with healthcare facilities and 6% to an antibiotic prescription. Of the symptom days 27% required staying at home and in 10% social insurance was claimed. Conclusion. Symptoms of infection among families with small children were common, with a runny nose being the most common. Physician consultations and antibiotic prescriptions were used in a small proportion of the symptom episodes. Social insurance was claimed in about one-third of the days with absence from day-care. © 2006 Taylor & Francis.

  • 22.
    Hedin, Katarina
    et al.
    Kronoberg County Council.
    Andre, Malin
    Clinical Research Centre, Dalarna.
    Hakansson, Anders
    Lund University.
    Mölstad, Sigvard
    Linköping University, Department of Medicine and Health Sciences, General Practice. Linköping University, Faculty of Health Sciences.
    Rodhe, Nils
    Clinical Research Centre, Dalarna.
    Petersson, Christer
    Kronoberg County Council.
    Infectious morbidity in 18-month-old children with and without older siblings2010In: FAMILY PRACTICE, ISSN 0263-2136, Vol. 27, no 5, p. 507-512Article in journal (Refereed)
    Abstract [en]

    Background. Infections are the most commonly reported health problems in children. Younger age and day care outside the home are two factors of importance for infectious morbidity. The influence of siblings on infectious symptoms is not clear. Objectives. To compare families with one child and families with more than one child in terms of reported infectious symptoms, physician consultations and antibiotic prescriptions. Methods. A prospective population-based survey was performed. During 1 month, all infectious symptoms, physician consultations and antibiotic prescriptions for 18-month-old children were noted by the parents. The 789 families also answered questions about socio-economic factors, numbers of siblings in the family and type of day care. Results. No difference in number of symptom days was found between children with and without older siblings. Neither could we find any significance in terms of having older siblings in relation to physician consultations and antibiotic prescriptions. Conclusions. The results of our study indicate that having older siblings not was important in relation to number of symptoms days, physician consultations or antibiotic prescriptions for 18-month-old children in Sweden today. Changes in social activities and attitudes towards antibiotic prescription may explain our different findings as compared with previous Swedish studies and studies from other countries.

  • 23.
    Hedin, Kristina
    et al.
    Unit of R&D, Kronoberg County Council, Växjö and Department of Clinical Science in Malmö, Sweden.
    André, Malin
    Centre for Clinical Research, Dalarna, Falun, Sweden.
    Hakansson, Anders
    Department of Clinical Science in Malmö — General Practice/Family Medicine, Lund University, Sweden.
    Mölstad, Sigvard
    Linköping University, Department of Medical and Health Sciences, General Practice. Linköping University, Faculty of Health Sciences. Unit of R&D in Primary Health Care, Jönköping.
    Rodhe, Nils
    Centre for Clinical Research, Dalarna, Falun, Sweden.
    Petersson, Christer
    Unit of R&D, Kronoberg County Council, Växjö and Department of Clinical Science in Malmö, Sweden.
    A population-based study of different antibiotic prescribing in different areas2006In: British Journal of General Practice, ISSN 0960-1643, E-ISSN 1478-5242, Vol. 56, no 530, p. 680-685Article in journal (Refereed)
    Abstract [en]

    Background Respiratory tract infections are the most common reason for antibiotic prescription in Sweden as in other countries. The prescription rates vary markedly in different countries, counties and municipalities. The reasons for these variations in prescription rate are not obvious.

    Aim To find possible explanations for different antibiotic prescription rates in children.

    Design of study Prospective population based study.

    Setting All child health clinics in four municipalities in Sweden which, according to official statistics, had high antibiotic prescription rates, and all child health clinics in three municipalities which had low antibiotic prescription rates.

    Method During one month, parents recorded all infectious symptoms, physician consultations and antibiotic treatments, from 848 18-month-old children in a log book. The parents also answered a questionnaire about socioeconomic factors and concern about infectious diseases.

    Results Antibiotics were prescribed to 11.6% of the children in the high prescription area and 4.7% in the low prescription area during the study month (crude odds ratio [OR] = 2.67; 95% confidence interval [CI] = 1.45 to 4.93). After multiple logistic regression analyses taking account of socioeconomic factors, concern about infectious illness, number of symptom days and physician consultations, differences in antibiotic prescription rates remained (adjusted OR = 2.61; 95% CI = 1.14 to 5.98). The variable that impacted most on antibiotic prescription rates, although it was not relevant to the geographical differences, was a high level of concern about infectious illness in the family.

    Conclusions The differences in antibiotic prescription rates could not be explained by socioeconomic factors, concern about infectious illness, number of symptom days and physician consultations. The differences may be attributable to different prescription behaviour.

  • 24.
    Jakobsen, Kristin Alise
    et al.
    University of Tromso.
    Melbye, Hasse
    University of Tromso.
    Kelly, Mark J
    Cardiff University.
    Ceynowa, Christina
    Carema Health Centre, Stockholm, Sweden .
    Mölstad, Sigvard
    Linköping University, Department of Medicine and Health Sciences, General Practice. Linköping University, Faculty of Health Sciences.
    Hood, Kerenza
    Cardiff University.
    Butler, Christopher C
    Cardiff University.
    Influence of CRP testing and clinical findings on antibiotic prescribing in adults presenting with acute cough in primary care2010In: SCANDINAVIAN JOURNAL OF PRIMARY HEALTH CARE, ISSN 0281-3432, Vol. 28, no 4, p. 229-236Article in journal (Refereed)
    Abstract [en]

