| 1. |
- Aanesen, Arthur, et al.
(författare)
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Prospective study of a Swedish infertile cohort 2005-08 : population characteristics, treatments and pregnancy rates
- 2014
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Ingår i: Family Practice. - : Oxford University Press (OUP). - 0263-2136 .- 1460-2229. ; 31:3, s. 290-7
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: We here report on results from a prospective study comprising 380 infertile couples undergoing infertility work-up and various treatments for infertility in our clinic. The aim was to investigate the overall birth rate as a result of different treatments, as well as spontaneous pregnancies.METHODS: Three hundred and eighty couples were consecutively included between December 2005 and May 2008. All couples underwent a fertility work-up, including hysterosalpingogram, hormonal characterization, clinical examination, screening for infectious diseases and semen analysis. The mean age of the women at the time of inclusion was 33.2 years. The mean duration of infertility prior to inclusion was 1.8 years. And 46.6% (n = 177) of the women had been pregnant prior to their first visit to the clinic and 30.0% (n = 114) had been pregnant earlier in their present relationship.RESULTS: As of November 2010, 57.3% (n = 218) of the women had given birth to a child when they were lost to follow up by the study. Spontaneous conception was observed in 11.3% (n = 43) of the women, 14.5% (n = 64) conceived after intrauterine insemination (IUI), 4.2% (n = 16) conceived after ovarian hyperstimulation and ovulation induction (OH/OI) and 28.4% (n = 113) after in vitro fertilization. There were 280 pregnancies and 58 spontaneous abortions (22.3%) in the group. Mean anti-mullerian hormone significantly correlated with antral follicle count and age and was significantly higher in the subgroup that became pregnant after IUI.CONCLUSIONS: Spontaneous pregnancies and IUI + OH/OI contributed significantly to the pregnancies observed in the total population. Predictive factors for pregnancy were anti-mullerian hormone in the group undergoing IUI treatment and in the age group ≥38-duration of infertility. Previous pregnancies, body mass index, estradiol, follicle stimulating hormone or having given birth prior to the infertility period were not predictive of pregnancy for the infertile couples in this study.
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| 2. |
- André, Malin, et al.
(författare)
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Asking for ’rules of thumb’ : a way to discover tacit knowledge in general practice
- 2002
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Ingår i: Family Practice. - : Oxford University Press (OUP). - 0263-2136 .- 1460-2229. ; 19:6, s. 617-622
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Tidskriftsartikel (refereegranskat)abstract
- Background. Research in decision-making has identified heuristics (rules of thumb) as shortcuts to simplify search and choice. Objective. To find out if GPs recognize the use of rules of thumb and if they could describe what they looked like. Methods. An explorative and descriptive study was set up using focus group interviews. The interview guide contained the questions: Do you recognize the use of rules of thumb? Are you able to give some examples? What are the benefits and dangers in using rules of thumb? Where do they come from? The interviews were transcribed and analysed using the templates in the interview guide, and the examples of rules were classified by editing analysis. Results. Four groups with 23 GPs were interviewed. GPs recognized using rules of thumb, producing examples covering different aspects of the consultation. The rules for somatic problems were formulated as axiomatic simplified medical knowledge and taken for granted, while rules for psychosocial problems were formulated as expressions of individual experience and were followed by an explanation. The rules seemed unaffected by the sparse objections given. A GP’s clinical experience was judged a prerequisite for applying the rules. The origin of many rules was via word-of-mouth from a colleague. The GPs acknowledged the benefits of using the rules, thereby simplifying work. Conclusion. GPs recognize the use of rules of thumb as an immediate and semiconscious kind of knowledge that could be called tacit knowledge. Using rules of thumb might explain why practice remains unchanged although educational activities result in more elaborate knowledge.
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| 3. |
- André, Malin, et al.
(författare)
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More physician consultations and antibiotic prescriptions in families with high concern about infectious illness-adequate response to infection-prone child or self-fulfilling prophecy?
- 2007
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Ingår i: Family Practice. - : Oxford University Press (OUP). - 0263-2136 .- 1460-2229. ; 24:4, s. 302-307
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Tidskriftsartikel (refereegranskat)abstract
- Background. Respiratory tract infections (RTI) in children is the most common cause of prescription of antibiotics. It is important to describe and analyse non-medical factors in order to develop more rational use of antibiotics. Objectives. To compare families with high and low concern about infectious illness with regard to social variables, perception of infection proneness and beliefs in antibiotics and to relate the concern for infectious illness to reported morbidity, physician consultations and antibiotic prescriptions for the 18-month-old child in the family. Methods. A prospective, population-based survey was performed. During 1 month, all infectious symptoms, physician consultations and antibiotic treatments for 18-month-old children were noted. The 818 families also answered questions about their socio-economic situation, illness perception and concern about infectious illness. Results. High concern about infectious illness was associated with more frequent physicians consultations and more prescriptions of antibiotics. There was no significant difference in reported days with symptoms of RTI, but the parents more often experienced their children with RTI without fever as being ill. The variables of infection proneness in the child, inadequate beliefs in antibiotics and the factor of being the only child were important explanatory factors for concern about infectious illness. Conclusions. High concern about infectious illness is an important determining factor for physician consultations and antibiotic prescription for small children. An adequate consultation, where the doctor deals with the parents' worries and gives appropriate information about symptoms and disease, might contribute to less antibiotic prescribing with preserved parental satisfaction.
