Primary Health Care Center

Nuuk, Greenland

Primary Health Care Center

Nuuk, Greenland
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Miravitlles M.,CIBER ISCIII | Cantoni J.,Bioclever | Naberan K.,Primary Health Care Center
Lung | Year: 2014

Background: Physical activity such as walking is strongly recommended for patients with chronic obstructive pulmonary disease (COPD). Methods: We undertook a multicenter observational study on COPD patients, collecting the daily walking time, COPD severity score (COPDSS), functional status [London Chest Activity of Daily Living (LCADL) questionnaire], health-related quality of life (QoL) rating [five-item EuroQL (EQ-5D) and Airways Questionnaire 20 (AQ20)], and anxiety and depression rating (Hospital Anxiety and Depression Scale). Multivariate logistic regression modeling was performed to identify the independent predictors of a low walking time (<30 min/day). Results: We included 4,574 patients with a mean (±standard deviation) age of 67.1 ± 10.0 years, with a mean FEV1 (%) of 54.0 ± 23.7. The mean daily walking time was 73.6 ± 67.1 min (58.9 % at ≥60 min and 13.7 % at <30 min). A strong direct relationship was observed between daily walking time and better QoL (EQ-5D and AQ20) and functional status (LCADL; p < 0.001 in all cases). The independent predictors of a low walking time were a worse score in EQ-5D [odds ratio (OR) (95 % confidence interval per one-point increase of 0.23 (0.15-0.35)], a higher COPDSS [OR per one-point increase of 1.04 (1.02-1.07)], and the presence of depression [OR 1.58 (1.25-2.01)]. Conclusions: After adjustment for age and severity of symptoms, poor health status, severity of COPD, and depression are the main factors associated with a low walking time in COPD patients. © 2014 Springer Science+Business Media.


Stein K.F.,Primary Health Care Center | Miclescu A.,Uppsala University Hospital
Scandinavian Journal of Pain | Year: 2013

Background: In recent years, multidisciplinary rehabilitation (MDR) became an alternative treatment option for chronic non-cancer pain. MDR is mostly available in specialized pain units, usually at rehabilitation centers where the level of knowledge and therapeutically options to treat pain conditions are considered to be high. There is strong evidence that MDR in specialized pain units is affecting pain and improves the quality of life in a sustainable manner. There are few studies about MDR outcome in primary health care, especially in those units situated in rural areas and with a different population than that encountered in specialized hospitals. That, in spite of the fact that the prevalence of pain in the patients treated in primary care practice is about 30%. The aim of this study is to analyze the effectiveness of MDR for chronic non-cancer patients in a primary health care unit. Methods: This study included a total of 51 patients with chronic pain conditions who were admitted and completed the local MDR-program at the primary health care unit in Arvika, Sweden. The major complaint categories were fibromyalgia (53%), pain from neck and shoulder (28%) or low back pain (12%). The inclusion criteria were age between 16 and 67 years and chronic non-cancer pain with at least 3 months duration. The multidisciplinary team consisted of a general practitioner, two physiotherapists, two psychologists and one occupational therapist. The 6-week treatment took place in group sessions with 6-8 members each and included cognitive-behavioral treatment, education on pain physiology, ergonomics, physical exercises and relaxation techniques.Primary outcomes included pain intensity, pain severity, anxiety and depression scores, social and physical activity, and secondary outcomes were sick leave, opioid consumption and health care utilization assessed in the beginning of the treatment and at one year follow-up. Data was taken from the Swedish Quality Register for Pain Rehabilitation (SQRP) and the patients' medical journal. Results: One year after MDR treatment, sick leave decreased from 75.6% to 61.5% (p< 0.05). Utilization of health-care during one year decreased significantly from 27.4 to 20.1 contacts (p= 0.02). There were significant improvements concerning social activity (p= 0.03) and depression (p< 0.05), but not in anxiety (p= 0.1) and physical activity (p= 0.08). Although not statistically significant, some numerical decrease in the mean levels of pain intensity, pain severity and opioid consumption were reported one year after MDR (p> 0.05). Conclusions: The results obtained one year after rehabilitation indicated that patients with chronic non-cancer pain might benefit from MDR in primary health care settings. Implications: This study suggests that MDR in primary care settings as well as MDR at specialized pain units may lead to better coping in chronic non-cancer pain conditions with lower depression scores and higher social activity, leading to lower sick leave. This study demonstrated that there is a place for MDR in primary health care units with the given advantage of local intervention in rural areas allowing the patients to achieve rehabilitation in their home environment. © 2013 Scandinavian Association for the Study of Pain.