    Objective. Respiratory tract infections are the most common indication for antibiotic prescribing in primary care. The value of clinical findings in lower respiratory tract infection (LRTI) is known to be overrated. This study aimed to determine the independent influence of a point of care test (POCT) for C-reactive protein (CRP) on the prescription of antibiotics in patients with acute cough or symptoms suggestive of LRTI, and how symptoms and chest findings influence the decision to prescribe when the test is and is not used. Design. Prospective observational study of presentation and management of acute cough/LRTI in adults. Setting. Primary care research networks in Norway, Sweden, and Wales. Subjects. Adult patients contacting their GP with symptoms of acute cough/LRTI. Main outcome measures. Predictors of antibiotic prescribing were evaluated in those tested and those not tested with a POCT for CRP using logistic regression and receiver operating characteristic (ROC) curve analysis. Results. A total of 803 patients were recruited in the three networks. Among the 372 patients tested with a POCT for CRP, the CRP value was the strongest independent predictor of antibiotic prescribing, with an odds ratio (OR) of CRP andgt;= 50 mg/L of 98.1. Crackles on auscultation and a patient preference for antibiotics perceived by the GP were the strongest predictors of antibiotic prescribing when the CRP test was not used. Conclusions. The CRP result is a major influence in the decision whether or not to prescribe antibiotics for acute cough. Clinicians attach less weight to discoloured sputum and abnormal lung sounds when a CRP value is available. CRP testing could prevent undue reliance on clinical features that poorly predict benefit from antibiotic treatment.

  • 25.
    Lindström, Kjell
    et al.
    Unit of Research and Development in Primary Care, Jönköping, Sweden.
    Ekedahl, Anders
    Department of Research and Development, National Corporation of Swedish Pharmacies.
    Carlsten, Anders
    Department of Research and Development, National Corporation of Swedish Pharmacies.
    Mårtensson, Jan
    Unit of Research and Development in Primary Care, Jönköping, Sweden and Department of Nursing Science, School of Health Sciences, Jönköping, Sweden.
    Mölstad, Sigvard
    Linköping University, Department of Department of Health and Society, General Practice. Linköping University, Faculty of Health Sciences.
    Can selective serotonin inhibitor drugs in elderly patients in nursing homes be reduced?2007In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 25, no 1, p. 3-8Article in journal (Refereed)
    Abstract [en]

    Objective. To investigate whether treatment with selective serotonin reuptake inhibitors (SSRIs) could be withdrawn for elderly residents who had been on treatment for at least one year and to evaluate a method for systematic drug review.

    Design. Open, prospective, interventional study.

    Setting. Four counties in Sweden. Subjects. Elderly residents at 19 nursing homes, with ongoing treatment with SSRIs for more than one year.

    Main outcome measures. Clinical evaluation, registration of drugs used and rating with Montgomery–Åsberg Depression Rating Scale (MADRS). A semi-structured telephone interview with 15 participating physicians and 19 nurses.

    Results. About one-third of all 822 residents in the nursing homes had ongoing antidepressant treatment, predominantly with SSRIs; 75% of them had been treated with SSRIs for at least one year and 119 (60%) of these were considered eligible for the study. The intervention was judged successful in 52% of these residents of whom 88% had a MADRS rating of less than 20 points. The GPs and the nurses experienced the method as practicable.

    Conclusions. Withdrawal of SSRI treatment was successful in the majority of cases. The MADRS may be a valuable addition to clinical evaluation when deciding whether to end or continue SSRI treatment.

  • 26.
    Little, Paul
    et al.
    University of Southampton, England .
    Stuart, Beth
    University of Southampton, England .
    Moore, Michael
    University of Southampton, England .
    Coenen, Samuel
    University of Antwerp, Belgium .
    Butler, Christopher C
    Cardiff University, Wales .
    Godycki-Cwirko, Maciek
    Medical University of Lodz, Poland .
    Mierzecki, Artur
    Pomeranian Medical University, Poland .
    Chlabicz, Slawomir
    Medical University of Bialystok, Poland .
    Torres, Antoni
    Hospital Clin Barcelona, Spain .
    Almirall, Jordi
    Hospital Mataro, Spain .
    Davies, Mel
    Ely, Wales .
    Schaberg, Tom
    Diakoniekrankenhaus, Germany .
    Mölstad, Sigvard
    Linköping University, Department of Medical and Health Sciences, General Practice. Linköping University, Faculty of Health Sciences. CRC Malmö, Sweden .
    Blasi, Francesco
    University of Milan, Italy .
    De Sutter, An
    University of Ghent, Belgium .
    Kersnik, Janko
    University of Ljubljana, Slovenia .
    Hupkova, Helena
    Comenius University, Slovakia .
    Touboul, Pia
    Nice University Hospital, France .
    Hood, Kerenza
    Cardiff University, Wales .
    Mullee, Mark
    University of Southampton, England .
    OReilly, Gilly
    University of Southampton, England .
    Brugman, Curt
    University of Medical Centre Utrecht, Netherlands .
    Goossens, Herman
    University of Antwerp, Belgium .
    Verheij, Theo
    University of Medical Centre Utrecht, Netherlands .
    Amoxicillin for acute lower-respiratory-tract infection in primary care when pneumonia is not suspected: a 12-country, randomised, placebo-controlled trial2013In: Lancet. Infectious diseases (Print), ISSN 1473-3099, E-ISSN 1474-4457, Vol. 13, no 2, p. 123-129Article in journal (Refereed)
    Abstract [en]