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| 4. |
- André, Malin, et al.
(författare)
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Use of rules of thumb in the consultation in general practice : an act of balance between the individual and the general perspective
- 2003
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Ingår i: Family Practice. - : Oxford University Press (OUP). - 0263-2136 .- 1460-2229. ; 20:5, s. 514-519
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Tidskriftsartikel (refereegranskat)abstract
- Background. Rules of thumb used by GPs could be considered as empirical evidence of intuition and a link between science and practice in general practice. Objective. The purpose of the present study was to analyse the description of the application of rules of thumb with regard to different situations in general practice. Methods. An explorative and descriptive study was started with focus group interviews. Four groups with 23 GPs were interviewed. The interviews were transcribed and analysed, and the rules and their application were classified by an editing analysis. Results. A specific set of rules of thumb was used for rapid assessment, when emergency and psychosocial problems were identified. When the main focus of the problems was identified as somatic or psychosocial, the GPs did not disregard the other aspects but described the use of rules in a simultaneous individualizing and generalizing process. The rules contained probability reasoning and risk assessment. Conclusion. Rules of thumb seemed to serve as a link between theoretical knowledge and practical experience and were used by the GPs in an act of balance between the individual and the general perspective.
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| 5. |
- Andres Gimeno-Feliu, Luis, et al.
(författare)
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Multimorbidity and immigrant status : associations with area of origin and length of residence in host country
- 2017
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Ingår i: Family Practice. - : Oxford University Press (OUP). - 0263-2136 .- 1460-2229. ; 34:6, s. 662-666
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Tidskriftsartikel (refereegranskat)abstract
- Aim. Multimorbidity is a growing phenomenon in primary care, and knowledge of the influence of social determinants on its evolution is vital. The aim of this study was to understand the relationship between multimorbidity and immigration, taking into account length of residence in the host country and area of origin of the immigrant population. Methods. Cross-sectional retrospective study of all adult patients registered within the public health service of Aragon, Spain (N = 1 092 279; 144 238 were foreign-born), based on data from the EpiChron Cohort. Age-standardized prevalence rates of multimorbidity were calculated. Different models of binary logistic regressions were conducted to study the association between multimorbidity, immigrant status and length of residence in the host country. Results. The risk of multimorbidity in foreign-borns was lower than that of native-borns [odds ratio (OR): 0.54, 95% confidence interval (CI): 0.53-0.55]. The probability of experiencing multimorbidity was lowest for Asians (OR: 0.34, 95% CI: 0.31-0.37) and Eastern Europeans (OR: 0.42, 95% CI: 0.40-0.43), and highest for Latin Americans (OR: 0.70, 95% CI: 0.68-0.72). Foreign-born immigrants residing in Aragon for >= 5 years had a higher multimorbidity risk than those residing for < 5 years (OR: 2.3, 95% CI: 2.2-2.4). Conclusion. Prevalence of multimorbidity is lower among foreign-borns as compared with native-borns, but increases rapidly with length of residence in the host country. However, the progressive development of multimorbidity among immigrants varies widely depending on area of origin. These findings provide important insight into the health care needs of specific population groups and may help minimize the negative impact of multimorbidity among the most vulnerable groups.
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| 8. |
- Bastholm Rahmner, Pia, et al.
(författare)
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Variations in understanding the drug-prescribing process : a qualitative study among Swedish GPs
- 2009
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Ingår i: Family Practice. - : Oxford University Press (OUP). - 0263-2136 .- 1460-2229. ; 26:2, s. 121-127
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: A majority of doctor-patient meetings result in the patient getting a prescription. This underlines the need for a high-quality prescription process. While studies have been made on single therapeutic drug groups, a complete study of the physicians' general thought process that comprises the prescription of all drugs still remains to be made. OBJECTIVE: To identify variations in ways of understanding drug prescribing among GPs. METHODS: A descriptive qualitative study was conducted with 20 Swedish physicians. Informants were recruited purposively and their understandings about prescribing were studied in semi-structured interviews. Data were analysed using a phenomenographic approach. RESULTS: Five categories were identified as follows: (A) GP prescribed safe, reliable and well-documented drugs for obvious complaints; (B) GP sought to convince the patient of the most effective drug treatment; (C) GP chose the best drug treatment taking into consideration the patient's entire life situation; (D) GP used clinical judgement and close follow-up to minimize unnecessary drug prescribing and (E) GP prescribed drugs which are cheap for society and environmentally friendly. The categories are interrelated, but have different foci: the biomedical, the patient and the society. Each GP had more than one view but none included all five. The findings also indicate that complexity increases when a drug is prescribed for primary or secondary prevention. CONCLUSIONS: GPs understand prescribing differently despite similar external circumstances. The most significant factor to influence prescribing behaviour was the physician's patient relation approach. GPs may need to reflect on difficulties they face while prescribing to enhance their understandings.
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