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Background: Patients' expectations and perceptions of the medical encounter and interactions are important tools in diabetes management. Some problems regarding the interaction during encounters may be related to a lack of communication skills on the part of either the physician or the patient. This study aimed at exploring the perceptions of type 2 diabetes patients regarding the medical encounters and quality of interactions with their primary health-care providers. Methods: Four focus group discussions ( two women and two men groups) were conducted among 27 purposively selected patients ( 13 men and 14 women) from six primary health-care centres in Muscat, Oman. Qualitative content analysis was applied. Results: The patients identified some weaknesses regarding the patient-provider communication like: unfriendly welcoming; interrupted consultation privacy; poor attention and eye contact; lack of encouraging the patients to ask questions on the providers' side; and inability to participate in medical dialogue or express concerns on the patients' side. Other barriers and difficulties related to issues of patient-centeredness, organization of diabetes clinics, health education and professional competency regarding diabetes care were also identified. Conclusion: The diabetes patients' experiences with the primary health-care providers showed dissatisfaction with the services. We suggest appropriate training for health-care providers with regard to diabetes care and developing of communication skills with emphasis on a patient-centred approach. An efficient use of available resources in diabetes clinics and distributing responsibilities between team members in close collaboration with patients and their families seems necessary. Further exploration of the providers' work situation and barriers to good interaction is needed. Our findings can help the policy makers in Oman, and countries with similar health systems, to improve the quality and organizational efficiency of diabetes care services.

OBJECTIVE: We aimed to evaluate if the course of dyspepsia is influenced by medical consultation in primary care. DESIGN, SETTING AND PATIENTS: Australian general practitioners (n = 27) recruited 157 dyspeptic patients, of whom 94 were eligible for follow-up. Dyspepsia, comorbidity, quality of life, emotional status, locus of control and consultation satisfaction were measured at baseline and follow-up (mean 3 months). MAIN OUTCOME MEASURE: Response was defined as improvement of dyspepsia over time on the Nepean Dyspepsia Index score. RESULTS: Dyspepsia improved in 82% (n = 77). There was no significant change in non-gastrointestinal symptoms. Half were worried or stressed by their symptoms, and 85% wanted reassurance, a need that (univariately) differentiated responders from non-responders (p = 0.02). Most patients seen in primary care with dyspepsia improved. If the doctor believed it was likely that the patient would follow their recommendations, the patient was nearly five times as likely to be a responder (OR 4.9, 95% CI 1.2-19.0). The only other significant predictor was acid suppression therapy (OR 3.5, 95% CI 1.1-10.9). CONCLUSION: Most primary care visits for dyspepsia are followed by improvement, which may be predicted in part by indicators of patient compliance. Prescription of acid suppression therapy may also improve outcome in dyspepsia

OBJECTIVES: Comparison of comorbidity and healthcare consumption in primary healthcare subjects with persistent functional gastrointestinal disorder (FGID) and a strictly gastrointestinal (GI) symptom-free group (SSF). METHODS: A stratified sample (n=1428, 21-86 years) of subjects living in the Osthammar community, Sweden, was limited to half of the community and classified through the Abdominal Symptom Questionnaire (ASQ) into two study groups, one with persistent FGID (n=71), another SSF (n=48). Symptoms were re-evaluated by means of the ASQ at a surgery visit, as was healthcare consumption during 2 years, and the levels of anxiety and depression, as measured with the Hospital Anxiety and Depression Scale. Diagnoses were set according to The International Classification of Diseases (ICD)-9 and the 14 diagnostic groups. RESULTS: Of the FGID patients, 97% had a non-GI diagnosis, compared with 100% of SSF (ns). The mean number of doctors' consultations (OR=3.5), phone calls to doctors (OR=3.4), number of prescriptions (OR=2.4) and number of set diagnoses (OR=3.9), anxiety level (OR=11.5) and depression (OR=5.2) were all statistically significantly higher (p<0.05) for FGID than for SSF, while the number of referrals and sick leave were not. Besides a GI diagnosis, there was no significant difference (p>0.05) in the spectrum of morbidity in terms of ICD-9 subgroup classification, except an increased proportion of older SSF subjects with circulatory disorders and hypertension. CONCLUSIONS: Functional gastrointestinal disorders are related to an increased demand on primary healthcare because of an increased overall comorbidity, which signifies a need for a holistic healthcare approach.