    Background Lower-respiratory-tract infection is one of the most common acute illnesses managed in primary care. Few placebo-controlled studies of antibiotics have been done, and overall effectiveness (particularly in subgroups such as older people) is debated. We aimed to compare the benefits and harms of amoxicillin for acute lower-respiratory-tract infection with those of placebo both overall and in patients aged 60 years or older. less thanbrgreater than less thanbrgreater thanMethods Patients older than 18 years with acute lower-respiratory-tract infections (cough of andlt;= 28 days duration) in whom pneumonia was not suspected were randomly assigned (1:1) to either amoxicillin (1 g three times daily for 7 days) or placebo by computer-generated random numbers. Our primary outcome was duration of symptoms rated "moderately bad" or worse. Secondary outcomes were symptom severity in days 2-4 and new or worsening symptoms. Investigators and patients were masked to treatment allocation. This trial is registered with EudraCT (2007-001586-15), UKCRN Portfolio (ID 4175), ISRCTN (52261229), and FWO (G.0274.08N). less thanbrgreater than less thanbrgreater thanFindings 1038 patients were assigned to the amoxicillin group and 1023 to the placebo group. Neither duration of symptoms rated "moderately bad" or worse (hazard ratio 1.06, 95% CI 0.96-1.18; p=0.229) nor mean symptom severity (1.69 with placebo vs 1.62 with amoxicillin; difference 0.07 [95% CI -0.15 to 0.007]; p=0.074) differed significantly between groups. New or worsening symptoms were significantly less common in the amoxicillin group than in the placebo group (162 [15.9%] of 1021 patients vs 194 [19.3%] of 1006; p=0-043; number needed to treat 30). Cases of nausea, rash, or diarrhoea were significantly more common in the amoxidllin group than in the placebo group (number needed to harm 21,95% CI 11-174; p=0.025), and one case of anaphylaxis was noted with amoxicillin. Two patients in the placebo group and one in the ammdcillin group needed to be admitted to hospital; no study-related deaths were noted. We noted no evidence of selective benefit in patients aged 60 years or older (n=595). less thanbrgreater than less thanbrgreater thanInterpretation When pneumonia is not suspected clinically, amoxicillin provides little benefit for acute lower-respiratory-tract infection in primary care both overall and in patients aged 60 years or more, and causes slight harms. less thanbrgreater than less thanbrgreater thanFunding European Commission Framework Programme 6, UK National Institute for Health Research, Barcelona Ciberde Enfermedades Respiratorias, and Research Foundation Flanders.

  • 27. Lundborg, CS
    et al.
    Olsson, E
    Mölstad, Sigvard
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, General Practice.
    Antibiotic prescribing in outpatients: a 1-week diagnosis-prescribing study in 5 counties in Sweden2002In: Scandinavian Journal of Infectious Diseases, ISSN 0036-5548, E-ISSN 1651-1980, Vol. 34, no 6, p. 442-448Article in journal (Refereed)
    Abstract [en]

    A diagnosis-antibiotic prescribing study initiated by the Swedish Strategic Programme for the Rational Use of Antimicrobial Agents and Surveillance of Resistance was performed in 5 counties in Sweden (total 1,290,000 inhabitants) during 1 week in November 2000. The aims of the study were to analyse diagnoses and antibiotics prescribed for outpatients and to appraise the feasibility of the data collection method. Physicians in primary care and departments of ENT, paediatrics and infectious diseases completed a questionnaire for each patient with an infectious disease complaint, including information about age, sex, diagnosis, diagnostic methods used and treatment. When an antibiotic was prescribed, the type and duration of treatment were noted. A total of 7, 071 forms were returned, of which 7,029 included information on diagnosis, infections of the respiratory tract, urinary tract and the skin or soft tissues were responsible for 70%, 14% and 10% of the visits, respectively. Antibiotics were prescribed in 59% of all cases and phenoxymethylpenicillin was the most commonly prescribed antibiotic. Of the forms returned, 94% emanated from primary care centres. In conclusion, this study provides information on the treatment pattern associated with various diagnoses and the pattern of use of various antibiotics. Such a study is relatively simple to perform and entails only a small extra workload for the participants.

  • 28.
    Malmvall, Bo-Erik
    et al.
    Linköping University, Department of Molecular and Clinical Medicine, Infectious Diseases. Linköping University, Faculty of Health Sciences.
    Mölstad, Sigvard
    Linköping University, Department of Medical and Health Sciences, Health and Society. Linköping University, Faculty of Health Sciences.
    Darelid, Johan
    Department of Infectious Diseases, Ryhov Hospital, Jönköping, Sweden.
    Hiselius, A.
    National Corporation of Swedish Pharmacies, Ryhov Hospital, Jönköping, Sweden.
    Larsson, L
    Pediatric Outpatient Clinic, Eksjö Primary Care Center, Eksjö, Sweden.
    Swanberg, J.
    Department of Clinical Microbiology, Ryhov Hospital, Jönköping, Sweden.
    Åbom, P-E
    Department of Communicable Disease Control, Jönköping, Sweden.
    Reduction of antibiotics sales and sustained low incidence of bacterial resistance: report on a broad approach during 10 years to implement evidence-based indications for antibiotic prescribing in Jönköping County, Sweden2007In: Quality Management in Health Care, ISSN 1063-8628, E-ISSN 1550-5154, Vol. 16, no 1, p. 60-67Article in journal (Refereed)
    Abstract [en]

    Background: Increased prevalence of resistance in major pathogens decreases the possibility to treat common infectious conditions. In the beginning of the 1990s, resistant pneumococci spread among children in southern Sweden, which alarmed both the profession and the medical authorities. We describe the measures taken to curb the spread of resistance and to reduce the use of antibiotics in outpatient care.

    Method: A national organization, Strama (Swedish Strategic Programme for the Rational Use of Antimicrobial Agents and Surveillance of Resistance), was initiated in 1994 and a regional committee was formed in Jönköping County in 1995. A multifaceted program was started aiming at reducing antibiotic use in the county by 25% and that the prevalence of resistant pneumococci should not increase.

    Results: The efforts by the Jönköping County committee has resulted in a 31% total reduction of the consumption of antibiotic drugs in primary care between 1993 and 2005 and a 50% reduction among children aged 0 to 4 years. There has been no increase in the prevalence of resistant pneumococci or Haemophilus influenzae in the county. The decrease in antibiotic use was greater than the average in Sweden.

    Conclusion: Our regional efforts have been successful. This has probably been achieved by a sustained strategy including repeated campaigns in the media, information to the profession, implementation of guidelines, and feedback to the profession on data on antibiotic prescribing and resistance. We believe it is of outmost importance not only to inform the profession but also the public on the limited effects of antibiotics in most respiratory tract infections.

