Papers by Frode Gallefoss
Research Square (Research Square), Sep 27, 2019
Nicotine & Tobacco Research, Sep 27, 2012
Lund and Scheffels (2011) discussed survey data on Norwegian general practitioners' (GP) percepti... more Lund and Scheffels (2011) discussed survey data on Norwegian general practitioners' (GP) perception of the harmfulness of snus, and the same GPs' tendency not to recommend snus in smoking cessation. Their abstract concluded that "[a]lmost two thirds of GPs had beliefs about the relative risk of snus and cigarettes that were at odds with scientific consensus. " The authors also expressed worry of an "unexploited intervention potential. "
Tidsskrift for Den Norske Laegeforening, Oct 7, 2004
Respiratory Medicine, Dec 1, 2006
Guidelines or recommendations for diagnosis and treatment of obstructive lung diseases defined as... more Guidelines or recommendations for diagnosis and treatment of obstructive lung diseases defined as asthma and/or chronic obstructive pulmonary disease (COPD) have been numerous in the Nordic countries during the last 25 years. A better-shared care between on one side the general practitioners or chest physicians and on the other side the patients and their closest surroundings of care has to be implemented in future guidelines. Guidelines are based on efficacy and not effectiveness studies, and do not properly focus the process of behavioural changes of health care professionals and patients. Primary care physicians treat the vast majority of patients with chronic airway disease of moderate severity. However, they find the evidence-based practice guidelines often complicated. Furthermore, less than 50% of the recommendations in guidelines may be evidence based. As rapid changes may occur in diagnosis and treatment options, future guidelines must be able to adapt to such rapid adjustments. No randomised studies are available on the effect of patient-relevant outcomes using guidelines on management of obstructive lung disease. More outcome research is necessary on both change of procedures and health endpoints after launching guidelines. Cost-effectiveness studies are important to make medical staff and administrative health care systems cooperate in the construction of future health care systems with both an improved medical and system quality.
BMC Pregnancy and Childbirth, Dec 1, 2019
Background: The use of tobacco products including Swedish snus (moist snuff) in pregnancy may cau... more Background: The use of tobacco products including Swedish snus (moist snuff) in pregnancy may cause adverse health outcomes. While smoking prevalence has decreased among fertile women in Norway, snus use has increased during the last years. We investigated whether these trends were reflected also during pregnancy in a population of women in Southern Norway. Methods: Data on smoking tobacco and snus use at three time points before and during pregnancy for 20,844 women were retrieved from the electronic birth record for the years 2012-2017. The results for the three-year period 2015-2017 were compared with a previously studied period 2012-2014. Prevalence and quit rates of tobacco use within groups of age, parity and education were reported. Within the same groups adjusted quit rates were analyzed using logistic regression. Mean birthweight and Apgar score of offspring were calculated for tobacco-users and non-users. Results: There was an increase of snus use before pregnancy from the period 2012-2014 to the period 2015-2017 from 5.1% (CI; 4.6 to 5.5) to 8.4% (CI; 7.8 to 8.9). Despite this, the use of snus during pregnancy did not increase from the first to the second period, but stabilized at 2.8% (CI; 2.5 to 3.2) in first trimester and 2.0% (CI; 1.7 to 2.2) in third trimester. Cigarette smoking decreased significantly both before and during pregnancy. Snus use and smoking during pregnancy were associated with a reduction in average birthweight, but no significant effects on Apgar scores. Odds ratios for quitting both snus and smoking tobacco during pregnancy were higher for women aged 25-34 years, for the primiparas and for those with a high level of education. Pregnant women were more likely to have quit tobacco use in the last time period compared to the first. Conclusions: While smoking during pregnancy was decreasing, the use of snus remained constant, levelling off to around 3% in first trimester and 2% in third trimester. Approximately 25% of those that used snus, and 40% that smoked before pregnancy, continued use to the third trimester. This calls for a continuous watch on the use of snus and other nicotine products during pregnancy.