The aim of this study is to present diagnostic patterns, diagnostics used and antibiotic treatment in relation to guidelines in 3 repeated diagnosis-prescription studies conducted simultaneously in general practice in 5 Swedish counties, during 1 week in November 2000, 2002 and 2005. General practitioners (GPs) at the participating health centres were asked to complete a form for all patients with symptoms of an infectious disease. During the studied periods a total of 15,371 consultations was registered. Consultations with GPs diagnosed as respiratory tract infection (RTI), especially consultations for sore throat, decreased considerably between y 2000 and 2005. The percentage of patients allocated an RTI diagnosis and prescribed an antibiotic declined significantly from 54% to 49% and the decline was most pronounced among children. Penicillin V remained the dominant antibiotic prescribed throughout the study periods. For lower urinary tract infections there was a significant change in choice of prescribed antibiotics with an increase for pivmecillinam and nitrofurantoin and a decrease for trimethoprim, in accordance with recommendations. The results indicate a quite close adherence to current guidelines, with changes in the pattern of consultations as well as in the management of infectious diseases in general practice in Sweden.

Background: Chronic obstructive pulmonary disease (COPD) is an important cause of morbidity and mortality worldwide. Diagnosis is customarily confirmed with spirometry, but there are few studies on documented spirometry use in everyday clinical practice. Methods: In a cross-sectional survey and study of the medical records of primary and secondary care COPD patients aged 18-75 in a Swedish region, patients with COPD were randomly selected from the registers of 56 primary care centres and 14 hospital outpatient clinics. Spirometry data at diagnosis ±6 months were analyzed. Results: From 1,114 patients with COPD, 533 with a new diagnosis of COPD during the four-year study period were identified. In 59% (n=316), spirometry data in connection with diagnosis were found in the medical records. Spirometry data with post-bronchodilator forced expiratory volume in one second (FEV₁)/ vital capacity (VC) ratios were available in 45% (n=241). FEV₁/VC ratio <0.70 were found in 160 patients, which corresponds to 30% of the patients with a new diagnosis. Lower age, female gender, current smoking, higher body mass index (BMI) and shorter forced exhalation time were related to COPD diagnosis despite an FEV₁/VC ratio of ≥0.70. The most common problem in the quality assessment was an insufficient exhalation time. Conclusions: Only a third of Swedish patients with COPD had their diagnosis confirmed with spirometry. Our data indicate that female gender, current smoking, higher BMI and short exhalation time increase the risk of being diagnosed with COPD without fulfilling the spirometric criteria for the disease.

Background: Physicians have a central role as gatekeepers to the social security system, includingsick-listing. Variation in physicians’ sick-listing practices has been demonstrated in several studies. Theobjective of this study was to determine whether local structural factors affect sick-listing practice.Methods: A total of 57 563 consecutive sick-listing certificates, issued during 4 months in 1995 and2 months in 1996, were collected from the local branches of the National Social Insurance Office ineight Swedish counties. County code, local community population size and presence of a hospital in thearea were used as indicators of local structural factors. Length of the sick-listing certificates and of thesick-listing episodes were used as outcome variables. Results: After ajustment for the influence of categoryof issuing physician, patients’ age, sex and diagnosis (‘case mix’), and type of certificate there was alarge variation of the length of the sick-listing certificates and of the sick-listing episodes betweencounties, between communities of various size and between communities with or without a hospitalin the area. All these factors were independently and significantly correlated to the length of thecertificate and of the sick-listing episode. Conclusions: The results support the hypothesis that physicians’sick-listing practice is influenced by local structural factors.

Objective  To investigate adherence to prescription in a female population aged 35–65 years.