  • 29. Melander, E
    et al.
    Nissen, A
    Henricsson, K
    Merlo, J
    Mölstad, Sigvard
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, General Practice.
    Kampmann, JP
    Lithman, T
    Hansen, EH
    Melander, A
    Utilisation of antibiotics in young children: Opposite relationships to adult educational levels in Danish and Swedish counties.2003In: European Journal of Clinical Pharmacology, ISSN 0031-6970, E-ISSN 1432-1041, Vol. 2003Article in journal (Refereed)
  • 30.
    Modig, Sara
    et al.
    Lund University, Malmö.
    Lannering, Christina
    Futurum, Jönköping.
    Östgren, Carl Johan
    Linköping University, Department of Medical and Health Sciences, General Practice. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in West Östergötland, Primary Health Care in Motala.
    Mölstad, Sigvard
    Linköping University, Department of Medical and Health Sciences, General Practice. Linköping University, Faculty of Health Sciences.
    Midlöv, Patrik
    Lund University, Malmö.
    The assessment of renal function in relation to the use of drugs in elderly in nursing homes; a cohort study2011In: BMC Geriatrics, ISSN 1471-2318, E-ISSN 1471-2318, Vol. 11, no 1Article in journal (Refereed)
    Abstract [en]

    Background

    Renal function decreases with age. Dosage adjustment according to renal function is   indicated for many drugs, in order to avoid adverse reactions of medications and/or   aggravation of renal impairment. There are several ways to assess renal function in   the elderly, but no way is ideal. The aim of the study was to explore renal function   in elderly subjects in nursing homes and the use of pharmaceuticals that may be harmful   to patients with renal impairment.

    Methods

    243 elderly subjects living in nursing homes were included. S-creatinine and s-cystatin   c were analysed. Renal function was estimated using Cockcroft-Gault formula, Modification   of Diet in Renal Disease (MDRD) and cystatin C-estimated glomerular filtration rate   (GFR). Concomitant medication was registered and four groups of renal risk drugs were   identified: metformin, nonsteroidal anti-inflammatory drugs (NSAID), angiotensin-converting   enzyme -inhibitors/angiotensin receptor blockers and digoxin. Descriptive statistics   and the Kappa test for concordance were used.

    Results

    Reduced renal function (cystatin C-estimated GFR < 60 ml/min) was seen in 53%. Normal   s-creatinine was seen in 41% of those with renal impairment. Renal risk drugs were   rather rarely prescribed, with exception for ACE-inhibitors. Poor concordance was   seen between the GFR estimates as concluded by other studies.

    Conclusions

    The physician has to be observant on renal function when prescribing medications to   the elderly patient and not only rely on s-creatinine level. GFR has to be estimated   before prescribing renal risk drugs, but using different estimates may give divergence   in the results.

  • 31.
    Monnet, Dominique L
    et al.
    Köpenhamn.
    Mölstad, Sigvard
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, General Practice.
    Cars, Otto
    Uppsala sjukhus.
    Defined daily doses of antimicrobials reflect antimicrobial prescriptions in ambulatory care2004In: Journal of Antimicrobial Chemotherapy, ISSN 0305-7453, E-ISSN 1460-2091, Vol. 53, p. 1109-1111Article in journal (Refereed)
  • 32.
    Mölstad, Sigvard
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, General Practice.
    Antibiotikaförskrivning i öppen vård-diagnos, diagnostik och preparatval2003In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 100, p. 318-321Article in journal (Other academic)
  • 33.
    Mölstad, Sigvard
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, General Practice.
    André, Malin
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, General Practice.
    Ont i halsen - nya riktlinjer för faryngotonsillit kräver nya rutiner!2003In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 100, p. 704-706Article in journal (Other academic)
  • 34.
    Mölstad, Sigvard
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, General Practice.
    Cars, O
    Strama Solna .
    Struwe, Johan
    Strama Solan .
    A Swedish working model for containment of antibiotic resistance2008In: Eurosurveillance, ISSN 1025-496X, Vol. 13, no 46Article in journal (Refereed)
  • 35.
    Mölstad, Sigvard
    et al.
    Linköping University, Department of Medical and Health Sciences, General Practice. Linköping University, Faculty of Health Sciences. Unit of Research and Development in Primary Care, Jönköping.
    Erntell, M
    Halmstad County Hospital.
    Hanberger, Håkan
    Linköping University, Department of Clinical and Experimental Medicine, Infectious Diseases. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Medicine, Department of Infectious Diseases in Östergötland.
    Melander, E
    Malmö University Hospital.
    Norman, C
    Swedish Institute for Infectious Disease Control.
    Skoog, G
    Swedish Institute for Infectious Disease Control.
    Stålsby Lundborg, C
    Department of Public Health Sciences, Stockholm.
    Söderström, A
    University of Gothenburg.
    Torell, E
    Uppsala University Hospital.
    Cars, O
    Swedish Institute for Infectious Disease Control.
    Sustained reduction of antibiotic use and low bacterial resistance: 10-year follow-up of the Swedish Strama programme2008In: Lancet. Infectious diseases (Print), ISSN 1473-3099, E-ISSN 1474-4457, Vol. 8, no 2, p. 125-132Article in journal (Refereed)
    Abstract [en]

    Increasing use of antibiotics and the spread of resistant pneumococcal clones in the early 1990s alarmed the medical profession and medical authorities in Sweden. Strama (Swedish Strategic Programme for the Rational Use of Antimicrobial Agents and Surveillance of Resistance) was therefore started in 1994 to provide surveillance of antibiotic use and resistance, and to implement the rational use of antibiotics and development of new knowledge. Between 1995 and 2004, antibiotic use for outpatients decreased from 15.7 to 12.6 defined daily doses per 1000 inhabitants per day and from 536 to 410 prescriptions per 1000 inhabitants per year. The reduction was most prominent in children aged 5–14 years (52%) and for macrolides (65%). During this period, the number of hospital admissions for acute mastoiditis, rhinosinusitis, and quinsy (peritonsillar abscess) was stable or declining. Although the epidemic spread in southern Sweden of penicillin-resistant Streptococcus pneumoniae was curbed, the national frequency increased from 4% to 6%. Resistance remained low in most other bacterial species during this period. This multidisciplinary, coordinated programme has contributed to the reduction of antibiotic use without measurable negative consequences. However, antibiotic resistance in several bacterial species is slowly increasing, which has led to calls for continued sustained efforts to preserve the effectiveness of available antibiotics.

