| 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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| 6. |
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| 7. |
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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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| 9. |
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| 10. |
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| 11. |
- Brorsson, Annika, et al.
(författare)
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My family dies from heart attacks. How hypercholesterolaemic men refer to their family history
- 1995
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Ingår i: Family Practice. - : Oxford University Press (OUP). - 1460-2229 .- 0263-2136. ; 12:4, s. 433-437
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Tidskriftsartikel (refereegranskat)abstract
- Patients often worry considerably about biomedically mild and self-limiting conditions. A previous study on non-selected primary care patients showed that this could be partly explained by frequent associations with cases of serious illness in their family histories. This study further investigated these phenomena in middle aged men with a recent diagnosis of hypercholesterolaemia. Sixty-three out of 453, 35-45-year-old male participants were diagnosed with moderate hypercholesterolaemia (6.5-7.7 mmol/l) in a health survey and received 20-30 minutes of life-style counselling. These sessions were audio-taped, transcribed and analysed with respect to the subjects' references to their family histories. Of the 63 men, 28 (45%) mentioned their family history. The main content category in these talks was perceived threat or risk, comprising the seriousness of the event in the family history on one hand and its believed relevance on the other. Fatal, serious or premature disease was discussed. Prevailing lay knowledge and beliefs about hypercholesterolaemia, risk factors and disease causation seemed to determine what conditions in the family history were judged relevant by the men. Several of the men referred to heredity and several regarded emotional closeness important. In a few cases the event referred to mainly functioned as an illustration or example of lay knowledge and beliefs. This study provides support for the view that the family history can play an important role for how asymptomatic patients interpret their risk factors for disease. This is important for the development of consultation skills.
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| 12. |
- Brotons, Carlos, et al.
(författare)
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Attitudes toward preventive services and lifestyle: the views of primary care patients in Europe. the EUROPREVIEW patient study.
- 2012
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Ingår i: Family practice. - : Oxford University Press (OUP). - 1460-2229 .- 0263-2136. ; 29:Suppl 1
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Tidskriftsartikel (refereegranskat)abstract
- For preventive interventions in general practice to succeed, patients' points of view must be taken into account in addition to those of GPs. Objective. To explore patients’ views and beliefs about the importance of lifestyle and preventive interventions, to assess their readiness to make changes to their lifestyle and their willingness to receive support from GPs. Methods. Cross-sectional survey conducted by EUROPREV in primary care practices in 22 European countries. Patients were consecutively selected and interviewed from September 2008 to September 2009. Results. Seven thousand nine hundred and forty-seven participants, 52.2% females. Only 30.5% of risky drinkers think they need to change, as opposed to 64% of smokers, 73.5% of patients with unhealthy eating habits and 73% with lack of physical activity. Risky drinkers reported that GPs initiated a discussion on alcohol consumption less often (42%) than on smoking (63%), eating habits (59%) or physical activity (55%). Seventy-five per cent, 66% and 63% of patients without hypertension, diabetes or hypercholesterolaemia, respectively, think blood pressure, blood sugar and serum cholesterol should be checked yearly. Women (80%) think they should be screened with the cervical smear test and 72.8% of women aged 30–49 years with mammography, yearly or every 2 years. Conclusions. A high proportion of patients attending primary care with unhealthy lifestyles (especially risky drinkers) do not perceive the need to change their habits, and about half the patients reported not having had any discussion on healthy lifestyles with their GPs. Patients overestimate their need to be screened for cardiovascular risk factors and for cancer.
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| 13. |
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| 14. |
- Dias, Nicole Geovana, et al.
(författare)
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Social support and the intimate partner violence victimization among adults from six European countries
- 2019
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Ingår i: Family Practice. - : Oxford University Press (OUP). - 0263-2136 .- 1460-2229. ; 36:2, s. 117-124
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundSocial support may buffer the negative effects of violence on physical and mental health. Family medicine providers play an essential role in identifying the available social support and intervening in intimate partner violence (IPV).ObjectiveThis study aimed at assessing the association between social support and the IPV victimization among adults from six European countries.MethodsThis is a cross-sectional multi-centre study that included individuals from Athens (Greece), Budapest (Hungary), London (UK), Östersund (Sweden), Porto (Portugal) and Stuttgart (Germany). Data collection was carried out between September 2010 and May 2011. The sample consisted of 3496 adults aged 18–64 years randomly selected from the general population in each city. The revised Conflict Tactics Scales was used to assess IPV victimization. Social support was assessed with the Multidimensional Scale of Perceived Social Support.ResultsParticipants reporting physical assault victimization experienced lower social support (mean ± SD) than their counterparts, 66.1 ± 13.96 versus 71.7 ± 12.90, P< 0.001, for women; and 67.1 ± 13.69 versus 69.5 ± 13.52, P = 0.002 for men. Similar results were found regarding sexual coercion victimization, 69.1 ± 14.03 versus 71.3 ± 12.97, P = 0.005 for women and 68.0 ± 13.29 versus 69.3 ± 13.62, P= 0.021 for men. This study revealed lower levels of social support among participants reporting lifetime and past year victimization, independent of demographic, social and health-related factors.ConclusionResults showed a statistically significant association between low social support and IPV victimization. Although the specific mechanisms linking social support with experiences of violence need further investigation, it seems that both informal and formal networks may be associated with lower levels of abusive situations.
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| 15. |
- Ejeby, Kersti, et al.