Design  Postal questionnaire study of 2991 randomly sampled 35- to 64-year-old women in seven provinces of central Sweden. Methods  The study was performed in 1995 as a cross-sectional postal questionnaire study in seven counties in central Sweden. The questionnaire was sent to a random sample of 4200 women between the ages of 35 and 64, of whom 2991 (71.2%) responded. The questionnaire asked about drugs prescribed during the past year and about factors potentially affecting adherence. Results  The same women had different degrees of adherence to different medications. A large number of factors were associated with adherence. Multivariate analysis revealed that age, scheduled check-up, perceived importance of medication, concerns about medication safety and taking medication for a respiratory or a cardiovascular disease were significantly related to adherence. Adherence ranged from 15–98% depending on these factors, and was the lowest among young women who regarded their medication as unimportant and who had no scheduled check-up; the highest reported adherence was found among elderly women who regarded their medication as important and who had a scheduled check-up. Conclusion  Factors that were associated with the perceived importance of medication had a positive effect on adherence, while concerns about medication safety had a negative effect.

BACKGROUND: Symptom prevalence is generally believed to increase with age. The aim of this study was to evaluate the age specific prevalence of 30 general symptoms among Swedish middle-aged women. METHODS: A cross-sectional postal questionnaire study in seven Swedish counties in a random sample of 4,200 women 35-64 years old, with 2,991 responders. Thirty general symptoms included in the Complaint Score subscale of the Gothenburg Quality of Life Instrument were used. RESULTS: Four groups of age specific prevalence patterns were identified after adjustment for the influence of educational level, perceived health and mood, body mass index, smoking habits, use of hormone replacement therapy, and use of other symptom relieving therapy. Only five symptoms (insomnia, leg pain, joint pain, eye problems and impaired hearing) increased significantly with age. Eleven symptoms (general fatigue, headache, irritability, melancholy, backache, exhaustion, feels cold, cries easily, abdominal pain, dizziness, and nausea) decreased significantly with age. Two symptoms (sweating and impaired concentration) had a biphasic course with a significant increase followed by a significant decrease. The remaining twelve symptoms (difficulty in relaxing, restlessness, overweight, coughing, breathlessness, diarrhoea, chest pain, constipation, nervousness, poor appetite, weight loss, and difficulty in urinating) had stable prevalence with age. CONCLUSION: Symptoms did not necessarily increase with age instead symptoms related to stress-tension-depression decreased.

Introduction

Seasonal variations in hemoglobin-A1c have been reported in diabetic patients, but the underlying mechanisms have not been elucidated.

Aims

To study if insulin sensitivity, insulin secretion, and fasting plasma glucose showed seasonal variations in a Swedish population-based cohort of elderly men.

Methods

Altogether 1117 men were investigated with a euglycemic insulin clamp and measurements of fasting plasma glucose and insulin secretion after an oral glucose tolerance test. Values were analyzed in linear regression models with an indicator variable for winter/summer season and outdoor temperature as predictors.

Results

 During winter, insulin sensitivity (M/I, unit = 100 × mg × min^-1 × kg^-1/(mU × L^-1)) was 11.0% lower (4.84 versus 5.44, P = 0.0003), incremental area under the insulin curve was 16.4% higher (1167 versus 1003 mU/L, P = 0.007). Fasting plasma glucose was, however, not statistically significantly different (5.80 versus 5.71 mmol/L, P = 0.28) compared to the summer season. There was an association between outdoor temperature and M/I (0.57 units increase (95% CI 0.29–0.82, P < 0.0001) per 10°C increase of outdoor temperature) independent of winter/summer season. Adjustment for life-style factors, type 2 diabetes, and medication did not alter these results.Read More:http://informahealthcare.com/doi/abs/10.3109/03009734.2011.628422

Conclusions

Insulin sensitivity showed seasonal variations with lower values during the winter and higher during the summer season. Inverse compensatory variations of insulin secretion resulted in only minor variations of fasting plasma glucose. Insulin sensitivity was associated with outdoor temperature. These phenomena should be further investigated in diabetic patients.

