Snuff use associated with abdominal obesity in former smokers.

AIM: To describe the consumption of snuff in a rural male population and to explore associations between snuff use and obesity. PARTICIPANTS AND METHODS: Tobacco use was explored in 834 men aged 30-75 years old who participated in a cross-sectional population survey in the municipality of Vara (participation rate was 81%). Self-reported questionnaires assessed the habits of smoking and snuff use. Anthropometric measures were obtained during a health examination. RESULTS: Of these men 21% (n = 179) were snuff users, 13% (n = 109) current smokers, and 65% (n = 546) were non-users. Of all snuff users 65% (n = 116) were former smokers, and 35% (n = 63) were exclusive snuff users (current users who never smoked). Among non-users 65% (n = 357) were never users and 35% (n = 189) had quit smoking without nicotine substitution. These men were characterized by abdominal obesity; OR 1.84 (1.08-3.12) (p = 0.002) (WHR 41.0) and OR 1.71 (1.08-2.72) (p = 0.022) (waist circumference 4102 cm). One can/week use of snuff among ex-smokers was associated with a 1.21 cm wider (0.05-2.36) (p = 0.041) waist circumference and 0.01 (0.00-0.02) units higher (p = 0.021) WHR. There were statistically significant associations between former smoking without current nicotine substitute and both general and abdominal obesity. No similar association with abdominal obesity was seen among exclusive snuff users. CONCLUSIONS: Abdominal obesity in current snuff users is limited to former smokers. The remaining effect of previous smoking has to be considered in future studies on obesity and related disorders in snuff users. Counselling among people who substitute snuff for smoking should include measures to prevent weight gain.

Falls among dizzy patients in primary healthcare: an intervention study with control group.

The objective of this study is to investigate whether vestibular rehabilitation can improve balance, reduce self-perceived handicap because of dizziness and, if possible, reduce falls among dizzy patients in primary healthcare. The study also finds out which of the balance measures and measure of self-perceived handicap, if any, predicted the risk of falls. The design of this study is an intervention study with control group. Fifty-eight patients, 65 years and older, with multisensory dizziness were taken as participants. The intervention group trained vestibular rehabilitation twice a week for 9 weeks. All patients were assessed at baseline and after 3 months, with four different balance measures and the Dizziness Handicap Inventory. After 6, 9 and 12 months, a follow-up by telephone was performed and, at 12 months, the patients also filled out a Dizziness Handicap Inventory questionnaire. Statistically significant differences were found between the groups between baseline and 3 months in one static balance measure and in one dynamic measure (P=0.038 and 0.044). In total, 40 falls were reported, 31 were classified as intrinsic falls, 26 of them caused by vertigo and nine falls were classified as extrinsic. No difference was found between the two groups in proportions of patients who fell. Poor ability to stand in tandem stance doubled the risk for falls. Vestibular rehabilitation can improve balance in elderly patients with multisensory dizziness. Vertigo is a common cause of falls in this group of patients and vestibular rehabilitation is a feasible treatment.

Dizziness among patients with whiplash-associated disorder: a randomized controlled trial.

OBJECTIVE: To investigate whether vestibular rehabilitation for patients with whiplash-associated disorder and dizziness had any effect on balance measures and self-perceived handicap. DESIGN: Randomized, controlled trial. SUBJECTS: Twenty-nine patients, 20 women and 9 men, age range 22-76 years. METHODS: The patients were randomized to an intervention group or a control group. The intervention comprised vestibular rehabilitation. All patients were assessed at baseline, after 6 weeks and after 3 months with 4 different balance measures and the Dizziness Handicap Inventory. RESULTS: After 6 weeks, the intervention group showed statistically significant improvements compared with the control group in the following measures: standing on one leg eyes open (p=0.02), blindfolded tandem stance (p=0.045), Dizziness Handicap Inventory total score (p=0.047), Dizziness Handicap Inventory functional score (p=0.005) and in Dizziness Handicap Inventory physical score (p=0.033). After 3 months, the intervention group showed statistically significant improvements compared with the control group in the following measures: standing on one leg eyes open (p=0.000), tandem stance (p=0.033) and Dizziness Handicap Inventory physical score (p=0.04). CONCLUSION: Vestibular rehabilitation for patients with whiplash-associated disorder can decrease self-perceived handicap and increase postural control.

Neighborhood social participation, use of anxiolytic-hypnotic drugs, and women's propensity for disability pension: a multilevel analysis.