(författare)
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Randomized controlled trial of transdiagnostic group treatments for primary care patients with common mental disorders
- 2014
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Ingår i: Family Practice. - : Oxford University Press (OUP). - 0263-2136 .- 1460-2229. ; 31:3, s. 273-280
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Tidskriftsartikel (refereegranskat)abstract
- Background. The purpose was to test the effectiveness of two transdiagnostic group interventions compared to care as usual (CAU) for patients with anxiety, depressive or stress-related disorders within a primary health care context. Objectives. To compare the effects of cognitive-based-behavioural therapy (CBT) and multimodal intervention (MMI) on the quality of life and relief of psychological symptoms of patients with common mental disorders or problems attending primary health care centre. Methods. Patients (n = 278), aged 18-65 years, were referred to the study by the GPs and 245 were randomized to CAU or one of two group interventions in addition to CAU: (i) group CBT administered by psychologists and (ii) group MMI administered by assistant nurses. The primary outcome measure was the Mental Component Summary score of short form 36. Secondary outcome measures were Perceived Stress Scale and Self-Rating Scale for Affective Syndromes. The data were analysed using intention-to-treat with a linear mixed model. Results. On the primary outcome measure, the mean improvement based on mixed model analyses across post-and follow-up assessment was significantly larger for the MMI group than for the CBT (4.0; P = 0.020) and CAU (7.5; P = .001) groups. Participants receiving CBT were significantly more improved than those in the CAU group. On four of the secondary outcome measures, the MMI group was significantly more improved than the CBT and CAU groups. The course of improvement did not differ between the CBT group and the CAU group on these measures. Conclusions. Transdiagnostic group treatment can be effective for patients with common mental disorders when delivered in a primary care setting. The group format and transdiagnostic approach fit well with the requirements of primary care.
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| 16. |
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| 17. |
- Engström, Gabriella, 1965-, et al.
(författare)
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Prevalence of Three Lower Urinary Tract Symptoms in Men –a Population-Based Study.
- 2003
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Ingår i: Family Practice. - : Oxford University Press (OUP). - 0263-2136 .- 1460-2229. ; 20:1, s. 7-10
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Tidskriftsartikel (refereegranskat)abstract
- Background. Lower urinary tract symptoms are a common and costly public health issue. In earlier studies, the prevalence of urinary symptoms can be seen to fluctuate because there is no consensus about how to define and categorize the severity of the symptoms. Objectives. The study was undertaken in order to investigate the prevalence of three common lower urinary tract symptoms (urgency, stress incontinence and post-micturition dribbling) and analyse health care-seeking behaviour. Methods. A self-administered questionnaire was developed to investigate all men aged 40-80 years residing in the community of Surahammar, Sweden. The questionnaire included items on three specific urinary symptoms: urgency, stress incontinence and post-micturition dribbling, and one question about health care-seeking behaviour. Results. A response rate of 86% was obtained in the questionnaire study. The overall prevalence of the lower urinary tract symptoms was 24%. The prevalence increased from 20% in the group aged 40-49 years to 28% in the group aged 70-80 years (P < 0.01). Post-micturition dribbling (21%) was the most frequent symptom, and stress incontinence (2.4%) was the least frequent symptom. The number of participants who sought health care was low (4%) and increased significantly with age (P < 0.001). Conclusions. The present study showed that 24% of the Swedish cohort of men of 40-80 years of age reported at least one of the following symptoms: urgency, stress incontinence or postmicturition dribbling. This study is consistent with other research regarding the low consultation frequency for these symptoms. Moreover, the study is also in accord with those findings indicating that for the majority of men with urinary symptoms, their health care providers are not aware of their problem.
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| 18. |
- Ewing, Marcela, 1960, et al.
(författare)
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Diagnostic profile characteristics of cancer patients with frequent consultations in primary care before diagnosis: a case control study
- 2018
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Ingår i: Family Practice. - : Oxford University Press (OUP). - 0263-2136 .- 1460-2229. ; 35:5, s. 559-566
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Tidskriftsartikel (refereegranskat)abstract
- Background. Many patients with common cancers are late diagnosed. Objectives. Identify consultation profiles and clinical features in patients with the seven most common cancers, who had consulted a general practitioner (GP) frequently before their cancer diagnosis. Methods. A case-control study was conducted in Region Vastra Gotaland, Sweden. A total of 2570 patients, diagnosed in 2011 with prostate, breast, colorectal, lung, gynaecological and skin cancers including malignant melanoma, and 9424 controls were selected from the Swedish Cancer Register and a regional health care database. Diagnostic codes [International Statistical Classification of Diseases and Related Health Problems, 10th revision (ICD-10)] from primary care for patients with >= 4 GP consultations registered in the year before cancer diagnosis were collected. Likelihood ratios (LRs) were calculated for variables associated with the different cancers. Results. Fifty-six percent of the patients had consulted a GP four or more times in the year before cancer diagnosis. Alarm symptoms or signs represented 60% of the codes with the highest LR, but only 40% of the 10 most prevalent codes. Breast lump had the highest LR, 11.9 [95% confidence interval (CI) 8.0-17.8]; abnormalities of plasma proteins had an LR of 5.0 (95% CI 3.0-8.2) and abnormal serum enzyme levels had an LR of 4.6 (95% CI 3.6-5.9). Early clinical features associated with cancer had been registered already at the first two GP consultations. Conclusion. One out of six clinical features associated with cancer were presented by cancer patients with four or more pre-referral consultations already at the two first consultations. These early clinical features that were focal and had benign characteristics might have been missed diagnostic opportunities.
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| 19. |
- Fhärm, Eva, 1955-, et al.
(författare)
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‘Aiming for the stars’—GPs’ dilemmas in the prevention of cardiovascular disease in type 2 diabetes patients : focus group interviews
- 2009
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Ingår i: Family Practice. - Oxford : Oxford University Press. - 0263-2136 .- 1460-2229. ; :26, s. 109-114
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundStudies have revealed low adherence to guidelines for treatment of diabetes and cardiovascular risk factors.ObjectiveTo explore general practitioners’ experiences regarding treatment practice in type 2 diabetes with specific focus on the prevention of cardiovascular disease.MethodsFourteen experienced general practitioners from nine health care centres with group practices were interviewed in focus groups. The interviews were digitally recorded, transcribed verbatim and analysed by qualitative content analysis.ResultsThe overall theme was “dilemmas” in GPs´ treatment practice for type 2 diabetes patients. Five main dilemma categories were identified. First, the GPs were hesitant about labelling someone who feels healthy as ill. Secondly, regarding communicating a diabetes diagnosis and its consequences; should the patient be frightened or comforted? Thirdly, the GPs experienced uncertainty in their role; were they to take responsibility for the care or not? Fourthly, the GPs expressed a conflict between lifestyle changes and drug treatment. Fifthly, the GPs described difficulties in integrating science into reality.ConclusionsThe five dilemmas in the general practitioners’ approach to diabetes patients and the treatment of their cardiovascular risk were related to the GPs´ professional role and communication with the patient. To consider these dilemmas in educational efforts is probably essential to achieve improved diabetes care and guideline adherence.