  • 36.
    Mölstad, Sigvard
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, General Practice.
    Stålby Lundborg, C
    Stockholm.
    Karlsson, A-K
    Uppsala.
    Cars, O
    Uppsala.
    Antibiotic prescription rates vary markedly between 13 european countries2002In: Scandinavian Journal of Infectious Diseases, ISSN 0036-5548, E-ISSN 1651-1980, Vol. 34, p. 366-371Article in journal (Refereed)
  • 37.
    Neumark, Thomas
    et al.
    Linköping University, Department of Medical and Health Sciences, General Practice. Linköping University, Faculty of Health Sciences.
    Brudin, Lars
    Linköping University, Department of Medical and Health Sciences, Clinical Physiology. Linköping University, Faculty of Health Sciences.
    Engström, Sven
    Linköping University, Department of Medical and Health Sciences, General Practice. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Central County Primary Health Care. Unit of Research and Development in Primary Care, Jönköping, Sweden.
    Mölstad, Sigvard
    Linköping University, Department of Medical and Health Sciences, General Practice. Linköping University, Faculty of Health Sciences.
    Trends in number of consultations and antibiotic prescriptions for respiratory tract infections between 1999 and 2005 in primary healthcare in Kalmar County, Southern Sweden2009In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 27, no 1, p. 18-24Article in journal (Refereed)
    Abstract [en]

    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.

  • 38.
    Neumark, Thomas
    et al.
    Linköping University, Department of Medicine and Health Sciences, General Practice. Linköping University, Faculty of Health Sciences.
    Brudin, Lars
    Linköping University, Department of Medicine and Health Sciences, Clinical Physiology . Linköping University, Faculty of Health Sciences.
    Mölstad, Sigvard
    Linköping University, Department of Medicine and Health Sciences, General Practice. Linköping University, Faculty of Health Sciences.
    Use of rapid diagnostic tests and choice of antibiotics in respiratory tract infections in primary healthcare: A 6-y follow-up study2010In: Scandinavian Journal of Infectious Diseases, ISSN 0036-5548, E-ISSN 1651-1980, Vol. 42, no 2, p. 90-96Article in journal (Refereed)
    Abstract [en]

    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 andlt;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.

  • 39.
    Neumark, Thomas
    et al.
    Linköping University, Department of Medical and Health Sciences, General Practice. Linköping University, Faculty of Health Sciences.
    Ekblom, Maria
    Department of Oto-Rhino-Laryngology, Kalmar County Hospital, Kalmar, Sweden.
    Brudin, Lars
    Linköping University, Department of Medical and Health Sciences, Clinical Physiology. Linköping University, Faculty of Health Sciences.
    Groth, Anita
    Department of Laboratory Medicine, NÄL, Trollhättan, Sweden.
    Eliasson, Ingvar
    Department of Laboratory Medicine, NÄL, Trollhättan, Sweden.
    Mölstad, Sigvard
    Linköping University, Department of Medical and Health Sciences, General Practice. Linköping University, Faculty of Health Sciences.
    Petersson, Ann-Cathrine
    Department of Clinical Microbiology Lund, University and regional laboratories Region Skåne, Sweden.
    Törngren, Annika
    Department of Oto-Rhino-Laryngology, Kalmar County Hospital, Kalmar, Sweden.
    Spontaneously draining acute otitis media in children: An observational study of clinical findings, microbiology and clinical course2011In: Scandinavian Journal of Infectious Diseases, ISSN 0036-5548, E-ISSN 1651-1980, Vol. 43, no 11-12, p. 891-898Article in journal (Refereed)
    Abstract [en]

    Conclusion: The study indicates that an active ‘‘wait and see’’ policy during the first 3 days can be justified in most children with otorrhea but antibiotics should be considered in children who initially present with abundant purulent secretion and pulsating eardrum.

    Objectives: To study the clinical recovery of acute otitis media (AOM) with otorrhea in children managed initially without antibiotics.

    Methods: Children aged 2-16, presenting with AOM and spontaneous otorrhea, were followed. Specimens for bacterial investigations were obtained, and symptoms were registered on daily basis. The main outcome measures were the frequency of patients treated with antibiotics due to persisting AOM within 9 days in relation to clinical and bacteriologic findings and new AOM within 3 months.

    Results: Twelve of 71 children who completed the trial received antibiotics during the first nine days due to lack of improvement, one child after 16 days due to recurrent AOM and six had new AOM after 30 days. A.otitidis was found in 23 samples, S.pneumoniae in 12, S.pyogenes in 6, F.nucleatum in five. M.pneumoniae, C.pneumoniae and F.necrophorum could not be detected Antibiotics were prescribed more extensively to patients with pulsating eardrum and abundant purulent secretion. All patients with presence of S.pyogenes received antibiotics.

  • 40.
    Neumark, Thomas
    et al.
    Linköping University, Department of Department of Health and Society, General Practice. Linköping University, Faculty of Health Sciences. Lindsdal Primary Health Centre, Kalmar, Sweden.
    Mölstad, Sigvard
    Linköping University, Department of Department of Health and Society, General Practice. Linköping University, Faculty of Health Sciences. Unit of Research and Development in Primary care, Jönköping.
    Rosén, Christer
    Department of Oto-Rhino-Laryngology, Kalmar County Hospital, Kalmar.
    Persson, Lars-Göran
    Unit of Research and Development in Primary care, Jönköping.
    Törngren, Annika
    Department of Oto-Rhino-Laryngology, Kalmar County Hospital, Kalmar.
    Brudin, Lars
    Linköping University, Department of Medicine and Care, Clinical Physiology. Linköping University, Faculty of Health Sciences.
    Eliasson, Ingvar
    Department of Clinical Microbiology and Immunology, Lund University Hospital, Lund, Sweden.
    Evaluation of phenoxymethylpenicillin treatment of acute otitis media in children aged 2-162007In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 25, no 3, p. 166-171Article in journal (Refereed)
    Abstract [en]

    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.