The European respiratory journal, Feb 1, 2001
Patient education in asthma can improve outcome but cost-effectiveness has not been widely assess... more Patient education in asthma can improve outcome but cost-effectiveness has not been widely assessed. The aim of the present study was to carry out a costeffectiveness analysis of patient education in asthmatics in a 12-month follow-up. The authors randomly allocated 78 asthmatics to a control or intervention group after they had received ordinary outpatient consultation care. Intervention consisted of two 2-h group sessions followed by 1-2 individual sessions administered by a nurse and a physiotherapist. Self-management was emphasized. Effectiveness was expressed in terms of quality of life and forced expiratory volume in one second (FEV1). Doctor visits, days off work, dispensed pharmaceuticals, hospital admissions, travel costs, time costs and educational costs were recorded. The control and intervention groups induced mean total costs of Norwegian Krone (NOK) 16,000 and 10,500 per patient, respectively. A 10-unit improvement in St. George9s Respiratory Questionnaire total score and a 5% improvement in FEV1 in the intervention group were associated with a saving of NOK 3,400 and 4,500, respectively, compared to the control group. The number needed to educate (NNE) to make one person symptom free was associated with a saving of NOK 12,200. The results were robust to realistic changes in the assumptions upon which they were based. It could be concluded from this study that patient education in asthmatics in a 12month follow-up improved patient outcomes and reduced costs.
![Research paper thumbnail of [Do health personnel talk about passive smoking with parents of small children?]](https://a.academia-assets.com/images/blank-paper.jpg)
PubMed, May 30, 2000
Introduction: Almost seven out of ten parents who smoke state that they have never received infor... more Introduction: Almost seven out of ten parents who smoke state that they have never received information on passive smoking from health personnel when they bring their children in for routine medical examination. We examined what GPs, doctors and nurses at mother-and-child clinics and midwives reported. Material and methods: A self-administered questionnaire focusing on practice as regards the matter of passive smoking and children was mailed to a representative sample of 1050 GPs, the senior midwives at Norway's 77 maternity departments, 492 senior public health nurses, and health personnel at 1024 mother-and-child clinics. The response rate varied from 71% (GPs) to 82% (senior midwives). Results: 70% of the personnel at mother-and-child clinics less often than "always" ask about exposure to passive smoking. 60% of the senior midwives report that the department's personnel less than "to a large extent" allocate time to talk with parents about passive smoking. 40% of the GPs and 50% of the paediatricians say that they "never" bring up the matter of passive smoking when they examine small children and do not know whether members of the household smoke or not. The rest of the GPs bring up the matter in 46% of consultations and the rest of the paediatricians in 63% of consultations. When the child has symptoms that can be associated with passive smoking, the GPs discuss the parents' smoking habits in 88% of the consultations and paediatricians in 100% of consultations. Interpretation: Only to a small extent do health personnel use their opportunities of motivating parents to change their smoking habits for the sake of the health of their children. Smoking is only brought up by professionals as a matter routine when the children develop symptoms of exposure to tobacco smoke.
PubMed, Nov 10, 2002
Background: The aim of this study was to evaluate enquiry about smoking and to identify the barri... more Background: The aim of this study was to evaluate enquiry about smoking and to identify the barriers to engaging in tobacco prevention among general practitioners (n = 147) in Vest-Agder county, Norway in 2001. Material and methods: The questionnaire was basically the same as used in a national survey in 1999. Results: If the patient did not have smoking related symptoms, GPs enquired about smoking in only 30% (mean) of cases. If the patient had such symptoms, the enquiry rate was 95%. If GPs were aware of their patients' smoking habits, they informed about the advantages of quitting smoking in approximately 2/3 (mean) of cases. Few engaged in smoking cessation support. The main experienced barrier to engage in smoking cessation was that it was time consuming. Half of the GPs would have preferred to refer those who wanted to quit to experts in smoking cessation. Approximately two thirds answered that they enquired more frequently about smoking habits in 2001 than in 1999, but survey data from 1999 suggests that enquiry rates remained unchanged from 1999 to 2001. Interpretation: GPs enquired possibly more frequently about smoking habits in 2001 than in 1999. The main barriers to engaging in tobacco prevention were considered smaller the more the GPs approached practical smoking cessation work.