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| 20. |
- Forslund, Tomas, et al.
(författare)
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Patterns of multimorbidity and pharmacotherapy : a total population cross-sectional study.
- 2020
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Ingår i: Family Practice. - : Oxford University Press (OUP). - 0263-2136 .- 1460-2229. ; 38:2, s. 132-140
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Treatment of multimorbid patients can be improved. Development of patient-centred care of high-quality requires context-bound understanding of the multimorbid population's patterns of demographics, co-morbidities and medication use.OBJECTIVE: The aim of this study was to identify patterns of multimorbidity in the total population of Region Stockholm, Sweden, by exploring demographics, claimed prescription drugs, risk of mortality and non-random association of conditions.METHODS: In this cross-sectional descriptive population-based cohort study, we extracted data from the Swedish VAL database (N = 2 323 667) including all consultations in primary and specialized outpatient care, all inpatient care and all prescriptions claimed during 2017. We report number of chronic conditions and claimed prescription drugs, physical and mental co-morbidity, and 1-year mortality. We stratified the analyses by sex. We examined non-random associations between diseases using cluster analysis.RESULTS: In total, 21.6% had multimorbidity (two or more chronic conditions) and 24.1% had polypharmacy (more than five claimed prescription drugs). Number of claimed drugs, co-occurrence of mental and physical conditions, and 1-year mortality increased as multimorbidity increased. We identified seven multimorbidity clusters with clinically distinct characteristics. The smallest cluster (7% of individuals) had prominent cardiovascular disease, the highest 1-year mortality rate, high levels of multimorbidity and polypharmacy, and was much older. The largest cluster (27% of individuals) was younger and heterogenous, with primarily mental health problems.CONCLUSIONS: Individuals with chronic conditions often show clinical complexity with both concordant and discordant conditions and polypharmacy. This study indicates that clinical guidelines addressing clustering of conditions may be one strategy for managing complexity.
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| 21. |
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| 22. |
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| 23. |
- Hamberg, Katarina, et al.
(författare)
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Scientific rigor in qualitative research : examples from a study of women´s health
- 1994
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Ingår i: Family Practice. - : Oxford University Press. - 0263-2136 .- 1460-2229. ; 11, s. 176-181
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Tidskriftsartikel (refereegranskat)abstract
- The increase in qualitative research in family medicine raises a demand for critical discussions about design, methods and conclusions. This article shows how scientific claims for truthful findings and neutrality can be assessed. Established concepts such as validity, reliability, objectivity and generalization cannot be used in qualitative research. Alternative criteria for scientific rigour, initially introduced by Lincoln and Guba, are presented: credibility, dependability, confirmability and transferability. These criteria have been applied to a research project, a qualitative study with in-depth interviews with female patients suffering from chronic pain in the locomotor system. The interview data were analysed on the basis of grounded theory. The proposed indicators for scientific rigour were shown to be useful when applied to the research project. Several examples are given. Difficulties in the use of the alternative criteria are also discussed.
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| 24. |
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| 25. |
- Hedin, Katarina, et al.
(författare)
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Infectious morbidity in 18-month-old children with and without older siblings
- 2010
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Ingår i: Family Practice. - : Oxford University Press (OUP). - 0263-2136 .- 1460-2229. ; 27:5, s. 507-512
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Infections are the most commonly reported health problems in children. Younger age and day care outside the home are two factors of importance for infectious morbidity. The influence of siblings on infectious symptoms is not clear. OBJECTIVES: To compare families with one child and families with more than one child in terms of reported infectious symptoms, physician consultations and antibiotic prescriptions. METHODS: A prospective population-based survey was performed. During 1 month, all infectious symptoms, physician consultations and antibiotic prescriptions for 18-month-old children were noted by the parents. The 789 families also answered questions about socio-economic factors, numbers of siblings in the family and type of day care. RESULTS: No difference in number of symptom days was found between children with and without older siblings. Neither could we find any significance in terms of having older siblings in relation to physician consultations and antibiotic prescriptions. CONCLUSIONS: The results of our study indicate that having older siblings not was important in relation to number of symptoms days, physician consultations or antibiotic prescriptions for 18-month-old children in Sweden today. Changes in social activities and attitudes towards antibiotic prescription may explain our different findings as compared with previous Swedish studies and studies from other countries.
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| 26. |
- Hemlin, C, et al.
(författare)
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Aspects of diagnosis of acute otitis media
- 1998
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Ingår i: Family practice. - : Oxford University Press (OUP). - 0263-2136 .- 1460-2229. ; 15:2, s. 133-137
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Tidskriftsartikel (refereegranskat)
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| 27. |
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| 28. |
- Hägglund, Doris, et al.
