Objectives. To study medication utilization and adherence to prescribed therapy in a female population in central Sweden. To study usage of hormone replacement therapy (HRT) in this population and to assess how HRT users compare to non-users regarding symptom reporting, general health and other variables. To evaluate symptom prevalence adjusted for potential symptom affecting variables. Material and methods. A cross-sectional postal questionnaire study was performed in 1995 in seven counties in central Sweden. A questionnaire was sent to a random sample of 4,200 women aged 35-64, of whom 2,991 responded (71.2%). The questionnaire contained questions on psycho-socio-economic background, quality of life, self-reported health, height and weight, climacteric symptom prevalence, and menopausal status and symptoms. It also comprised questions on medication prescribed during the past year. Results. 40% used prescribed medication and 12% took four drugs or more. Age, educational level, self-rated health, and BMI remained significantly correlated to drug use in multivariate analysis. Adherence ranged from 15%-98% depending on age, a scheduled check-up, perceived importance of medication, concern about medication, taking cardiovascular and respiratory disease drugs. The highest adherence was found for hormonal medication the lowest for musculoskeletal medication. HRT was used by 15% of the women. 13 % used other symptom relieving therapy. HRT users reported higher score of vasomotor symptoms, except for sweating during the daytime. Prevalence of general symptoms did not necessarily increase with age. Especially symptoms related to stress-tension-depression decreased with age. Four different symptom prevalence patterns were found. Conclusions. Age, health status, educational level and body mass index (BMI) appear to affect drug use. Adherence to therapy is highest among elderly women who regard their medication as important and have a scheduled check-up. HRT relieves some vasomotor symptoms but does not affect other symptoms or self-rated health. Prevalence of symptoms related to Stress-tension-depression appears to decrease with age.

Bacterial Vaginosis (BV) is a disorder of unknown etiology, characterized by a foul smelling vaginal discharge, loss or reduction of the normal vaginal Lactobacilli, and overgrowth of other anaerobic bacteria. Thus, it presents a formidable problem for clinicians as well as microbiologists researching its etiology, clinical course, treatment, and epidemiology. The present work focuses on the unresolved issues of the epidemiology and treatment of BV in order to provide valid methods for treatment studies of this condition and to describe the prevalence of BV in defined populations. The first study validates the use of PAP-stained smears in the diagnosis of BV. The study assesses the methods of Amsel’s clinical criteria and Nugent criteria on Gram-stain smears, against Pap-stained smears and also validates different observers. The result shows that the PAP-staining of vaginal smears is a good method in BV diagnosis; the kappa value is 0.86 (interobserver weighted kappa index) compared to 0.81 for Gram-stained smears, and 0.70 for rehydrated air-dried smears using the mean Nugent score as the criterion standard. This enables population based studies on archived PAP-stained smears from the screening of cervical cancer. In the second study, we use the knowledge gained from study one to investigate the prevalence of BV in a cohort from the population of Åland. The prevalences of BV on the Åland Islands were: 15.6 %, 11.9 %, 8.7 %, and 8.6% in 1993, 1998, 2003, and 2008, respectively. This means that the prevalence of BV decreased between1993-2008 from 15.6% to 8.6%. The confidence intervals are not overlapping, thus indicating a significant decrease in prevalence from 1993 to 2008. The third study is a prospective, double-blind placebo controlled treatment study of BV. After conventional treatment with clindamycin, the patients were treated with adjuvant treatment of Lactobacilli-loaded tampons or placebo. The study showed no differences between the treatment and the placebo group, indicating that the tampon does not work at all. There are a variety of possible explanations for the result, which are analyzed in this thesis. The fourth study aimed to evaluate whether clindamycin is retained for a long time in the vaginal mucosa, thus disturbing the Lactobacilli in an attempt to reimplant Lactobacilli in the probiotic treatment studies. In conventional treatment, it is also useful to know whether clindamycin is retained, especially when considering the pressure from antibiotics on the antimicrobial sensitivity pattern. In the study, we found that the clindamycin disappears rapidly. Conclusion: BV research requires effort from many different scientific disciplines and the riddle of this condition and its treatment can only be resolved by concerted actions in research and treatment. The vision for the future includes, among other factors, better molecular biology based diagnostic tools, and knowledge of population based bacterial floras.

