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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. Source


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. Source


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. Source


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. Source


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. Source

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