(författare)
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Urinary incontinence : an unexpected large problem among young females. Results from a population-based study
- 1999
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Ingår i: Family Practice. - : Oxford University Press (OUP). - 0263-2136 .- 1460-2229. ; 16:5, s. 506-509
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Tidskriftsartikel (refereegranskat)abstract
- Background. The International Continence Society has defined urinary incontinence as a condition in which involuntary loss of urine is objectively demonstrable and is a social or hygiene problem. Urinary incontinence is presumably a common health problem among women even in younger ages. Objectives.The primary aim was to investigate the prevalence of urinary incontinence (UI) in a female population with a special focus on younger women (18–30 years old). The secondary aim was to investigate the association between UI and number of deliveries, use of contraceptives or oestrogen substitutions, and urinary tract infections (UTIs). Methods.A population-based study with a self-administered questionnaire was set in the community of Surahammar, Sweden. Subjects were all women (3493) aged 18–70 years living in Surahammar during 1995. The main outcome measures were the prevalence of UI and variables such as number of deliveries, use of contraceptives or oestrogen substitutions, and UTIs. Results. Twenty-six per cent of the women reported problems of UI. The prevalence of UI in younger women was 12%. The number of reported complaints of UTIs was significantly higher in the women with UI compared with women without urinary incontinence (wUI). In the younger women UTI, nulliparous or having given birth to one or two children were most frequent in those with UI. The use of contraceptives was more common in younger women without UI (P < 0.05). However, the use of oestrogen was more common in older women in the age group 51–70 years with UI (P < 0.01). Conclusion.Our findings have shown that 26% of the women who took part in the survey reported problems of UI. Among women below 30 years of age, 12% reported complaints of UI. We found a high prevalence of UI in younger women with a UTI, not taking oestrogen, nulliparous or having given birth to one or two children. There are needs for further investigations with a special focus on younger women
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| 29. |
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| 30. |
- Johansson, Eva E., et al.
(författare)
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"I've been crying my way" : qualitative analysis of a group of female patients' consultation experiences
- 1996
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Ingår i: Family Practice. - : Oxford University Press. - 0263-2136 .- 1460-2229. ; 13:6, s. 498-503
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Tidskriftsartikel (refereegranskat)abstract
- Background and objectives What do women patients, sick-listed for biomedically undefined musculoskeletal disorders, expect and experience when they consult a doctor? With the purpose to learn more about this, a qualitative interview study was conducted.Methods Twenty women participated. They were patients at an urban health care centre in northern Sweden. Data were gained through repeated, semi-structured interviews, and analysed according to grounded theory.Results The participants described an atmosphere of distrust in the consultation. They had felt ignored, disregarded and rejected by doctors, and had worked out strategies to keep up medical attention in their search for a creditable diagnosis. They were somatizing, claiming under cover, and pleading, to catch the doctor's interest. In addition, they upheld their self-respect by mystifying and martyrizing themselves and their symptoms, and by condemning physicians as ignorant.Discussion The patient's consultation experiences are discussed from different aspects; the biomedical framework, the power asymmetry, and the gendered positions of patient and doctor. The findings indicate the importance of making doctors aware of the context behind frustrations in doctor-patient interaction.
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| 31. |
- Johansson, Kajsa, et al.
(författare)
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Attitudes toward management of patients with subacromial pain in Swedish primary care
- 1999
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Ingår i: Family Practice. - 0263-2136 .- 1460-2229. ; 16:3, s. 233-237
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Tidskriftsartikel (refereegranskat)abstract
- Objective. We aimed to describe the attitudes among GPs and physiotherapists toward the diagnostic approach and management of patients with a common shoulder disorder. Method. A questionnaire was sent out to 188 GPs and 71 physiotherapists. The total response rate was 71.8%. The questions were based on a written case simulation with cues about history and symptoms. Results. The results showed a unanimous opinion of the diagnosis. Rotator cuff tendinitis was marked as the most probable. The two groups showed similarities in the way that they would examine the patient. The GPs referred the patients to the physiotherapists significantly more often than the other way around. The most probable choice of treatment made by the GPs was non-steroidal anti-inflammatory drugs (NSAIDs) and by the physiotherapists, movement exercises together with ergonomics. Most treatment alternatives had at least 20% of the responders marking a neutral attitude, and few treatments were disregarded. Conclusions. We conclude that in Swedish primary care GPs and physiotherapists have a uniform diagnostic approach towards patients with subacromial pain, but their choice of treatment reflects an uncertainty about the effectiveness of conservative treatments. The questioned pathogenesis of the suggested diagnosis and lack of research regarding the efficacy of conservative treatments could explain this uncertainty.
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| 32. |
- Johansson, Kajsa, et al.
(författare)
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Subacromial corticosteroid injection or acupuncture with home exercises when treating patients with subacromial impingement in primary care-a randomized clinical trial
- 2011
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Ingår i: Family Practice. - : Oxford University Press. - 0263-2136 .- 1460-2229. ; 28:4, s. 355-365
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Tidskriftsartikel (refereegranskat)abstract
- bjective. To compare the efficacy of subacromial corticosteroids injected by a GP with physiotherapy combining acupuncture and home exercises as treatments for SIS. less thanbrgreater than less thanbrgreater thanMethods. A randomized clinical trial was performed in primary health care. Patients diagnosed with SIS were randomized to either subacromial corticosteroid injection (s) or 10 acupuncture treatments combined with home- exercises. The main outcomes were pain and shoulder function (Adolfsson-Lysholm shoulder assessment score). Secondary outcomes were health-related quality of life (HRQL) (EuroQol-five dimension self-report questionnaire) and the patients global assessment of change. All patients were assessed at baseline and after 6 weeks and 3, 6 and 12 months. less thanbrgreater than less thanbrgreater thanResults. One hundred and seventeen patients with SIS were included, of which 91 complied with the study protocol. There were no significant differences between treatments with regard to pain, shoulder function and HRQL in change over time. However, both treatment groups improved significantly from baseline over time. less thanbrgreater than less thanbrgreater thanConclusions. Both subacromial corticosteroid injection and a series of acupuncture treatments combined with home exercises significantly decreased pain and improved shoulder function in patients with SIS, but neither treatment was significantly superior to the other.
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| 33. |
- Johansson, Lennart, et al.
(författare)
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Rapid test, throat culture and clinical assessment in the diagnosis of tonsillitis.