Tovar J.,Lund University | Nilsson A.,Lund University | Johansson M.,Lund University | Ekesbo R.,Primary Health Care Center | And 3 more authors.
Nutrition and Metabolism | Year: 2012

Background: Different foods can modulate cardiometabolic risk factors in persons already affected by metabolic alterations. The objective of this study was to assess, in healthy overweight individuals, the impact of a diet combining multiple functional concepts on risk markers associated with cardiometabolic diseases (CMD). Methods. Fourty-four healthy women and men (50-73 y.o, BMI 25-33, fasting glycemia ≤ 6.1 mmol/L) participated in a randomized crossover intervention comparing a multifunctional (active) diet (AD) with a control diet (CD) devoid of the "active" components. Each diet was consumed during 4 wk with a 4 wk washout period. AD included the following functional concepts: low glycemic impact meals, antioxidant-rich foods, oily fish as source of long-chain omega-3 fatty acids, viscous dietary fibers, soybean and whole barley kernel products, almonds, stanols and a probiotic strain (Lactobacillus plantarum Heal19/DSM15313). Results: Although the aim was to improve metabolic markers without promoting body weight loss, minor weight reductions were observed with both diets (0.9-1.8 ± 0.2%; P < 0.05). CD did not modify the metabolic variables measured. AD promoted significant changes in total serum cholesterol (-26 ± 1% vs baseline; P < 0.0001), LDL-cholesterol (-34 ± 1%; P < 0.0001), triglycerides (-19 ± 3%; P = 0.0056), LDL/HDL (-27 ± 2%; P < 0.0001), apoB/apoA1 (-10 ± 2%; P < 0.0001), HbA 1c(-2 ± 0.4%; P = 0.0013), hs-CRP (-29 ± 9%; P = 0.0497) and systolic blood pressure (-8 ± 1% P = 0.0123). The differences remained significant after adjustment for weight change. After AD, the Framingham cardiovascular risk estimate was 30 ± 4% (P < 0.0001) lower and the Reynolds cardiovascular risk score, which considers CRP values, decreased by 35 ± 3% (P < 0.0001). Conclusion: The improved biomarker levels recorded in healthy individuals following the multifunctional regime suggest preventive potential of this dietary approach against CMD. © 2012 Tovar et al; licensee BioMed Central Ltd.


Ronkainen J.,Primary Health Care Center | Ronkainen J.,University of Oulu | Ronkainen J.,Karolinska Institutet | Agreus L.,Karolinska Institutet
Best Practice and Research: Clinical Gastroenterology | Year: 2013

Gastro-oesophageal reflux disease (GORD) occurs when reflux of gastric contents causes troublesome symptoms and/or complications (the Montreal definition). GORD is a common condition with a substantial economical burden to the community and it has a significant negative effect on health-related quality of life (HRQoL) while endoscopic findings like erosive oesophagitis per se seem to correlate badly with the experienced HRQoL. The prevalence of GORD varies over the world for unknown reasons, but genetic differences, difference in the Helicobacter pylori prevalence and life style factors like obesity might influence. The prevalence is lowest in East Asia (2.5-9.4%) and higher in Mid (7.6-19.4%) and Western Asia (12.5-27.6%). The highest population-based prevalence is reported from Europe (23.7%) and the US (28.8%). GORD seems to be fairly stable over time both in terms of symptoms and erosive oesophagitis, but the prevalence seems to be increasing both in Asia and in the West. © 2013 Elsevier Ltd. All rights reserved.


Bjerregaard P.,University of Southern Denmark | Pedersen H.S.,Primary Health Care Center | Nielsen N.O.,University of Southern Denmark | Dewailly E.,Laval University
Science of the Total Environment | Year: 2013

The purpose of the study was to analyse temporal trends (1993-2009) of the concentrations of organochlorine contaminants (14 congeners of polychlorinated biphenyls (PCB) and 11 pesticides) in the blood of Greenland Inuit according to age and urbanisation. Statistical determinants for the contaminant concentrations included (for PCB congener 153) age (δr2=0.35), marine diet (δr2=0.10), smoking (δr2=0.02), and sex (δr2=0.01) with comparable results for other organochlorine contaminants. After adjustment for age, diet, smoking, and sex a significant decreasing trend was present for all contaminants ranging from 41% for mirex to 56% for hexachlorobenzene. The temporal trend was most pronounced among participants below the age of 65years. The decrease started later in villages than in towns. The decrease was present in all age groups and in the capital, other towns, and villages. The decrease is probably due to a combination of reduced concentrations of the contaminants in the wildlife and a slight temporal reduction in the consumption of marine mammals. The significant downwards trend of legacy POPs shows that the legislation works but it must be kept in mind that according to the cumulated scientific evidence there are a multitude of non-regulated persistent organic contaminants in the diet as well as high levels of methylmercury. © 2013 Elsevier B.V.


