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Cobalamin communication in Sweden 1990 – 2000: views, knowledge and practice among Swedish physicians
Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Family Medicine. Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Medicine.
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.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 940
Keyword [en]
Medicine, Cobalamin, folate, iron, homocysteine, MMA, vitamin B12 deficiency, therapy tradition, drug epidemiology, communication, receivers, senders
Keyword [sv]
Medicin
National Category
Dermatology and Venereal Diseases
Research subject
Medicine
Identifiers
URN: urn:nbn:se:umu:diva-416ISBN: 91-7305-803-3 (print)OAI: oai:DiVA.org:umu-416DiVA: diva2:143410
Public defence
2005-01-28, 933, Byggnad 3a 9 trappor, Norrlands Universitetssjukhus, Umeå, 13:00 (English)
Opponent
Supervisors
Available from: 2005-01-18 Created: 2005-01-18 Last updated: 2009-11-25Bibliographically approved
List of papers
1. Medical intelligence in Sweden. Vitamin B12: oral compared with parenteral?
Open this publication in new window or tab >>Medical intelligence in Sweden. Vitamin B12: oral compared with parenteral?
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2005 (English)In: Postgraduate medical journal, ISSN 0032-5473, E-ISSN 1469-0756, Vol. 81, no 953, 191-193 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Sweden is the only country in which oral high dose vitamin B12 has gained widespread use in the treatment of deficiency states. OBJECTIVE: The aim of the study was to describe prescribing patterns and sales statistics of vitamin B12 tablets and injections in Sweden 1990-2000.Design, setting, and sources: Official statistics of cobalamin prescriptions and sales were used. RESULTS: The use of vitamin B12 increased in Sweden 1990-2000, mainly because of an increase in the use of oral high dose vitamin B12 therapy. The experience, in statistical terms a "total investigation", comprised 1,000,000 patient years for tablets and 750,000 patient years for injections. During 2000, 13% of residents aged 70 and over were treated with vitamin B12, two of three with the tablet preparation. Most patients in Sweden requiring vitamin B12 therapy have transferred from parenteral to oral high dose vitamin B12 since 1964, when the oral preparation was introduced. CONCLUSION: The findings suggest that many patients in other post-industrial societies may also be suitable for oral vitamin B12 treatment.

Keyword
Administration; Oral, Adolescent, Adult, Aged, Child, Child; Preschool, Female, Humans, Infant, Infant; Newborn, Injections; Intramuscular, Male, Middle Aged, Physician's Practice Patterns/trends, Prescriptions; Drug/statistics & numerical data, Sweden, Tablets, Vitamin B 12/*administration & dosage, Vitamin B 12 Deficiency/*drug therapy
Identifiers
urn:nbn:se:umu:diva-14819 (URN)10.1136/pgmj.2004.020057 (DOI)15749797 (PubMedID)
Available from: 2008-10-10 Created: 2008-10-10 Last updated: 2017-12-14Bibliographically approved
2. Controversies around vitamin B12 in Sweden.: Attitudes and values behind clinical decision-making in primary health care 1996
Open this publication in new window or tab >>Controversies around vitamin B12 in Sweden.: Attitudes and values behind clinical decision-making in primary health care 1996
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1997 (English)In: Hematology, ISSN 1024-5332, E-ISSN 1607-8454, Vol. 2, no 4, 341-350 p.Article in journal (Refereed) Published
Abstract [en]

Over a five-year period, 1991-1995, the vitamin B12 market in Sweden increased three-fold, from approximatelyy 2 million U.S. dollars to approximately 6 million U.S. dollars. Most prescriptions, approximately 60%, originated from primary health care. The attitudes, values and knowledge of the family physicians/general practitioners were elucidated by a questionnaire study with visuo-analogue opinion scales, evaluating 24 basic statements on problems associated with the management of vitamin B12 deficiency. The questionnaire was sent to a representative sample of 506 family physicians/general practitioners. Response rate was 74%. Dropout analysis supported the view that responders provided a representative sample of Swedish FP/GPs. Analysis of the answers was compatible with the hypothesis that the mentioned increase in Swedish B12 market reflected increased awareness in primary health care about the biochemical, pathophysiological and social problems associated with vitamin B12 deficiency.