Tidsskrift for Den Norske Laegeforening, May 10, 2001
PubMed, May 20, 1998
250 patients with obstructive lung disease who had attended an out-patient clinic were assessed a... more 250 patients with obstructive lung disease who had attended an out-patient clinic were assessed after reporting on individual medication practices and their personal knowledge of the disease. 56% of the patients reported using two types of asthma medicine. The use of three, four, and five or more antasthmatica was reported by 26%, 9% and 5%, respectively. 90% had been prescribed an inhalation corticosteroid. Of these, one in five reported using it only when required, whereas in the age group 18-34 years the corresponding figure was one in three (34%). Regardless of what medication the patients were using, 20% reported that they often forgot to take it, 20% that they stopped taking it when their asthma improved, and 38% that they did not think about what time of the day they took their medicine. These practices of taking medication occurred more frequently in the young than in older patients. Practices did not vary with either a person's sex, duration of disease, or the patient's personal assessment of the seriousness of the disease. Patients with a higher level of education seemed to have greater knowledge of their disease than those with only secondary education, as was also the case with nonsmokers compared to smokers.
PubMed, May 30, 2000
Background: Limited data is available as to what extent Norwegian hospital doctors ask their pati... more Background: Limited data is available as to what extent Norwegian hospital doctors ask their patients about their smoking habits, and to what extent doctors offer their patients help in smoking cessation. Material and methods: A random sample of 1,025 hospital doctors was mailed a questionnaire. After 14 days a reminder letter was sent to non-responders; 76% of the doctors responded. Results: Altogether 98% of the doctors stated that they asked their patients with smoking-related disease about their smoking habits. In cases of non-smoking related disease, 73% of the doctors stated that they asked about the smoking habits of their patients (83% of female and 69% of male doctors). If doctors knew that a patient wanted to quit smoking, 25% of them stated that they often recommended nicotine replacement therapy. Less than 7% of the doctors regularly offered smoking cessation courses, handed out self-assistant material, or gave the patients other smoking cessation advice. Interpretation: The study indicates that doctors often ask their patients about their smoking habits, but there is clear potential for improvement as to the smoking cessation advice.
Patient Education and Counseling, 2003
Information on the potential effect of smoking on the outcome of patient education in asthma is l... more Information on the potential effect of smoking on the outcome of patient education in asthma is lacking. We randomly allocated 78 asthmatics to either a control or intervention group. Intervention consisted of two 2-h group sessions followed by 1-2 individual sessions each by a nurse and a physiotherapist. Self-management was emphasised following a stepwise treatment plan at exacerbations. Smokers experienced more general practitioner (GP) visits (P=0.001) and absenteeism from work (P=0.02), a greater need for rescue medication (P=0.03), a larger drop in FEV1 (P=0.02) and worse St. George's respiratory questionnaire (SGRQ) scores (P<0.001) compared to non-smokers during the 1-year follow-up. In multiple linear and logistic regression models smoking was still associated with worse SGRQ scores, a drop in FEV1, higher need for GP visits and rescue medication and higher total costs. We, thus, conclude that smoking was associated with reduced health related quality of life, a drop in FEV1, increased need for rescue medication and GP visits and higher costs after patient education during the 1-year follow-up, compared to no smoking.