  • 41.
    Nilsson, Staffan
    et al.
    Linköping University, Department of Medical and Health Sciences, General Practice. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in East Östergötland, East County Primary Health Care.
    Mölstad, Sigvard
    Linköping University, Department of Medical and Health Sciences, General Practice. Linköping University, Faculty of Health Sciences.
    Karlberg, Catarina
    Unit of R&D in Primary Care, Jönköping, Sweden .
    Karlsson, Jan-Erik
    Department of Internal Medicine, Ryhov County Hospital, Jönköping, Sweden .
    Persson, Lars-Göran
    Unit of R&D in Primary Care, Jönköping, Sweden .
    No connection between the level of exposition to statins in the population and the incidence/mortality of acute myocardial infarction: An ecological study based on Sweden’s municipalities2011In: Journal of Negative Results in Biomedicine, ISSN 1477-5751, E-ISSN 1477-5751, Vol. 10, no 6Article in journal (Refereed)
    Abstract [en]

    Background

    Randomised controlled trials have shown an excellent preventive effect of statins on ischemic heart disease. Our objective was to investigate if a relation can be detected between acute myocardial infarction- (AMI) mortality or incidence and statin utilisation, for men and women in different age-groups on a population basis.

    Results

    The utilisation rate of statins increased almost three times for both men and women between 1998 and 2002. During 1998-2000 the incidence of AMI decreased clearly for men but only slightly for women. Mortality decreased from 1998 to 2002. The change in statin utilisation from 1998 to 2000 showed no correlation to the change in AMI mortality from 2000 to 2002. Statin utilisation and AMI- incidence or mortality showed no correlations when adjusting for socio-economic deprivation, antidiabetic drugs and geographic coordinates.

    Conclusions

    Despite a widespread and increasing utilisation of statins, no correlation to the incidence or mortality of AMI could be detected. Other factors than increased statin treatment should be analysed especially when discussing the allocation of public resources.

  • 42.
    Nilsson, Staffan
    et al.
    Linköping University, Department of Medicine and Health Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in the East of Östergötland, East County Primary Health Care.
    Scheike, Morten
    Engblom, David
    Linköping University, Department of Clinical and Experimental Medicine, Cell Biology. Linköping University, Faculty of Health Sciences.
    Karlsson, Lars-Göran
    Mölstad, Sigvard
    Linköping University, Department of Medicine and Health Sciences. Linköping University, Faculty of Health Sciences.
    Åkerlind, Ingemar
    Linköping University, Department of Medicine and Health Sciences, Health and Society. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in the West of Östergötland, Unit of Research and Development in Local Health Care, County of Östergötland.
    Örtoft, Kjell
    Nylander, Eva
    Linköping University, Department of Medicine and Health Sciences, Clinical Physiology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Clinical Physiology.
    Chest pain and ischaemic heart disease in primary care2003In: British Journal of General Practice, ISSN 0960-1643, Vol. 53, no 490, p. 378-382Article in journal (Refereed)
    Abstract [en]

    Background: Chest pain is the main symptom of first presentation with ischaemic heart disease (IHD). Little is known about the incidence of IHD among patients consulting the general practitioner (GP) for chest pain.

    Aims: To estimate the occurrence of IHD among patients consulting for chest pain, to study the results of the bicycle exercise test, and to estimate the incidence of IHD in the population.

    Design of study: Prospective descriptive study.

    Setting: Three primary health centres in south-eastern Sweden

    Method: All patients without a current IHD diagnosis, aged 20 to 79 years, and consulting for a new episode of chest pain, were included consecutively. The outcome was classified as IHD, possible IHD or not IHD, according to the results of a postal questionnaire, an exercise test or hospital care. Data from the hospital registry on patients with a diagnosis of IHD were analysed retrospectively.

    Results: Out of 38 075 GP consultations, 577 (1.5%) were for chest pain. IHD was diagnosed in 41 (8%) of the chest pain patients, in 41 (83%) the diagnosis was excluded, and in 50 (9%) the diagnosis was judged as being uncertain. Even though the diagnostic criteria were strict, the exercise tests led to a diagnostic conclusion in 77% of the cases, most frequently a normal test result. Combining data from primary and hospital care, the yearly incidence of IHD was 6.5 diagnosed per 1000 inhabitants (aged 20 to 79 years old).

    Conclusion: The incidence of a new episode of chest pain bringing the patient to the GP was low. Eight per cent of the patients received an IHD diagnosis, and in 9% further investigation or clinical assessment is needed.

  • 43.
    Nilsson, Staffan
    et al.
    Linköping University, Department of Medical and Health Sciences, General Practice. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in the East of Östergötland, East County Primary Health Care.
    Örtoft, Kjell
    Mölstad, Sigvard
    Linköping University, Department of Medical and Health Sciences, General Practice. Linköping University, Faculty of Health Sciences.
    The accuracy of general practitioners' clinical assessment of chest pain patients2008In: European Journal of General Practice, ISSN 1381-4788, E-ISSN 1751-1402, Vol. 14, no 2, p. 50-55Article in journal (Refereed)
    Abstract [en]

    Objective: To study general practitioners' (GP) assessment of the probability of ischaemic heart disease (IHD) and GP action in daily practice regarding chest pain patients.

    Methods: All chest pain patients aged 20-79 years, attending three primary health-care centres in south-east Sweden and assessed by the GP to have high, low or very low probability of IHD, were included consecutively over a two year period. The “GP action in daily practice” was classed as “active decisions” (investigation or treatment) or “wait and see”. “IHD” or “not IHD” was settled according to the results of acute hospital investigation or exercise testing/myocardial perfusion scintigraphy.