Identifiers
urn:nbn:se:umu:diva-4355 (URN)10.3109/10245339709163373 (DOI)
Available from: 2005-01-18 Created: 2005-01-18 Last updated: 2017-12-14
3. Shifts in B12 opinions in primary health care of Sweden.
Open this publication in new window or tab >>Shifts in B12 opinions in primary health care of Sweden.
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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.

Identifiers
urn:nbn:se:umu:diva-4356 (URN)11484864 (PubMedID)
Available from: 2005-01-18 Created: 2005-01-18 Last updated: 2017-12-14
4. Vitamin B12 in primary health care and geriatrics - attitudes, knowledge, competence.
Open this publication in new window or tab >>Vitamin B12 in primary health care and geriatrics - attitudes, knowledge, competence.
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2001 (English)In: International Journal of Geriatric Psychiatry, ISSN 0885-6230, E-ISSN 1099-1166, Vol. 16, no 10, 987-992 p.Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: The objective of the study was to test attitudes, knowledge and competence of Swedish general practitioners and geriatricians concerning B12-associated problems in 1998. METHODS: Postal questionnaires were sent to a random sample of 485 GPs and a total sample of 613 geriatricians. The response rates were 70% in the GP group and 69% in the geriatrician group. The questionnaire contained 24 statements to be evaluated by a visuo-analogue scale. RESULTS: There were small numerical differences between the two physician groups. The geriatricians were more aware of risk groups for B12 deficiency. GPs were less categorical concerning low hit rate in the laboratory testing of clinical conclusions. There were statistical differences in both directions for statements on pitfalls in laboratory diagnostics. GPs were somewhat less prone to give risk groups prophylactic B12 therapy. CONCLUSIONS: GPs and geriatricians appeared to be familiar with the current debate on B12-associated problems, suggesting that health care quality will be unaffected by patient transfer from hospital care to primary health care. Copyright 2001 John Wiley & Sons, Ltd.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:umu:diva-4357 (URN)10.1002/gps.455 (DOI)11607944 (PubMedID)
Available from: 2005-01-18 Created: 2005-01-18 Last updated: 2017-12-14
5. Sex differences in cobalamin (vitamin B12) opinions of Swedish physicians.
Open this publication in new window or tab >>Sex differences in cobalamin (vitamin B12) opinions of Swedish physicians.
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2002 (English)In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 56, no 4, 299-303 p.Article in journal (Refereed) Published
Abstract [en]

The aim of the study was to elucidate possible sex differences in knowledge, competence and attitudes behind decision-making on cobalamin-associated problems (vitamin B(12)). The study was conducted by postal questionnaires to Swedish physicians in 1996-98. The participants were recruited by random sampling of general practitioners (1996, 1998), and a total sampling of geriatricians (1998). The overall response rate was 71%. The study group comprised 480 female physicians and 526 male physicians. The responses to 24 statements in the questionnaire were measured by means of visual analogue scales. Group differences were evaluated by medians and shapes of distributions. The female doctors appeared to value patient-related symptoms and signs more than male doctors. Conversely, male doctors relied on laboratory tests more than female doctors. As reflected by questionnaire answers, female doctors appeared to be more informed than male doctors on cobalamin-associated clinical problems. Group differences between the sexes were marginal from a numerical point of view. It is suggested that the statistical differences observed should be regarded as negligible until confirmed by further studies.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:umu:diva-4358 (URN)10.1080/08039480260242804 (DOI)12470322 (PubMedID)
Available from: 2005-01-18 Created: 2005-01-18 Last updated: 2017-12-14

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