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Objective

Many adolescent males report negative experiences of consultations with general practitioners (GPs), which contrasts with the importance of patient-centredness that GPs themselves emphasise. A better understanding of this discrepancy might facilitate improvements. The aim was to explore and describe adolescent males’ encounters with GPs in Swedish primary healthcare centres using a lifeworld perspective.

Design

Qualitative lifeworld-based study. Video-recorded observations were analysed using a phenomenological-hermeneutical method.

Setting

Two primary healthcare centres in mid-Sweden.

Subjects

Nine males aged 15 to 19, video-recorded during their encounters with GPs in March through May 2022.

Findings

Adolescent males navigate between being children in need of parental support and men who can take initiative and responsibility. They face cognitive, emotional, and relational demands, the complexity of which renders them particularly vulnerable. When feeling exposed and not knowing what to expect, they struggle to make themselves understood, and to understand what the GP is saying and what is happening. The difficulties that they have disclosed to the GP in trust need to be recognised and carefully acted upon. Thus the GP must respond appropriately to this complex mix of vulnerabilities to prevent feelings of disappointment or of having exposed themselves in vain.

Conclusion

The complexity of encounters with adolescent males imposes great demands on GPs to identify and adapt to their individual needs. A proper ethical response involves helping them navigate the challenges of the consultation while also respecting them as persons and meeting their age-dependent needs.

As available treatments in obstructive sleep apnea (OSA) are all associated with side effects or adherence problems, there is a need for alternative treatment options.

In this randomised, open, parallel-group intervention study the effect of head extension by cervical collar was evaluated in patients with moderate OSA. 

One hundred patients with moderate OSA (apneas and hypopneas per estimated hours asleep = respiratory events index: 15–30) were randomised to either lifestyle intervention (LS) or cervical collar in combination with lifestyle intervention (CC/LS). Both groups received lifestyle advice. In addition, the treatment group were treated with a cervical collar, which allows adjustment of head extension, during sleep. Assessment with questionnaires and polygraphy were performed at baseline and after 6 ± 2 weeks.

A linear regression model was used to assess a total effect on respiratory events index, which was the primary endpoint. 

In the intention to treat (ITT) analysis, the CC/LS group decreased their respiratory events index (P = 0.008) and oxygen desaturation index (P = 0.008) more than the LS group with a mean difference of -4.5 and -4.3, respectively. In the sub-analysis, there was a clear effect on respiratory events index in the supine position (mean difference between the groups -9.1, p=0.018) but not on non-supine AHI (-2.3, p=0.17).  

We conclude that head extension by cervical collar during sleep resulted in improved respiratory events index and oxygen desaturation index values in patients with moderate OSA. Cervical collar can be a second-line treatment option in this group, especially in positional OSA.

Background

Many adolescent males visit a general practitioner regularly, yet many report unmet health needs and negative experiences. This indicates a gap between provided healthcare and the needs of adolescent males. In order to improve adolescent males’ possibilities to discuss their health concerns with general practitioners, the study’s aim was to explore and describe how adolescent males understand and assign meaning to their experiences of consultations with general practitioners.

Methods

This qualitative study was conducted at two healthcare centres in mid-Sweden in 2022. Nine males 15 to 19 years old described their experiences in semi-structured interviews immediately after consulting a general practitioner, regardless of reason for the consultation and whether or not accompanied by a parent. The analysis was guided by thematic analysis according to Braun & Clarke and reflective lifeworld theory’s concepts of openness and sensitivity.

Results

One overarching theme, To be listened to, and three themes were developed: To handle insecurity and uneasiness, To be understood and cared for, and To get parental support on his terms. In a good appointment, the general practitioner cares about him, listens attentively, and takes him seriously. More importantly, the general practitioner’s understanding permeates the consultation, so that all aspects of it is adapted to him. The adolescent males doubted their ability to express themselves and to understand what would happen in the consultation, and therefore feared being dismissed without receiving any help. Such difficulties may be due to unfinished neurocognitive development and inexperience. They struggled with embarrassment, partly due to notions of masculinity, and strived to balance their needs of parental support, privacy, and being the one that the doctor listens to.

Conclusions

We argue that adolescent males are particularly vulnerable due to on-going neurocognitive and emotional development, inexperience, and notions of masculinity. However, good experiences can be generated through rather simple means. Adolescent males need individual adaptations demonstrating that they are cared for, understood and taken seriously. Furthermore, they need an unhurried pace to facilitate understanding, verbal affirmations to mitigate embarrassment, and help in navigating parental involvement.

Study objectives: This study aimed to investigate the effect of telemonitoring compared with standard clinic visits on adherence to continuous positive airway pressure (CPAP) treatment after 6 months. In addition, the impact of other factors including CPAP side effects on treatment adherence were assessed.