Respiratory Medicine, Jun 1, 2002
The aims were to explore the effects and health economic consequences of patient education in pat... more The aims were to explore the effects and health economic consequences of patient education in patients with COPD in a 12-month follow-up. Sixty-two patients with mild-to-moderate chronic obstructive pulmonary disease (COPD) were at our outpatient clinic randomly allocated to an intervention group or a control group.The intervention group participated in a 4-h schooling, followed by one-to-two individual nurse and physiotherapist consultations. Selfmanagement was emphasized following a stepwise treatment plan. Effectiveness was expressed in terms of proportions in need of general practitioner (GP) consultations, patient satisfaction and utilization of rescue medication.Doctor visits, days off work, dispensed pharmaceuticals, hospital admissions, travel costs, educational and time costs were recorded. The control and intervention groups induced mean total costs of NOK19 900 and 10 600 per patient, respectively.The results were robustto realistic changes in the assumptions upon which they were based.For every NOK put into patient education, there was a saving of 4.8.The NNE to make one patient independent of their GP was1.7 (95% CI:1.3-2.8) and associated with a concomitant saving of NOK15 800.The corresponding NNEto make one person satisfied withtheir GP was 4.5 (95% CI: 2.9-10) and NOK 41900, respectively. A reduced need of100 DDD of rescue medication was associated with a concomitant saving of NOK5600.We conclude that patient education of patients with COPD in a12-month followup improved patient outcomes and reduced costs.
American Journal of Respiratory and Critical Care Medicine, Dec 1, 1999
The effect of patient education on steroid inhaler compliance and rescue medication utilization i... more The effect of patient education on steroid inhaler compliance and rescue medication utilization in patients with asthma or chronic obstructive pulmonary disease (COPD) has not been previously investigated in a single study. We randomized 78 asthmatics and 62 patients with COPD after ordinary outpatient management. Intervention consisted of two 2-h group sessions and 1 to 2 individual sessions by a trained nurse and physiotherapist. A self-management plan was developed. We registered for 12 mo medication dispensed from pharmacies according to the Anatomical Therapeutic Chemical (ATC) classification index. Steroid inhaler compliance (SIC) was defined as (dispensed/prescribed) ϫ 100 and being compliant as SIC Ͼ 75%. Among asthmatics 32% and 57% were compliant (p ϭ 0.04) with a median (25th/75th percentiles) SIC of 55% (27/96) and 82% (44/127) (p ϭ 0.08) in the control and intervention groups, respectively. Patient education did not seem to change SIC in the COPD group. Uneducated patients with COPD were dispensed double the amount of short-acting inhaled  2-agonists compared with the educated group (p ϭ 0.03). We conclude that patient education can change medication habits by reducing the amount of short-acting inhaled  2-agonists being dispensed among patients with COPD. Educated asthmatics showed improved steroid inhaler compliance compared with the uneducated patients, whereas this seemed unaffected by education in the COPD group. Gallefoss F, Bakke PS. How does patient education and self-management among asthmatics and patients with chronic obstructive pulmonary disease affect medication?
Quality of Life Research, May 1, 2014
Purpose To assess health-related quality of life (HRQOL) of subjects at risk of type 2 diabetes u... more Purpose To assess health-related quality of life (HRQOL) of subjects at risk of type 2 diabetes undergoing lifestyle intervention, and predictors for improved HRQOL. Methods The Finnish Diabetes Risk Score was used by general practitioners to identify individuals at risk. Lowintensity interventions with an 18-month follow-up were employed. HRQOL was assessed using the SF-36 at baseline and compared with results from a general Norwegian population survey and further at 6 and 18 months. Simple and multiple linear regression analyses were applied to identify predictors of changes in HRQOL of clinical importance. Results Two hundred and thirteen participants (50 % women; mean age: 46 years, mean body mass index: 37) were included: 182 returned for 18-month follow-up, of whom 172 completed the HRQOL questionnaire. HRQOL was reduced with clinical significance compared with general Norwegians. The mean changes in HRQOL from the baseline to the follow-up were not of clinical importance. However, one out of three individuals achieved a moderate or large clinical improvement in HRQOL. The best determinant for improved HRQOL was obtained for a composite, clinically significant lifestyle change, i.e. both a weight reduction of at least 5 % and an improvement in exercise capacity of at least 10 %, which was associated with an improvement in five out of the eight SF-36 domains. Conclusion Subjects at risk of type 2 diabetes report a clinically important reduction in HRQOL compared with general Norwegians. The best predictor of improved HRQOL was a small weight loss combined with a small improvement in aerobic capacity.