- 2003
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Ingår i: Family Practice. - : Oxford University Press (OUP). - 1460-2229 .- 0263-2136. ; 20:2, s. 108-111
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Tidskriftsartikel (refereegranskat)abstract
- Objectives. Our aim was to identify a group of patients with clinical signs of tonsillitis to whom antibiotics could be prescribed without further diagnostic actions, and to compare the outcome of clinical assessment with the result of an antigen detection test using culture as the gold standard. Methods. During two winter months, patients aged >=4 years attending for sore throat at three primary health care centres in Malmö, Sweden, were examined. Odds ratios, sensitivities, specificities and predictive values were calculated for clinical assessment and for an antigen detection test. Results. Among the 169 participating patients, growth of group A ß-haemolytic streptococci (GAS) was found in 53 cultures, and 23 patients (14%) were clinically assessed as ‘absolutely positive’, representing positive clinical assessment. Nineteen had positive cultures for GAS. The sensitivity, specificity and predictive positive and negative value for the antigen detection test were 82, 96, 90 and 93%, respectively, and for positive clinical assessment 36, 97, 83 and 77%. Conclusion. It is possible to identify a small group of patients with convincing signs of tonsillitis in which the specificity as well as the predictive positive value of the rapid test and the clinical assessment are close to equal. Antibiotics may be prescribed to these patients without further diagnostic actions. Keywords. Antigen detection test, clinical assessment, rapid te
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| 34. |
- Kleppang, Annette Løvheim, et al.
(författare)
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The psychometric properties of the Hopkins Symptom Checklist-10 : A Rasch analysis based on adolescent data from Norway
- 2016
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Ingår i: Family Practice. - : Oxford University Press. - 0263-2136 .- 1460-2229. ; 33:6, s. 740-745
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundThe Hopkins Symptom Checklist (HSCL-10) is widely used for both clinical and epidemiological purposes to measure psychological distress among adolescents and adults.ObjectiveThe purpose of this study was to investigate the psychometric properties of the HSCL-10 among adolescents in Norway using Rasch analysis.MethodsThe study is based on cross-sectional data from the Norwegian Youth Health Surveys, conducted by the Norwegian Institute of Public Health in 2001 and 2009. The target group comprised of 15- to 16-year olds (Grade 10 students) in Hedmark County, Norway. Ten items with four response categories, intended to measure anxiety and depression, were analysed. The analysis focused on invariance, including differential item functioning (DIF) across genders and years of investigations. In addition, the categorization of the items, targeting, possible multidimensionality and response dependency, was analysed.ResultsThe HSCL-10 shows good reliability and on the whole, the items work well. However, one item, ‘Sleeping difficulties’, clearly misfit and some items work differently for boys and girls and between years of investigations. There is also need for a better targeting of the scale.ConclusionsThe HSCL-10 has the potential to measure the psychological distress among adolescents but there is a room for improvement. Further judgement needs to be made as to whether the misfitting item ‘Sleeping difficulties’ should be removed or retained.
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| 35. |
- Lapi, Francesco, et al.
(författare)
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Epidemiology of invasive meningococcal disease and its sequelae : a population-based study in Italian primary care, 2000-2019
- 2023
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Ingår i: Family Practice. - 0263-2136 .- 1460-2229.
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Tidskriftsartikel (refereegranskat)abstract
- Background Invasive meningococcal disease (IMD) is a severe infectious disease. Although effective preventive and therapeutical strategies are available, the fatality rate remains high in the general population, with an occurrence of meningococcal-related severe sequelae involving 10-20% of survivors. Given the crucial role of general practitioners in recognizing and preventing IMD and its related sequelae, we aim to assess the burden of these conditions in primary care. Methods Using an Italian primary care database, the incidence rate of IMD was calculated in the period 2000-2019 by capturing the first diagnosis registered during follow-up. As far as meningococcal-related sequelae are concerned, we identified and clinically evaluated each potential sequela during the first 3 months, from 3 to 12 months, and up to 36 months. Results Among 508 patients diagnosed with IMD, 403 (incidence rate: 0.24 per 10,000 person-years) comprised those diagnosed with IMD in patients aged 15 years or older. We ascertained 104 sequelae (20.4%); 76% of them occurred in those aged 25 or older; 42, 27, and 35 were assessed as short-, medium-, or long-term sequelae, respectively. Overall, 4.7% of IMD patients reported physical sequelae, while 12.2% and 5.7% of patients reported neurological and psychological sequelae, respectively. Conclusion Our study showed that a substantial proportion of IMD and related sequelae occur in individuals aged over 25, with a non-negligible burden for healthcare systems. As for the paediatric population, effective communication on the relevance of meningococcal vaccination in adults should be proficiently fostered.
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| 36. |
- Lehti, Arja, 1956-, et al.
(författare)
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Health, attitude to care and pattern of attendance among gypsy women : a general practice perspective
- 2001
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Ingår i: Family Practice. - Oxford : Oxford University Press. - 0263-2136 .- 1460-2229. ; 18:4, s. 445-448
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: There is a lack of knowledge about health and attitude to care among gypsies. OBJECTIVES: The aim of this study was to explore the reasons for and patterns of attendance among gypsy women in primary health care and to shed light on health problems of gypsies. METHODS: Four gypsy women, frequently attending a primary health care centre, were interviewed in depth. Data were analysed according to grounded theory. Additional facts were received from record files. RESULTS AND CONCLUSIONS: The gypsy women seldom approached the health centre alone but paid a visit together with relatives or friends. The women usually presented the same type of symptoms, often pain, headache and depression, and obtained the same type of diagnosis and treatment. The symptoms had an acute character and the women wanted immediate access. A collective pattern, a hierarchical order and a strict rule system characterized the gypsy life and coloured the relation to health and illness. Young women were especially vulnerable and could easily end up outside the collective and display symptoms.
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| 37. |
- Lenander, Cecilia, et al.