Methods: Consecutive patients (n = 217) who were prescribed CPAP treatment for obstructive sleep apnea were randomized to either telemonitoring or standard-care follow-up. All patients were followed up 6 months after treatment started. Clinical/anthropometric variables, socioeconomical and lifestyle factors, psychological distress, daily function, and personality traits along with CPAP side effects were assessed. Differences between groups were analyzed using 2-sample t-test, chi-square test, or Fisher's exact test. Regression modeling was used to explore associations between dependent and independent variables.

Results: There were no differences in CPAP adherence between telemonitoring and standard-care groups after 6 months (53.2% vs 48.7%; P = .54). CPAP side effects such as dry throat (odds ratio = 2.17; 95% confidence interval = 1.25-3.70), increased awakenings (2.50; 1.31-4.76), and exhaling problems (3.70; 1.25-10.1) were independently associated with low CPAP adherence, although these associations were weakened when adding smoking to the model. No other baseline or follow-up factors were associated with CPAP adherence at 6 months.

Conclusions: We could not show that telemonitoring follow-up improved adherence levels. Dry throat, increased awakenings, exhaling problems, and smoking had negative effects on CPAP adherence. Preventing side effects and assessing smoking status is therefore of importance when wanting to improve CPAP adherence.

BACKGROUND: Among the myriad voices advocating diverging ideas of what general practice ought to be, none seem to adequately capture its ethical core. There is a paucity of attempts to integrate moral theory with empirical accounts of the embodied moral knowledge of GPs in order to inform a general normative theory of good general practice. In this article, we present an empirically grounded model of the professional morality of GPs, and discuss its implications in relation to ethical theories to see whether it might be sustainable as a general practice ethic.

METHODS: We observed and interviewed sixteen GPs and GP residents working in health care centres in four Swedish regions between 2015-2017. In keeping with Straussian Grounded Theory, sampling was initially purposeful and later theoretically guided, and data generation, analysis and theoretical integration proceeded in parallel. The focal concept of this article was refined through multidimensional property supplementation.

RESULTS: The voice of the profession is one of four concepts in our emerging theory that attempt to capture various motives that affect GPs' everyday moral decisionmaking. It reflects how GPs appreciate the situation by passing three professional-moral judgments: Shall I see what is before me, or take a bird's-eye view? Shall I intervene, or stay my hand? And do I need to speak up, or should I rather shut up? By thus framing the problem, the GP narrows down the range of considerations, allowing them to focus on its morally most pertinent aspects. This process is best understood as a way of heeding Løgstrup's ethical demand. Refracted through the lens of the GP's professional understanding of life, the ethical demand gives rise to specific moral imperatives that may stand in opposition to the express wishes of the other, social norms, or the GP's self-interest.

CONCLUSIONS: The voice of the profession makes sense of how GPs frame problematic situations in moral terms. It is coherent enough to be sustainable as a general practice ethic, and might be helpful in explaining why ethical decisions that GPs intuitively understand as justified, but for which social support is lacking, can nevertheless be legitimate.

Objective: To investigate to what degree adolescent males (1) value confidentiality, (2) experience confidentiality and are comfortable asking sensitive questions when visiting a general practitioner (GP), and (3) whether self-reported symptoms of poor mental health and health-compromising behaviours (HCB) affect these states of matters.

Design: Cross-sectional.

Setting: School-based census on life, health and primary care in Region Sörmland, Sweden.

Subjects: 2,358 males aged 15–17 years (response rate 84%).

Main outcome measures: The impact of poor mental health and HCBs on adolescent males’ valuing and experiencing private time with the GP, having professional secrecy explained, and being comfortable asking about the body, love and sex, analysed with structural equation modelling.

Results: Almost all respondents valued confidentiality regardless of their mental health or whetherthey engaged in HCBs: 86% valued spending private time with the GP, and 83% valued receivinga secrecy explanation. Among those who had visited a GP in the past year (n¼1,200), 74% had experienced private time and 42% a secrecy explanation. Three-quarters were at least partly comfortable asking sensitive questions. Adolescent males with HCBs were more likely to experience a secrecy explanation (approximative odds ratio [appOR] 1.26;p¼0.005) and to be comfortable asking about sex than their peers (appOR 1.22;p¼0.007). Respondents reporting experienced confidentiality were more comfortable asking sensitive questions (appOR 1.25–1.54;p0.010).

Conclusion: Confidentiality matters regardless of poor mental health or HCBs and makes adolescent males more comfortable asking sensitive questions. We suggest that GPs consistently offerprivate time and explain professional secrecy.

KEY POINTS

• Confidentiality for adolescent males has been scantily studied in relation to mental healthand health-compromising behaviours.
• In this study, most adolescent males valued confidentiality, regardless of their mental healthand health-compromising behaviours.
• Health-compromising behaviours impacted only slightly, and mental health not at all, on experiences of confidentiality in primary care.
• When provided private time and an explanation of professional secrecy, adolescent males were more comfortable asking the GP sensitive questions.