Respiratory Medicine, Oct 1, 2008
Background: Health related quality of life (HRQL), mood disorders and coping abilities have previ... more Background: Health related quality of life (HRQL), mood disorders and coping abilities have previously not been evaluated in an unselected sample of patients with primary lung cancer. Design: A prospective study was performed on all patients diagnosed with primary lung cancer in Southern Norway from 2002 to 2005. HRQL was assessed according to EORTC, anxiety and depression according to HAD and coping ability according to SoC. Results: Fatigue and sore mouth were more pronounced in SCLC than in NSCLC. Besides this, there were no difference in EORTC scores between histological groups. Non-responders to EORTC were older and more than twice as many had poor performance status compared to those answering. According to HAD, 17% of patients scored compatible with anxiety and 14% with depression, and one in four consistent with manifest anxiety and/or depression. Mean SoC score was 58.3. A HAD score compatible with anxiety or depression was associated with considerably worse EORTC function scores. A reduced coping ability according to SoC was only weakly associated with anxiety and depression. These scores are poorer than that recorded in selected EORTC databases from chemotherapy and radiotherapy studies. Conclusion: In this real-life survey on unselected patients with newly diagnosed lung cancer, mean HRQL scores were poorer than reference values from previous, treatment-based studies, documenting a higher burden of illness in lung cancer than previously documented. Anxiety and depression are common in lung cancer and are clearly related to reduced quality of life. From the clinical point of view, an increased focus on information when lung cancer is diagnosed, seems justified, as well as specific attention for patients with lung cancer with accompanying mood disorders.
European journal of cardiovascular prevention & rehabilitation, Apr 1, 2006
Study designs and other criteria for inclusion in the review It was unclear whether the primary s... more Study designs and other criteria for inclusion in the review It was unclear whether the primary studies were identified from a systematic review of the literature or selectively. Data on the effectiveness of the smoking cessation programme came from a clinical trial carried out by the authors of the current study. Two long-term studies were used to derive mortality data (and life expectancy) in patients at high and low risk. Sources searched to identify primary studies Not reported. Criteria used to ensure the validity of primary studies The validity of the primary studies was ensured by the choice of a clinical trial and studies with a long follow-up. Methods used to judge relevance and validity, and for extracting data Not reported. Number of primary studies included Three primary studies were the primary source of effectiveness data. Methods of combining primary studies The primary studies were not combined since each study provided a discrete series of estimates. The Kaplan-Meier method and the Gompertz parametric survival functions were used for analysing survival data for the first 20 years.
Respiratory Medicine, Mar 1, 2000
The eect of patient education on morbidity in asthmatics and COPD patients has not previously bee... more The eect of patient education on morbidity in asthmatics and COPD patients has not previously been investigated in a single study. We randomized 78 asthmatics and 62 COPD patients after ordinary outpatient management. Intervention consisted of educational group sessions and individual sessions administered by a trained nurse and physiotherapist. A self-management plan was developed. The utilization of health resources and absenteeism from work was self-reported monthly. During the 12-month follow-up, approximately two (P=0Á001) and three (P=0Á001) times as many uneducated asthmatics and COPD patients, respectively, visited their general practitioner (GP) compared with educated. The mean reduction in GP consultations for the educated were 73% (P50Á001) and 85% (P50Á0001) for the asthma and COPD group, respectively, compared with uneducated. Fifty percent of uneducated asthmatics reported absenteeism from work compared with 24% of the educated (P=0Á06). The mean reduction in days o work for the educated was 69% (P=0Á03), compared with uneducated. A positive correlation was observed between St George's Respiratory Questionnaire total score and number of GP visits for both the asthma and COPD group (P50Á001). We conclude that patient education in asthmatics and COPD patients reduced the need for GP visits and kept a greater proportion of patients independent of their GP. Patient education among asthmatics also reduced the number of days o work and appeared to increase the proportion of patients not reporting absenteeism from work at all. Increasing number of GP visits was correlated with decreased health-related quality of life as measured by the SGRQ for both the asthmatics and the COPD patients.
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Papers by Frode Gallefoss