(författare)
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Effects of an intervention (SäkläK) on prescription of potentially inappropriate medication in elderly patients
- 2017
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Ingår i: Family Practice. - : Oxford University Press (OUP). - 0263-2136 .- 1460-2229. ; 34:2, s. 213-218
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Tidskriftsartikel (refereegranskat)abstract
- Background. Polypharmacy is known to increase the risk for drug-related problems, and some drugs, potentially inappropriate medications (PIMs), are especially troublesome. Objective. To analyse the effects on prescription of PIMs of the SäKLäK project, an intervention model created to improve medication safety for elderly patients in primary care. Method. The SäkläK project was a multiprofessional intervention in primary care consisting of self-assessment, peer review, feedback and written agreements for change. Five Swedish primary care centres participated in the intervention and five served as comparison group. Data were collected from the Swedish Prescribed Drug Register on PIMs (long-acting benzodiazepines, anticholinergics, tramadol, propiomazine, antipsychotics and non-steroidal anti-inflammatory drugs) prescribed to patients aged 65 years and older. Total number of patients and change in patients using PIMs before and after intervention with-in groups was analysed as well as differences between intervention and comparison group. Results. A total of 32 566 prescriptions of PIMs were dispensed before the intervention, 19 796 in the intervention group and 12 770 in the comparison group. After intervention a decrease was seen in both groups, intervention-22.2% and comparison-8.8%. All groups of PIMs decreased, except for antipsychotics in the comparison group. For the intervention group, a significant decrease in mean dose/patient was seen after the intervention but not in the comparison group. Conclusion. Our study shows this method has some effects on prescription of PIMs. The evaluation indicates this is a feasible method for improvement of medication use in primary care and the method should be tested on a larger scale.
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| 38. |
- Lundkvist, j, et al.
(författare)
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The more time spent on listening, the less time spent on prescribing antibiotics in general practice
- 2002
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Ingår i: Family Practice. - 0263-2136 .- 1460-2229. ; 19:6, s. 638-640
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Tidskriftsartikel (refereegranskat)abstract
- Objective. To analyse the variation between primary care centres (PCCs) with regard to prescribing antibiotics and to investigate whether the variation can be explained by factors related to patient satisfaction and to socio-demographic characteristics of the populations in the catchment areas of the PCCs. Methods. The frequency of prescription of antibiotics by GPs at the PCCs was used as the dependent variable in a multivariate regression analysis. Questionnaire data for patient satisfaction and register data for socio-demographic characteristics were used as explanatory variables. The study was set in a county in south-east Sweden, and 6734 patients consulting GPs at 39 out of the 41 PCCs in the county participated. Variables correlating with the frequency of antibiotics prescription at PCC level and with patient satisfaction were the main outcome measures. Results. A seven-fold variation in the extent of the prescription of antibiotics between the PCCs was observed. In the multivariate analysis, a high antibiotic prescription rate relates to high overall patient satisfaction with GP consultation as well as to the share of males in the listed population but to low satisfaction with the time spent by the GP on listening to the patient. Conclusion. A high frequency of prescription of antibiotics at a PCC may reflect a general disposition among GPs to give priority to maintaining good relations with the patients. However, a low level of prescription may be consistent with patient satisfaction if more time is spent on listening to and informing the patients. Thus more time spent on listening to the patients may reduce the prescription of antibiotics without reducing patient satisfaction.
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| 39. |
- Ma, Li, 1970-, et al.
(författare)
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The association between screen time and reported depressive symptoms among adolescents in Sweden
- 2021
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Ingår i: Family practice. - Oxford : Oxford University Press (OUP). - 1460-2229 .- 0263-2136. ; 38:6, s. 773-779
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: How screen use is associated with adolescents' mental health has been widely debated in public media during the last decade, but there is still lack of information about if and how the associations vary between types of electronic media. OBJECTIVE: This study aimed to examine how time spent on types of screen use (social media, gaming alone, gaming in groups and watching TV) was associated with depressive symptoms among adolescents in Sweden, and whether gender moderated these associations. METHODS: We analysed data from the Swedish section of the Children of Immigrants: Longitudinal Survey in Four European Countries. The final sample consisted of 3556 eighth grade adolescents in 2011 (51% girls). We used logistic regression analysis to estimate the odds ratio of feeling depressed often versus less often/not at all using time spent on different types of screen use as predictor variables. Additionally, we tested interaction effects between gender and the predictor variables. RESULTS: Our results showed that spending more than 2 hours on social media was associated with higher odds of feeling depressed often compared with spending 2 hours or less. Not watching TV was associated with higher odds of feeling depressed often compared with watching TV. These patterns did not differ across genders. Gaming alone and gaming in groups were not associated with depressive symptoms. CONCLUSIONS: Our findings suggest that more frequent social media use and not watching TV were associated with a higher level of depressive symptoms. © The Author(s) 2021. Published by Oxford University Press. This study examined how time spent on four types of screen use including social media, gaming alone, gaming in groups and watching TV was associated with depressive symptoms among adolescents in Sweden, and whether these associations differed for girls and boys. We analysed data from the Swedish section of the Children of Immigrants: Longitudinal Survey in Four European Countries. The final sample consisted of 3556 eighth grade adolescents in 2011 (51% girls). We used logistic regression analysis to estimate the odds ratio of feeling depressed often versus less often/not at all using time spent on different types of screen use as predictor variables. In addition, we tested interaction effects between gender and the predictor variables. Our results showed that social media use and not watching TV was associated with higher odds of feeling depressed often. Gaming alone and gaming in groups were not associated with higher level of depressive symptoms. These patterns did not differ across genders.
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| 40. |
- Maghout Juratli, Sham, et al.