Objetivos del estudio: Describir la epidemiología del Episodio Depresivo Mayor (EDM) en la población general española y comparar los resultados con los datos reflejados en la literatura internacional. Métodos: Estudio observacional, transversal, sobre una muestra representativa de la población general española adulta (n= 5473). Se usó el instrumento CIDI 3.0. El estudio forma parte del proyecto ESEMED (European Study of the Epidemiology of Mental Disorders), desarrollado en 6 países europeos. Resultados principales: La prevalencia vida y 12 meses del EDM fue de 10.6% y 4.0% respectivamente. Las mujeres, las personas de 50-64 años, los separados, viudos o divorciados, las amas de casa o los desempleados mostraron un mayor riesgo de depresión. La cronicidad ascendió al 37% y la edad de inició fue de 30 años. La asociación con otros trastornos fue elevada así como la discapacidad, que afectó a todos los dominios estudiados. El uso de servicios fue del 59% y los porcentajes de tratamietno adecuado del 31,2%. Conclusiones: El EDM es un trastorno prevalente, con frecuencia comórbido y de repercusión relevante en el funcionamiento, sin embargo recibe tratamiento en un porcentaje insuficiente de los casos. La comparación con los resultados internacionales mostró diferencias significativas en el perfil epidemiológico. Se discute el posible papel de los determinantes socioculturales en las diferencias encontradas / Objectives: To describe the epidemiology of Major Depressive Episode (MDE) in the general population of Spain and to compare results with previous data from scientific literature. Methods: The ESEMED-Spain study is a cross-sectional, general population, household survey representative of Spanish non-institutionalized adult population (N=5,473). The Composite International Diagnostic Interview 3.0 was used. The ESEMED project was developed in 6 European countries. Main results: Lifetime prevalence of MDE was 10.6% while 12-month prevalence was 4.0%. Being a woman, aged 50-64, previously married, widowed, or unemployed was associated to higher risk of MDE. Persistence of depression ascended to 37% and the median age of onset was 30.0. Comorbidity with other disorders was high and also disability, which affected all domains of functioning. The use of services for MDE was 59% and the percentage of minimally adequate treatment was 31.2%. Conclusions: MDE is a prevalent disorder; it’s often comorbid with other conditions and has a big impact on functionality. Nevertheless, only a small percentage of the cases receive treatment. The comparison with the international results showed significant differences in the epidemiologic profile. The possible role of sociocultural determinants in explaining those differences are discussed.

Diss. (sammanfattning) Uppsala : Univ., 2003. / Härtill 4 uppsatser.

Diss. (sammanfattning) Umeå : Univ., 2007. / Härtill 5 uppsatser.

Diss. (sammanfattning) Linköping : Linköpings universitet, 2007. / Härtill 4 uppsatser.

Thesis (Ph. D.)--University of Alabama at Birmingham, 2008. / Title from first page of PDF file (viewed Feb. 10, 2009). Includes bibliographical references (p. 71-78).

Thesis (M. P.H.M. (Primary Health Care Management))--Mahidol University, 2007. / LICL has E-Thesis 0024 ; please contact computer services.

Thesis (M.P.H.)--University of Texas Health Science Center at Houston, School of Public Health, 2008. / Source: Masters Abstracts International, Volume: 46-05, page: 2670. Adviser: Florence J. Dallo. Includes bibliographical references.

Thesis (M.S.P.H.)--University of South Florida, 2009. / Title from PDF of title page. Document formatted into pages; contains 68 pages. Includes bibliographical references.