    Results: 516 patients were included, 93 high, 145 low and 278 very low probability cases. The outcome was “IHD” in 47%, 9% and 1% respectively. The sensitivity and specificity of the “GP assessment of the probability of IHD” were 72% and 89%. The sensitivity and specificity of the “GP action in daily practice” were 88% and 72%, respectively. The negative predictive value was 98%.

    Conclusion: GP assessment, after clinical evaluation, that the probability of IHD was low did not safely rule out IHD. GP action in daily practice however, indicates that general practice is an appropriate level of care for chest pain patients.

  • 44.
    Odenholt, I
    et al.
    Malmö.
    Bylander-Groth, A
    Malmö.
    Frimodt-Möller, N
    Köpenhamn.
    Skinlo Rokstad, K
    Bergen.
    Mölstad, Sigvard
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, General Practice.
    Differences in antibiotic prescribing patterns between general general practitioners in Scandinavia: A questionnaire study2002In: Scandinavian Journal of Infectious Diseases, ISSN 0036-5548, E-ISSN 1651-1980, Vol. 34, p. 602-609Article in journal (Refereed)
  • 45.
    Olofsson, Magnus
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences.
    Lindgren, Per-Eric
    Linköping University, Department of Clinical and Experimental Medicine, Medical Microbiology. Linköping University, Faculty of Health Sciences.
    Östgren, Carl Johan
    Linköping University, Department of Medical and Health Sciences, General Practice. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in West Östergötland, Primary Health Care in Motala.
    Midlöv, P.
    Department of Clinical Sciences in Malmö, Lund University, Sweden.
    Mölstad, Sigvard
    Linköping University, Department of Medical and Health Sciences, General Practice. Linköping University, Faculty of Health Sciences.
    Colonization with Staphylococcus aureus in Swedish nursing homes: A cross-sectional study2012In: Scandinavian Journal of Infectious Diseases, ISSN 0036-5548, E-ISSN 1651-1980, Vol. 44, no 1, p. 3-8Article in journal (Refereed)
    Abstract [en]

    Background: Screening for bacterial colonization among risk populations could provide better estimates of the volume of the bacteria-related disease reservoir and the level of antimicrobial resistance, than do conventional laboratory reports. Methods: Two hundred and one participants at 10 Swedish nursing homes were screened for colonization with Staphylococcus aureus between January and October 2009. Of the 201 participants, 61 (30%) were male. The median age was 86 y. All participants were systematically sampled from the nasal mucosa, the pharyngeal mucosa, the groin, and active skin lesions, if any. Results: Ninety-nine of 199 participants (50%) were colonized with S. aureus. The colonization rate was 34% for the nose, 35% for throat, 10% for groin, and 54% for active skin lesions. An antibiotic-resistant S. aureus isolate was identified in 8.5% of all participants regardless of colonization status. A total of 24 resistant isolates were detected, and 21 of these were resistant to fluoroquinolones. There was no case of colonization with methicillin-resistant S. aureus (MRSA). Conclusions: The presence of resistant isolates was generally low, and the greater part of the resistance was fluoroquinolone-related. To achieve reasonable precision, screening programmes of this kind must include samples from both the nose and throat, and, although low, the prevalence of antimicrobial resistance in Swedish nursing homes still calls for reflection on how to use the fluoroquinolones wisely. © 2012 Informa Healthcare.

  • 46.
    Olofsson, Magnus
    et al.
    Linköping University, Department of Medical and Health Sciences, General Practice. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in the West of Östergötland, Primary Health Care Centres.
    Toepfer, Michael
    County Hospital Ryhov, Jönköping.
    Östgren, Carl Johan
    Linköping University, Department of Medical and Health Sciences, General Practice. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in the West of Östergötland, Primary Health Care Centres.
    Midlöv, Patrik
    Division of General Practice/Family Medicine, Department of Clinical Sciences in Malmö, Lund University .
    Matussek, Andreas
    County Hospital Ryhov, Jönköping.
    Lindgren, Per-Eric
    Linköping University, Department of Clinical and Experimental Medicine, Medical Microbiology. Linköping University, Faculty of Health Sciences.
    Mölstad, Sigvard
    Division of General Practice/Family Medicine, Department of Clinical Sciences in Malmö, Lund University.
    Low level of antimicrobial resistance in Escherichia coli among Swedish nursing home residents2013In: Scandinavian journal of infectious diseases, ISSN 1651-1980, Vol. 45, no 2, p. 117-123Article in journal (Refereed)
    Abstract [en]

    Background: Screening for bacterial colonization and antimicrobial resistance (AMR) among a defined population could aid in the identification of at-risk populations and provide targets for antibiotic stewardship and infection control programmes. Methods: Two hundred and sixty-eight participants at 11 Swedish nursing homes underwent serial screening for colonization with Escherichia coli between March 2008 and September 2010. Seventy-two of the 268 participants (27%) were male. The median age was 85 y. Samples were collected from urine, the rectal mucosa, the groin, and active skin lesions. Results: Two hundred and nine of 268 participants (78%) were colonized with E. coli at any body site/fluid. The specific colonization rates were 81% (rectum), 48% (urine), 30% (groin), 59% (unknown), and 13% (skin lesion). An antibiotic-resistant E. coli isolate was identified in 18% of all participants regardless of colonization status; all together, 87 resistant isolates were detected. Only 1 participant carried isolates with resistance to third-generation cephalosporins (cefotaxime and ceftazidime). Conclusions: The presence of resistance was generally low, and the greater part of the resistant cases was connected with 3 common antibiotics: ampicillin, trimethoprim/sulfamethoxazole, and ciprofloxacin. In spite of generally increasing resistance against third-generation cephalosporins in E. coli in Sweden, this study does not implicate residence at a Swedish nursing home as a risk factor for the acquisition of expressed cephalosporin resistance.