(författare)
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Demographic and lifestyle factors associated with perceived stress in the primary care setting : a MetroNet study
- 2011
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Ingår i: Family Practice. - : Oxford University Press (OUP). - 0263-2136 .- 1460-2229. ; 28:2, s. 156-162
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Stress and stress-related disorders are common in primary care. The stress-related needs for patients are often unmet partially due to the time and resource constraints inherent to many primary care settings. We examined the relative significance of key demographic and lifestyle factors related to stress among primary care patients. This information is unknown and needed to strategize these increasingly limited resources.METHODS: We distributed surveys to 100 consecutive adult patients in each of four family medicine centres in metropolitan Detroit between 2006 and 2007. Hierarchical multivariable regression analyses were used to assess the relative significance of the demographic and lifestyle factors related to stress.RESULTS: Of the 400 distributed surveys, 315 (78.7%) answered a minimum of 70% of the questions and were included in the analysis. The lifestyle factors [exercise, body mass index (BMI), sleep, social support, recovery or self-care skills (such as the ability to rest, relax and recuperate)] explained 39% (P < 0.001) of the variance in stress compared to 10% (P < 0.001) by the demographic factors (age, gender, race, employment, education and marital status). Stress was inversely related to sleep (P < 0.001), recovery (P < 0.001) and social support (P = 0.02) and positively to education (P < 0.001).CONCLUSIONS: The modifiable lifestyle factors explained significantly more of perceived stress among primary care patients than the demographic factors. Sleep and recovery had the biggest inverse relationship with stress, which suggests that they should be the primary target for assessment and intervention in patients who report stress or stress-related disorders.
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| 41. |
- Marklund, Bertil, et al.
(författare)
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Promoting medical self-care : evaluation of a family intervention implemented in the primary health care by pharmacies
- 1999
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Ingår i: Family Practice. - : Oxford University Press. - 0263-2136 .- 1460-2229. ; 16:5, s. 522-527
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Tidskriftsartikel (refereegranskat)abstract
- Background: Medical self-care is the range of behaviours undertaken by people to promote or restore health when dealing with a medical problem.Objectives: The aim of the study was to evaluate medical self-care effects of a family intervention implemented in primary health care by pharmacies, in terms of non-professional and professional involvement.Methods: The intervention was implemented in one of two primary health care areas during a 4-month period and involved consecutive families acting as an intervention (IG, n = 94) or a control (CG, n = 93) group. Eight telephone interviews were conducted with each family. The families were asked about complaints of illness, how long they prevailed and how they were treated.Results: The results showed (P < 0.05–0.0001) that the IG had more medical problems (931 versus 621) compared with the CG, were less hospitalized (4 versus 10), stayed at home more to take care of sick children (84 versus 40), read more medical brochures (121 versus 31), tried more non-medical treatments (228 versus 116), and had fewer visits to the department of paediatrics but more visits to primary health care (69 and 98 versus 90 and 68).Conclusions: Due to the non-randomization procedure, some caution with regard to generalization of the results must be taken, but they are in concordance with established knowledge of the usefulness of medical self-care. The results indicate that a brief intervention for families can change the use of health authorities. It therefore seems meaningful to implement the intervention in a more comprehensive way in the primary health care setting, while at the same time trying to implement it as a large-scale randomized experimental study, comprising aspects such as the individual's need for care, the use of the right organization level and the assessment of economic costs and savings.
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| 42. |
- Martin-Merino, Elisa, et al.
(författare)
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Prevalence, incidence, morbidity and treatment patterns in a cohort of patients diagnosed with anxiety in UK primary care
- 2010
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Ingår i: Family Practice. - : Oxford University Press (OUP). - 0263-2136 .- 1460-2229. ; 27:1, s. 9-16
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Tidskriftsartikel (refereegranskat)abstract
- Background. Anxiety disorders are common and can cause substantial quality of life impairment. Objective. The aim of this study was to investigate the frequency of anxiety in UK primary care. Treatment patterns and factors associated with an anxiety diagnosis were also assessed. Methods. The Health Improvement Network was used to identify all patients aged 10-79 years with a new diagnosis of anxiety in 2002-04 (n = 40 873) and age-, sex- and calendar-year-matched controls (n = 50 000). A nested case-control analysis was used to quantify potential risk factors for anxiety by multivariate logistic regression. Results. The prevalence of anxiety was 7.2% and the incidence was 9.7 per 1000 person-years. Incidence and prevalence were highest in women and young adults (20-29 years). Anxiety was associated with heavy alcohol use, smoking and addiction problems as well as stress, sleep and depression disorders. Anxiety patients used health care services more frequently than controls. Among patients diagnosed with anxiety, 63% were treated pharmacologically. Antidepressants accounted for almost 80% of prescriptions. Conclusions. The prevalence and incidence of anxiety are high in UK primary care and are almost twice as high in women than in men. Anxiety is associated with other psychiatric morbidity as well as frequent health care use. Antidepressants are the most commonly used pharmacological treatment.
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| 43. |
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| 44. |
- Mattsson, B, et al.
(författare)
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Attitudes towards predictive testing in Huntington's disease--a deep interview study in Sweden.
- 1991
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Ingår i: Family Practice. - : Oxford University Press (OUP). - 0263-2136 .- 1460-2229. ; 8:1, s. 23-7
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Tidskriftsartikel (refereegranskat)abstract
- Ten persons with a 50% risk of inheriting Huntington's disease were interviewed in depth about experiences of the disease with special regard to their attitude to a predictive test. The persons showed great interest, concern and worry about a test: six were generally positive while four were negative or uncertain. Every interview had a very personal character and early life experiences seemed to have a determinative influence on the attitude to the test. Persons who were without symptoms of the disease and had passed the mean age of onset within the family (usually older individuals) were largely enthusiastic about a test, as were those with slight and undetermined symptoms. Younger persons, especially those with a qualitatively good contact with the affected parent, seemed to be less interested. Contradictions during the interview were more common among those positive to testing and an ambivalence among many was reflected in a tendency towards changing opinions over time.
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| 45. |
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| 46. |
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| 47. |
- Milos, Veronica, et al.