Garcia-Meseguer M.J.,University of Castilla - La Mancha | Burriel F.C.,Ministry of Health and Social Affairs of Castilla La Mancha | Garcia C.V.,Primary Health Care Center | Serrano-Urrea R.,University of Castilla - La Mancha
Appetite | Year: 2014

The aim of this work was to characterize food habits of Spanish University students and to assess the quality of their diet and some possible determinant factors according to Mediterranean food pattern among other indices. Two hundred eighty-four enrolled students during the academic year 2012-2013 participated in this survey. For each individual a questionnaire involving anthropometric measurements, types of housing, smoking habits and levels of physical activity were self-reported. Food consumption was gathered by two nonconsecutive 24 hour recalls including one weekend day. BMI within the normal range was showed by 72.5% of students and 75% of the sample reflected a sedentary lifestyle or low physical activity. The percentage of total energy from each macronutrient was approximately 17% proteins, 40% carbohydrates and 40% lipids. The ratio of polyunsaturated to monounsaturated fat only reached 0.32. Cholesterol consumption in men exceeded the intake in women by 70 mg/day but nutritional objectives were exceeded in both genders. The main source of protein had an animal origin from meat (38.1%), followed by cereals (19.4%) and dairy products (15.6%). The assessment of diet quality conducted by Healthy Eating Index (HEI) and Mediterranean Diet Score (MDS) revealed a low-intermediate score in both (51.2±12.8 and 4.0±1.5, respectively). The main deviations from Mediterranean pattern were a low intake of vegetables and fruit and a high consumption of meat and dairy products. According to HEI classification, 96.1% of subjects scored "poor" or "needs improvement" about the quality of their diet and only 5.3% of students achieved a high adherence to Mediterranean diet. It is necessary to foster changes toward a healthier diet pattern according to cultural context in this population for preventing cardiovascular diseases, type 2 diabetes and insulin resistance. © 2014 Elsevier Ltd.


Aro P.,Karolinska Institutet | Talley N.J.,University of Newcastle | Agreus L.,Karolinska Institutet | Johansson S.-E.,Karolinska Institutet | And 4 more authors.
Alimentary Pharmacology and Therapeutics | Year: 2011

Background Data on the impact of functional dyspepsia on health-related quality of life in the general adult population are scarce. Aim To explore the impact of functional dyspepsia applying the Rome III definition on health-related quality of life in the general population. Method A random sample of an adult Swedish population (n = 1001, The Kalixanda study) was invited to undergo an oesophagogastroduodenoscopy. An extended abdominal symptom questionnaire and Short Form-36 (SF-36) questionnaire, which includes eight domains measuring physical, mental and social aspects of quality of life, were completed at the clinic visit just before oesophagogastroduodenoscopy. Results Two hundred and two (20%) individuals reported uninvestigated dyspepsia (UID), 157 (16%) functional dyspepsia (FD), 52 (5%) epigastric pain syndrome (EPS) and 122 (12%) postprandial distress syndrome (PDS). UID, FD and PDS had a clinically meaningful (a ≤yen; 5 point) and statistically significant impact (P < 0.05) on health-related quality of life in all SF-36 domains except for Role Emotional. EPS had a significant impact on Bodily Pain and Vitality. Overlap of FD with irritable bowel syndrome (IBS) had a significant impact on Bodily Pain (P = 0.002) and General Health (P = 0.02) while FD overlap with gastro-oesophageal reflux symptoms (GERS) had a significant impact on Bodily Pain (P = 0.02) compared with FD without any overlap with IBS or GERS. Conclusion Functional dyspepsia impacts all main domains describing physical, mental and social aspects of health-related quality of life in the general population. Overlap of functional dyspepsia with irritable bowel syndrome or gastro-oesophageal reflux symptoms impacts the domain related to bodily pain. © 2011 Blackwell Publishing Ltd.


Ronkainen J.,University of Oulu | Ronkainen J.,Karolinska Institutet | Ronkainen J.,Primary Health Care Center | Talley N.J.,University of Newcastle | And 6 more authors.
American Journal of Gastroenterology | Year: 2011