  • 47.
    Pettersson, Eva
    et al.
    KI .
    Vernby, Åsa
    KI .
    Mölstad, Sigvard
    Unit of Research and Development in Primary Care, Jönköping.
    Stålby, Cecilia
    KI .
    Infections and antibiotic prescribing in Swedish nursing homes: A cross-sectional study2008In: Scandinavian Journal of Infectious Diseases, ISSN 0036-5548, E-ISSN 1651-1980, Vol. 40, p. 393-398Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to present and assess the treatment of infections in Swedish nursing homes. It included 58 nursing homes with 3002 residents. During 3 months, nurses in the nursing homes recorded all infections requiring a physician's opinion. Of the 889 infectious episodes, 84% were treated with antibiotics. Many of the antibiotics were issued after indirect contact with the physician (38%). Indications for antibiotics were in 55% of the cases urinary tract infections (UTI), in 17% skin and soft-tissue infections and in 15% respiratory tract infections (RTI). The most common antibiotics were penicillins (38%), followed by quinolones (23%) and trimethoprim (18%). For the major indication, lower UTI in women, half of the cases were not treated according to the recommendations. The main concerns were length of treatment and overprescribing of quinolones. For the second major diagnosis, pneumonia, the high use of doxycycline could be questioned. Continuing education on infections and their treatment in nursing homes is needed. Training should preferably include both physicians and nurses as a high proportion of antibiotics is issued without direct contact with the physician.

  • 48.
    Rodhe, Nils
    et al.
    FoU Jönköping .
    Englund, Lars
    Uppsala univ .
    Mölstad, Sigvard
    Unit of Research and Development in Primary Care, Jönköping.
    Samuelsson, Eva
    Umeå univ .
    Bacteriuria is associated with urge urinary incontinence in older women2008In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 26, no 1, p. 35-39Article in journal (Refereed)
    Abstract [en]

    Objective To evaluate the concept that increased post-void residual urine volume (PVR) is a risk factor for bacteriuria. Design Cross-sectional study. Setting Three nursing homes in Jönköping, southern Sweden. Subjects A total of 147 elderly residents in municipal nursing homes. Main outcome values PVR volumes measured with a portable ultrasonic bladder scan, urine specimen, and questionnaire data on incontinence, immobility, impaired cognition, neurological diseases, and medications. Results Mean age was 86 years and 78% were women. The prevalence of a PVR for the four chosen cut-off values (30, 50, 100, and 150 ml) was 51%, 39%, 20%, and 7%, respectively. The prevalence of bacteriuria was 42%, 46% for women and 28% for men. Elevated PVR was not associated with bacteriuria, incontinence, immobility, impaired cognition or neurological disease (stroke, Parkinson's disease). Conclusion Bacteriuria and elevated PVR are common among elderly residents in nursing homes. The study could not confirm that elevated PVR predisposes to bacteriuria in elderly residents in nursing homes.

  • 49.
    Rodhe, Nils
    et al.
    Uppsala University.
    Lofgren, Sture
    County Hospital Ryhov.
    Strindhall, Jan
    Jönköping University.
    Matussek, Andreas
    County Hospital Ryhov.
    Mölstad , Sigvard
    Linköping University, Department of Medicine and Health Sciences, Primary Care . Linköping University, Faculty of Health Sciences.
    Cytokines in urine in elderly subjects with acute cystitis and asymptomatic bacteriuria2009In: SCANDINAVIAN JOURNAL OF PRIMARY HEALTH CARE, ISSN 0281-3432 , Vol. 27, no 2, p. 74-79Article in journal (Refereed)
    Abstract [en]

    Objective. Searching for useful diagnostic tools to discriminate between asymptomatic bacteriuria (ASB) and acute cystitis, this study compared urinary levels of cytokines/chemokines and leukocyte esterase in three groups of elderly subjects; those with acute cystitis, those with ASB, and those without bacteriuria. Design. Comparative laboratory. Setting. Primary care. Subjects. A total of 16 patients with acute cystitis, 24 subjects with ASB, and 20 controls without bacteriuria, all of whom were aged 80 or over. Main outcome measures. Urinary levels of IL-1, TNF-, IL-12, IL-18, CXCL1 (GRO-), CXCL8 (IL-8), CCL2 (MCP-1), IL-6, IL-10, and leukocyte esterase. Results. Urinary levels of CXCL1, CXCL8, and IL-6 were significantly higher in acute cystitis patients than in the ASB group. The sensitivities and specificities for CXCL8, IL-6, and leukocyte esterase to discriminate between acute cystitis and ASB were 63% (95% CI 36-84) and 96% (95% CI 77-100) (cut-off 285 pg/mg creatinine), 81% (95% CI 54-95) and 96% (95% CI 77-100) (cut-off 30 pg/mg creatinine), and 88% (95% CI 60-98) and 79% (95% CI 57-92) (cut-off 2, on a scale of 0-4), respectively. Conclusions. The results indicate that measurement of urinary cytokines, and also leukocyte esterase, when using a cut-off value 2, could be useful in clinical practice to discriminate between symptomatic and asymptomatic urinary tract infections in the elderly. A combination of IL-6 and leukocyte esterase could be even more useful. This needs to be evaluated in prospective studies on the diagnosis and treatment of urinary tract infections in an elderly population.

  • 50.
    Rodhe, Nils
    et al.
    Uppsala univ .
    Löfgren, Sture
    Ryhov Jönköping .
    Matussek, Andreas
    Ryhov Jönköping .
    André, Malin
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, General Practice.
    englund, lars
    Englund, Lars
    uppsala univ .
    Kûhn, Inger
    KI .
    Mölstad, Sigvard
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, General Practice.
    Asymptomatic bacteriuria in the elderly: High prevalence and high turnover of strains2008In: Scandinavian Journal of Infectious Diseases, ISSN 0036-5548, E-ISSN 1651-1980Article in journal (Refereed)
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