(författare)
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Theory-based interventions to reduce prescription of antibiotics-A randomized controlled trial in Sweden
- 2013
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Ingår i: Family Practice. - : Oxford University Press (OUP). - 0263-2136 .- 1460-2229. ; 30:6, s. 634-640
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Tidskriftsartikel (refereegranskat)abstract
- Background.: Upper respiratory tract infections (URTIs) are the most common reason for consulting a GP and for receiving an antibiotic prescription, although evidence shows poor benefit but rather increasing antibiotic resistance. Interventions addressing physicians have to take into consideration the complexity of prescribing behaviour. Objective.: To study whether interventions based on behavioural theories can reduce the prescribing of antibiotics against URTIs in primary care. Setting and subjects.: GPs at 19 public primary health care centres in southern Sweden. Methods.: We performed a randomized controlled study using two behavioural theory-based interventions, the persuasive communication intervention (PCI) and the graded task intervention (GTI), which emerged from social cognitive theory and operant learning theory. GPs were randomized to a control group or one of two intervention groups (PCI and GTI). Main outcome measures.: Changes in the rate of prescription of antibiotics against URTIs in primary care patients of all ages and in patients aged 0-6 years. Results.: No significant differences were seen in the prescription rates before and after the interventions when patients of all ages were analysed together. However, for patients aged 0-6 years, there was a significant lower prescription rate in the PCI group (P = 0.037), but not the GTI group, after intervention. Conclusion.: Theory-based interventions have limited impact on reducing the prescription of antibiotics against URTIs in primary care. Future studies are needed to draw firm conclusions about their effects. © The Author 2013. Published by Oxford University Press. All rights reserved.
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| 48. |
- Missiou, Aristea, et al.
(författare)
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Health outcomes in primary care: a 20-year evidence map of randomized controlled trials
- 2023
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Ingår i: Family Practice. - : OXFORD UNIV PRESS. - 0263-2136 .- 1460-2229. ; 40:1, s. 128-137
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Forskningsöversikt (refereegranskat)abstract
- Objective To quantify the different types of health outcomes assessed as primary outcomes in randomized controlled trials (RCTs) in the primary care (PC) setting during the last 20 years and identify whether potential gaps exist in specific types of health care and types of intervention. Methods We systematically searched PubMed, Scopus, and Cochrane Central Register of Controlled Trials, from January 2000 to September 2020 for published RCTs in PC. We recorded characteristics of eligible studies and mapped evidence by health outcome category (patient health outcomes, health services outcomes); and for each outcome category, by types of health care (preventive, acute, chronic, palliative), and by types of intervention (drug, behavioural, on structure, and on process). For RCTs assessing patient health outcomes as primary outcomes, we further mapped using the quality-of-care dimensions, that is, effectiveness, safety, and patient-centredness. Results Of the 518 eligible RCTs in PC, 357 (68.9%) evaluated a patient health outcome as the primary outcome, and 161 (31.1%) evaluated only health services outcomes as primary outcomes. Many focused on population with chronic illness (224 trials; 43.2%) and evaluated interventions on processes of health care (239 trials; 46.1%). Research gaps identified include preventive and palliative care, behavioural interventions, and safety and patient-centredness outcomes as primary outcomes. Conclusion Our evidence map showed research gaps in certain types of health care and interventions. It also showed research gaps in assessing safety and measures to place patient at the centre of health care delivery as primary outcomes.
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| 49. |
- Moharra, Montse, et al.
(författare)
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Implementation of a cross-border health service : physician and pharmacists' opinions from the epSOS project
- 2015
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Ingår i: Family Practice. - : Oxford University Press (OUP). - 0263-2136 .- 1460-2229. ; 32:5, s. 564-567
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Tidskriftsartikel (refereegranskat)abstract
- Objective(s). To explore the opinions of health professionals with experience of the European Patient Smart Open Services (epSOS) system regarding the epSOS services perceived utility, potential impact and main barriers and facilitators to its use. Methods. Qualitative study design involving focus groups with health care professionals with experience of epSOS system. A semi-structured topic guide was developed to guide the discussion. Results. epSOS services were seen as interesting intuitive services and easy to operate. The greatest impact was in terms of positive impact on communication, clinical safety and patient management. Data reliability, difficulties in accessing the service and aspects related to information technology architecture were considered the most relevant barriers. Conclusion. This study has provided insights into the strengths and limitations of two new eHealth services for use across countries within the European Union, and has provided indications of how those services could be improved.
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| 50. |
- Nemlander, Elinor, et al.
(författare)
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Validation of a diagnostic prediction tool for colorectal cancer : a case–control replication study
- 2023
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Ingår i: Family Practice. - : Oxford University Press. - 0263-2136 .- 1460-2229.
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundEarly detection of colorectal cancer (CRC) is crucial for survival. Primary care, the first point of contact in most cases, needs supportive risk assessment tools. We aimed to replicate the Swedish Colorectal Cancer Risk Assessment Tool (SCCRAT) for non-metastatic CRC in primary care and examine if risk factor patterns depend on sex and age.Methods2,920 adults diagnosed with non-metastatic CRC during the years 2015–2019 after having visited a general practitioner the year before the diagnosis were selected from the Swedish Cancer Register and matched with 11,628 controls, using the same inclusion criteria except for the CRC diagnosis. Diagnostic codes from primary care consultations were collected from a regional health care database. Positive predictive values (PPVs) were estimated for the same 5 symptoms and combinations thereof as in the baseline study.ResultsThe results for patients aged ≥50 years old in the present study were consistent with the results of the SCCRAT study. All symptoms and combinations thereof with a PPV >5% in the present study had a PPV >5% in the baseline study. The combination of bleeding with abdominal pain (PPV 9.9%) and bleeding with change in bowel habit (PPV 7.8%) were the highest observed PPVs in both studies. Similar risk patterns were seen for all ages and when men and women were studied separately.ConclusionThis external validation of the SCCRAT for non-metastatic CRC in primary care replicated the baseline study successfully and identified patients at high risk for CRC.
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