AIMS: The increasing number of people on disability pension in Sweden is of concern for Swedish policy-makers, and there is a need for a better understanding of the mechanisms behind disability pension. We investigated (i) whether women living in the same neighborhood have a similar propensity for disability pension that relates to neighborhood social participation, and (ii) whether there is an association between anxiolytic-hypnotic drug (AHD) use and disability pension in women that is modified by the neighborhood context. METHODS: We used multilevel logistic regression with 12,156 women aged 45 to 64 (first level) residing in 95 neighborhoods (second level) in the city of Malmö (250,000 inhabitants), Sweden, who participated in the Malmö Diet and Cancer Study (1991-96). RESULTS: Both AHD use (OR = 2.09, 95% CI 1.65, 2.65) and neighborhood rate of low social participation (OR = 11.85, 95% CI 5.09, 27.58) were associated with higher propensity for disability pension. The interval odds ratio indicated that the influence of neighborhood social participation was large compared with the unexplained variance between the neighborhoods. The association between AHD use and disability pension was not modified by the neighborhood context. The median odds ratio was 1.44 after adjusting for individual characteristics and 1.27 after the additional adjusting for neighborhood social participation. CONCLUSIONS: Women living in the same neighborhood appear to have a similar propensity for disability pension, beyond individual characteristics, and this contextual effect seems largely explained by neighborhood social participation. In addition, AHD use might increase the propensity for disability pension in women.

Balance performance and self-perceived handicap among dizzy patients in primary health care.

OBJECTIVE: To study the diagnostic panorama at a primary health care centre where the physiotherapist is specialized in dizziness. To study balance measures of dizzy patients as well as measures of self-perceived handicap and to analyse whether these measures correlate. DESIGN: Retrospective study of computerized medical records. SETTING: A primary health care centre in Malmö, Sweden. SUBJECTS: A total of 119 patients with dizziness, 73 women and 46 men, aged from 22 to 90 years. MAIN OUTCOME MEASURES: Diagnoses according to specified criteria. Four balance measures: tandem standing, standing on one leg, walking in a figure of eight, and walking heel to toe on a line. The Dizziness Handicap Inventory (DHI). RESULTS: Six different groups of diagnoses were found: multisensory dizziness, peripheral vestibular disorder, dizziness as a symptom caused by whiplash-associated disorder, unspecific dizziness, phobic postural vertigo, and dizziness of cervical origin. The group with multisensory dizziness performed poorer on the balance measures than the other groups. The group with phobic postural vertigo had the highest total scores on DHI, while the vestibular group had the lowest total score. Subjects over 65 years old had more disturbances in balance, but a lower level of self-perceived handicap, than subjects aged 65 or younger. DHI did not correlate with any of the balance measures. CONCLUSIONS: Self-perceived handicap, measured with DHI, and disturbed balance measured with clinical methods, do not necessarily correlate. Elderly patients with dizziness seem to have more disturbances in balance than younger patients but a lower level of self-perceived handicap.

Benign paroxysmal positional vertigo among elderly patients in primary health care.

BACKGROUND: Dizziness influences well-being in old age, and benign paroxysmal positional vertigo (BPPV) is a common cause. The condition is diagnosed using the Hallpike maneuver and treated by the particle-repositioning maneuver or habituation exercises. OBJECTIVE: To identify patients with BPPV among a variety of diagnoses represented by the ICD-10 diagnosis R42 in people 65 aged years and older who visited primary health care because of vertigo and dizziness. METHODS: Searches were performed in the computerized medical records of 6 different health care centers over the period of 1 year for the ICD-10 diagnosis R42 and the age group 65 years and older. Letters were sent to the patients identified with an invitation for assessment and physical examination by a physiotherapist. Thirty-eight patients responded to the letter and were included in the study. All patients were assessed by physical examination including the Hallpike maneuver. RESULTS: The study group included 13 men and 25 women, 65-94 (median 83) years of age. After physical examination, 15 patients were found to have BPPV (confidence interval 24-55%). CONCLUSION: In this study, 2 of 5 of the patients with ICD-10 diagnosis R42 (dizziness and giddiness) had BPPV. BPPV is probably an underestimated cause of dizziness/vertigo among elderly patients in primary health care.

Research methods courses as a means of developing academic general practice. Fifteen years' experience from Sweden and Denmark.

Since 1989, the authors have given courses in research methodology, and these courses are now given at six venues in southern Sweden, as well as in Denmark. The course corresponds to half a year's full-time study, with half the time devoted to lectures and studies of literature, while the rest is spent on an individual project under supervision. To enable part-time study, the course extends over 1(1/2) years. In 15 years roughly 1000 people, mainly physicians, have been given training in basic research methods. The course model has been appreciated by clinically active colleagues, who have been able to attend a course and simultaneously work with patients. Among the GPs in the region, one in five has taken this course, and one in five has then gone on to start formal PhD studies. The authors have thus succeeded in their goal of giving basic scientific schooling to many physicians and recruiting some for further research.

Self-rated health in relation to age and gender: influence on mortality risk in the Malmö Preventive Project.

