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Shifts in B12 opinions in primary health care of Sweden.
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
Umeå University, Faculty of Medicine, Department of Medical Biosciences, Clinical chemistry.
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2001 (English)In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 29, no 2, 122-128 p.Article in journal (Refereed) Published
Abstract [en]

AIMS: The diagnosis and management of vitamin B12 deficiency varies between countries and within countries. The aim of the study was to map current attitudes and values behind clinical decision-making in Swedish primary health care, which has a unique B12 tradition: two patients out of three are treated with oral high-dose cyanocobalamin. Most patients with B12-associated problems are managed in primary health care by general practitioners (GPs). METHODS: The study was designed to elucidate possible opinion shifts among GPs during the period 1996-1998. GPs (n=499), stratified and randomized, received a questionnaire with 24 statements on B12-associated clinical and laboratory problems, to be evaluated by a visuo-analogue scale. RESULTS: The majority of GPs in primary health care in Sweden accepted homocysteine and methylmalonic acid (MMA) as markers for functional deficiency of vitamin B12. The evaluation of classical markers of B12 deficiency was wary and balanced. There was a consensus of the need for B12 therapy to risk groups such as patients with atrophic gastritis or previous gastric surgery. The answers also appeared to reflect an improvement of professional knowledge and competence concerning B12-associated problems among Swedish GPs between 1996 and 1998. CONCLUSIONS: The overriding conclusion was that B12-associated opinions of Swedish GPs were stable within the period studied, with marginal improvements of knowledge and competence.

Place, publisher, year, edition, pages
2001. Vol. 29, no 2, 122-128 p.
URN: urn:nbn:se:umu:diva-4356PubMedID: 11484864OAI: diva2:143407
Available from: 2005-01-18 Created: 2005-01-18 Last updated: 2016-03-03
In thesis
1. Cobalamin communication in Sweden 1990 – 2000: views, knowledge and practice among Swedish physicians
Open this publication in new window or tab >>Cobalamin communication in Sweden 1990 – 2000: views, knowledge and practice among Swedish physicians
2005 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Cobalamin (vitamin B12) is one of several essential micronutrients needed by the human organism. Other important micronutritients, which interplay with vitamin B12, are folate and iron. During the last ten years, the attention has been drawn to different forms of neurological disorders supposed to be caused by vitamin B12 deficiency. Vitamin B12 deficiency states are common among elderly patients in primary health care and sometimes in hospital care, especially in geriatric practice.

This is a study to define the cobalamin treatment traditions, among Swedish physicians in the period 1990 – 2000. The period was distinguished by an intense debate on the issue by the physicians, an increase of cobalamin consumption, and a shift from parenteral therapy towards oral high-dose therapy.

It had been known that symptoms of cobalamin deficiency could start in the nervous system. This knowledge was reinforced by the application of homocysteine and methyl-malonic acid (MMA) in deficiency diagnosis. Introduction of homocysteine and MMA in deficiency diagnosis changed the view on deficiency prevalence, by identifying persons at risk to develop B12 deficiency prior to established symptoms.

In this study, Swedish physicians are regarded mainly as receivers of communication about the markers homocysteine and MMA, and deficiency states of cobalamin and folate. The main senders were scientists from North America, Norway, Denmark, and Sweden.

This study sets the senders and the receivers of cobalamin communication on a collegial level and quantifies and evaluates the feed-back from the receivers. The receivers, gen¬eral practitioners and geriatricians, appeared to be familiar with old knowledge and frontier concepts in the field. Thus, it is suggested that the increase of B12 prescriptions in Sweden 1990 – 2000 reflected an increased awareness of B12-associated clinical problems among the physicians managing the majority of deficiency patients, although a possible overconsumption of pharmaceutical drugs must be kept in mind.

Place, publisher, year, edition, pages
Umeå: Folkhälsa och klinisk medicin, 2005. 66 p.
Umeå University medical dissertations, ISSN 0346-6612 ; 940
Medicine, Cobalamin, folate, iron, homocysteine, MMA, vitamin B12 deficiency, therapy tradition, drug epidemiology, communication, receivers, senders, Medicin
National Category
Dermatology and Venereal Diseases
Research subject
urn:nbn:se:umu:diva-416 (URN)91-7305-803-3 (ISBN)
Public defence
2005-01-28, 933, Byggnad 3a 9 trappor, Norrlands Universitetssjukhus, Umeå, 13:00 (English)
Available from: 2005-01-18 Created: 2005-01-18 Last updated: 2009-11-25Bibliographically approved

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