Aims: We estimated measurement error (ME) corrected effects of   insulin sensitivity (M/I), from euglycaemic insulin clamp, and insulin   secretion, measured as early insulin response (EIR) from oral glucose   tolerance test (OGTT), on fasting plasma glucose, HbA1c and type 2   diabetes longitudinally and cross-sectional.   Methods: : In a population-based study (n = 1128 men) 17 men made   replicate measurements to estimate ME at age 71 years. Effect of 1 SD   decrease of predictors M/I and EIR on longitudinal response variables   fasting plasma glucose (FPG) and HbA1c at follow-ups up to 11 years,   were estimated using uncorrected and ME-corrected (with the regression   calibration method) regression models.   Results: : Uncorrected effect on FPG at age 77 years was larger for M/I   than for EIR (effect difference 0.10 mmol/l, 95% CI 0.00;0.21), while   ME-corrected effects were similar (0.02 mmol/l, 95% CI -0.13;0.15   mmol/l). EIR had greater ME-corrected impact than M/I on HbA1c at age   82 years (-0.11%, -0.28; -0.01%).   Conclusions: : Due to higher ME effect of EIR on glycaemia is   underestimated as compared with M/I. By correcting for ME valid   estimates of relative contributions of insulin secretion and insulin   sensitivity on glycaemia are obtained.

The least-squares estimator of the slope in a simple linear regression model is biased towards zero when the predictor is measured with random error. A corrected slope may be estimated by adding data from a reliability study, which comprises a subset of subjects from the main study. The precision of this corrected slope depends on the design of the reliability study and estimator choice.Previous work has assumed that the reliability study constitutes a random sample from the main study. A more efficient design is to use subjects with extreme values on their first measurement. Previously, we published a variance formula for the corrected slope, when the correction factor is the slope in the regression of the second measurement on the first. In this paper we show that both designs improve by maximum likelihood estimation (MLE). The precision gain is explained by the inclusion of data from all subjects for estimation of the predictor's variance and by the use of the second measurement for estimation of the covariance between response and predictor. The gain of MLE enhances with stronger true relationship between response and predictor and with lower precision in the predictor measurements. We present a real data example on the relationship between fasting insulin, a surrogate market, and true insulin sensitivity measured by a gold-standard euglycaemic insulin clamp, and simulations, where the behavior of profile-likelihood-based confidence intervals is examined. MLE was shown to be a robust estimator for non-normal distributions and efficient for small sample situations.

Abstract: Purpose – The purpose of this study is to evaluate whether dialogue groups for physicians can improve their psychosocial work environment. Design/methodology/approach – The study assessed the impact of eight dialogue groups, which involved 60 physicians at a children's clinic in one of the main hospitals in Stockholm. Psychosocial work environment measures were collected through a validated instrument sent to all physicians (n=68) in 1999, 2001 and 2003. Follow-up data were collected after the termination of the groups. Findings – The overall score of organizational and staff wellbeing, as assessed by the physicians at the clinic, deteriorated from 1999 until 2003 and then improved 2004. This shift in the trend coincided with the intervention. No other factors which might explain this shift could be identified. Research limitations/implications – In a naturalistic study of this kind it is not possible to prove any causal relationships. A controlled survey of management programmes concerning the work environment among physicians would be of interest for further research. Practical implications – The results suggest that dialogue groups may be one way to improve the psychosocial work environment for physicians. Originality/value – There is a lack of intervention studies regarding the efficacy of management programmes directed toward physicians, concerning the effects on professional and personal wellbeing. This is the first time dialogue groups have been studied within a health care setting.

Background: Research into the efficacy of programs of leadership and group dynamics in undergraduate medical education is sparse. Aims: The aim of this study was to apply and test a pre-post evaluation design of a one-week experiential learning based course of group dynamics. Methods: Two questionnaires were sent to 160 medical students, before and after the course. The response rate was acceptable (73%). Results: While there was a small change in attitudes towards openness in their professional role and group dynamics, there was a major change in two subgroups of students to these topics. The students who were least interested in collaborative constructivist learning and those students who mainly looked for practical value were the students who changed their attitudes most towards openness in their professional role. Conclusions: It appears that those students who would be least likely to voluntarily attend such a course were the ones who learned the most. This study does not allow for any generalizations regarding the outcome of experiential learning of group dynamics, but it is an argument for the use of systematic evaluations in order to identify students who can benefit from courses aimed at improving profound knowledge.