AIMS: A study was undertaken to examine whether poor self-rated health (SRH) can independently predict all-cause mortality during 22-year follow-up in middle-aged men and women. SUBJECTS AND METHODS: Data are derived from a population-based study in Malmö, Sweden. This included baseline laboratory testing and a self-administered questionnaire. The question on global SRH was answered by 15,590 men (mean age 46.4 years) and 10,089 women (49.4 years). Social background characteristics (occupation, marital status) were based on data from national censuses. Mortality was retrieved from national registers. RESULTS: At screening 4,261 (27.3%) men and 3,085 (30.6%) women reported poor SRH. Among subjects rating their SRH as low, 1,022 (24.0%) men and 228 (7.4%) women died during follow-up. Corresponding figures for subjects rating their SRH as high were 1801 (15.9%) men and 376 (5.4%) women. An analysis of survival in subjects reporting poor SRH revealed an age-adjusted hazard risk ratio (HR, 95%CI) for men HR 1.5 (1.4-1.7), and for women HR 1.4 (1.2-1.6). The corresponding HR after adjusting for possible social confounders was for men HR 1.3 (1.1-1.4), and women HR 1.1 (0.9-1.4). When additional adjustment was made for biological risk factors the association for men was still significant, HR 1.2 (1.1-1.3). CONCLUSION: Poor SRH predicts increased long-term mortality in healthy, middle-aged subjects. For men the association is independent of both social background and selected biological variables. The adjustment for biological variables can be questioned as they might represent mediating mechanisms in a possible causal chain of events.

Effects of specific rehabilitation for dizziness among patients in primary health care. A randomized controlled trial.

OBJECTIVE: To investigate whether specific rehabilitation for patients with dizziness has any effect on clinical balance measures and/or the apprehension of dizziness measured with a visual analogue scale (VAS). DESIGN: Randomized controlled trial. SUBJECTS: Forty-two patients, 50 years or older with dizziness of central or age-related origin, identified in primary health care. METHOD: The patients were randomized to either an intervention or a control group. The intervention included balance training and vestibular rehabilitation in group sessions twice a week for six weeks. All patients were assessed at baseline, after six weeks and after three months with five different balance measures and visual analogue scale. RESULTS: Statistically significant differences were found between the two groups comparing results at baseline and after six weeks regarding standing one leg eyes closed (SOLEC) on right foot (p =0.011). Results of SOLEC right foot after three months differed significantly between the groups (p=0.033) as did SOLEC left foot (p=0.035). No difference between the groups were found in the Romberg test, figure of eight, walking heel to toe, 'stops walking when talking', standing one leg eyes open or estimating the experience of dizziness measured with visual analogue scale. CONCLUSIONS: Balance training and vestibular rehabilitation improved the ability to stand on one leg with eyes closed in persons with dizziness aged 50 years or over.

Rapid test, throat culture and clinical assessment in the diagnosis of tonsillitis.

OBJECTIVES: Our aim was to identify a group of patients with clinical signs of tonsillitis to whom antibiotics could be prescribed without further diagnostic actions, and to compare the outcome of clinical assessment with the result of an antigen detection test using culture as the gold standard. METHODS: During two winter months, patients aged > or =4 years attending for sore throat at three primary health care centres in Malmö, Sweden, were examined. Odds ratios, sensitivities, specificities and predictive values were calculated for clinical assessment and for an antigen detection test. RESULTS: Among the 169 participating patients, growth of group A beta-haemolytic streptococci (GAS) was found in 53 cultures, and 23 patients (14%) were clinically assessed as 'absolutely positive', representing positive clinical assessment. Nineteen had positive cultures for GAS. The sensitivity, specificity and predictive positive and negative value for the antigen detection test were 82, 96, 90 and 93%, respectively, and for positive clinical assessment 36, 97, 83 and 77%. CONCLUSION: It is possible to identify a small group of patients with convincing signs of tonsillitis in which the specificity as well as the predictive positive value of the rapid test and the clinical assessment are close to equal. Antibiotics may be prescribed to these patients without further diagnostic actions.

Is there an interaction between self-rated health and medication with analgesics and hypnotics in the prediction of disability pension?

AIMS: Several studies have shown that self-rated health (SRH) is associated with drug use. The aim of this study was to investigate the possible interaction between SRH and use of analgesics and hypnotics and its ability to predict disability pension. METHODS: In 1974-78. complete birth-year cohorts of middle-aged male residents in Malmö, Sweden, were invited to a health screening, and the cohort in this study comprised 5,798 men with complete data followed up for 11 years. RESULTS: At inclusion, 27% rated their health as less than perfect, 11% used analgesics, 3% used hypnotics and, during follow-up. 12% received a disability pension. The adjusted hazard ratios of disability pension were 3.1 (CI: 2.6, 3.6) for those who had rated their health as less than perfect and 2.7 (2.3, 3.2) for subjects who used analgesics and/or hypnotics. For subjects with the combined risk of poor SRH and medication, the hazard ratio was 5.5 (4.6, 6.5). The granting of disability pension attributable to the interaction between poor SRH and medication was estimated at 47%, which was statistically significant. CONCLUSIONS: Disability pension among middle-aged men was associated with self-rated health as well as medication and clear evidence of synergism between the two factors was found, while there were no indications of medication acting as a causal link between poor SRH and disability pension. Several mechanisms may contribute to the findings, but the information gained may be used as means to identify those at risk for disability pension.