Objectives: Symptomatic gastroesophageal reflux disease (GERD) is associated with a significantly increased risk of esophageal adenocarcinoma, but its natural history in the general population is poorly understood. Whether nonerosive reflux disease (NERD) is a risk factor for Barrett's esophagus (BE), the precursor of esophageal adenocarcinoma, is unknown. Furthermore, quantifying the risk of incident BE in those with untreated reflux esophagitis has not been possible. We aimed, in a prospective follow-up study with endoscopy, to evaluate the risk of BE in a cohort from the Swedish general population (the Kalixanda Study). Methods: Those with endoscopic or histological findings suggestive of GERD and randomly half of those with NERD (n481) were invited for follow-up investigation including endoscopy and a validated symptom questionnaire 5 years after the initial study. Multinomial logistic regression was used to estimate relative risk ratios (RRRs) and 95% confidence intervals (CIs) for change in presentation of GERD. Results: Of the 405 subjects available for inclusion, endoscopy was performed in 284 (response rate 70.1%). The incidence of BE was 9.9/1,000 person-years. Of those with NERD at baseline (n=113), progression to erosive esophagitis was found in 11; 2 developed BE. Erosive esophagitis (n=90) progressed to a more severe grade in 12 and to BE in 8 cases. Erosive esophagitis at baseline was independently associated with BE at follow-up (RRR 5.2; 95% CI 1.2-22.9). Conclusions: Compared with being free of GERD at follow-up, erosive esophagitis is a major risk factor for BE (with a fivefold increased risk) after 5 years in the general population. © 2011 by the American College of Gastroenterology.


Aro P.,Karolinska Institutet | Talley N.J.,University of Newcastle | Johansson S.-E.,Karolinska Institutet | Agreus L.,Karolinska Institutet | And 3 more authors.
Gastroenterology | Year: 2015

Background & Aims Functional dyspepsia (FD) is associated with anxiety but it is not clear if one causes the other. We investigated whether anxiety and depression precede the onset of FD (based on the modified Rome III criteria) and gastroesophageal reflux symptoms (GERS) in a population-based follow-up study. Methods Participants from the Kalixanda study (n = 3000), randomly selected from the national population register of Sweden, were given the validated Abdominal Symptom Questionnaire 1998-2001; 1000 of these participants then were selected randomly to undergo esophagogastroduodenoscopy and were given the Abdominal Symptom Questionnaire along with the Hospital Anxiety and Depression Scale questionnaire. All eligible subjects who underwent endoscopy (n = 887) were invited to participate in a follow-up study in June-August 2010 and were given the same questionnaires. Data were analyzed by logistic regression. Results Of the 703 subjects who completed the follow-up questionnaires (79.3%); 110 were found to have FD at baseline (15.6%) and 93 at the follow-up examination (13.3%); 48 of these were new cases of FD. GERS without organic disease was reported by 273 individuals (38.8%) at baseline and by 280 at follow-up examination (39.8%); 93 cases were new. Major anxiety was associated with FD at the follow-up evaluation (odds ratio [OR], 6.30; 99% confidence interval [CI], 1.64-24.16). Anxiety was associated with postprandial distress syndrome at baseline (OR, 4.83; 99% CI, 1.24-18.76) and at the follow-up examination (OR, 8.12; 99% CI, 2.13-30.85), but not with epigastric pain syndrome. Anxiety at baseline was associated with new-onset FD at the follow-up examination (OR, 7.61; 99% CI, 1.21-47.73), but not with GERS. Conclusions In a study of the Swedish population, anxiety at baseline, but not depression, increased the risk for development of FD by 7.6-fold in the next 10 years. Anxiety did not affect risk for GERS. © 2015 AGA Institute.


Sigurdsson B.,University of Iceland | Palsson S.P.,University of Iceland | Johannsson M.,University of Iceland | Olafsdottir M.,Primary Health Care Center | Aevarsson O.,University of Iceland
Nordic Journal of Psychiatry | Year: 2013

Background: The degree and direction of hypothalamic-pituitary-adrenal (HPA) dysfunction to male mental health is unclear. Aims: The aim of the study was to investigate the relationship between cortisol and male mental health. Methods: In this community study, 534 males were screened, using the Beck Depression Inventory (BDI), Gotland Male Depression Scale (GMDS) and a general health questionnaire. Those with signs of depression (n = 65) and controls (n = 69) were evaluated in a psychiatric examination according to the DSM-IV criteria for depressive disorder (DD). In a sub-sample (n = 51) saliva cortisol was measured five times on a single day. Results: Evening cortisol was significantly higher in untreated individuals with DD. Significantly higher evening cortisol (at 22 h) correlated also with a history of physical disorder, a history of any mental disorder and MADRS score ≥ 20 (Montgomery-Åsberg Depression Rating Scale). High cortisol, measured as AUC (area under curve), correlated with a high MADRS score but not with any other health variable tested. Morning cortisol did not correlate with any health variable; however, cortisol awakening response (CAR) could not be investigated. The BDI and GMDS scores did not correlate with cortisol measurements. Conclusion: Evening saliva cortisol measurement seems most informative, as it correlates with male depressive syndrome in our study but replications with larger studies are needed. © 2013 Informa Healthcare.

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