Scandinavian journal of primary health care
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Scand J Prim Health Care · Mar 2020
Randomized Controlled Trial Multicenter Study Comparative StudyLong-term effects on function, health-related quality of life and work ability after structured physiotherapy including a workplace intervention. A secondary analysis of a randomised controlled trial (WorkUp) in primary care for patients with neck and/or back pain.
Objective: To study the long-term effects of a workplace intervention in addition to structured physiotherapy regarding self-reported measures in patients with acute/subacute neck and/or back pain. Design: WorkUp - a cluster-randomised controlled trial in 32 primary care centers in Sweden, from January 2013 through December 2014 (ClinicalTrials.gov ID: NCT02609750). Intervention: Structured physiotherapy with the workplace dialogue 'Convergence Dialogue Meeting' (CDM), conducted by the treating physiotherapist as an add-on. ⋯ Key pointsIn earlier analysis of the primary outcome (work ability measured by absenteeism) in this trial, a positive effect was found when the workplace intervention 'Convergence Dialogue Meeting' (CDM) was added to structured physiotherapy for patients with neck or back pain. By contrast, in this new analysis of secondary outcomes (self-reported function, health and perceived work ability), there was no added effect of CDM above structured physiotherapy alone, although patients in both the intervention and reference group improved over time. The addition of CDM to physiotherapy is therefore justified by its specific effect on behavior (work absence) rather than any effect on clinical outcomes.
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Scand J Prim Health Care · Mar 2020
A study of guidelines for respiratory tract infections and their references from Swedish GPs: a qualitative analysis.
Background: National guidelines are important instruments in reducing inappropriate antibiotic prescriptions. Low adherence to guidelines is an acknowledged problem that needs to be addressed. Method: We evaluated established characteristics for guidelines in the guidelines for lower respiratory tract infection, acute otitis media and pharyngotonsillitis in primary care. ⋯ Results: We found important between-guidelines differences, which we believe affects adherence. The GPs reported persistent preconceptions about diagnosis and treatment, which we believe reduces their adherence to the guidelines. Conclusion: To increase adherence, it is important to consider doctors' preconceptions when creating new guidelines.
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Scand J Prim Health Care · Mar 2020
Comparative Study Observational StudyImpact of changes in physical activity or BMI on risk of heart failure in women - the prospective population study of women in Gothenburg.
Objective: To longitudinally evaluate the impact of change in physical activity or change in body mass index (BMI) over time on the risk of developing heart failure (HF) in women without a previous diagnosis of HF. Design and setting: Longitudinal, observational, prospective study of women in Gothenburg, Sweden. Data on BMI and level of physical activity were collected from examinations 1968-1992 and hospital diagnoses and mortality data were ascertained from 1980 to 2012. ⋯ The risk of developing HF may be reduced by increasing the level of activity in sedentary middle-aged women. For younger women, avoiding obesity is most important to reduce the risk of later HF. Primary care has a key role in guiding women towards the most effective lifestyle changes to prevent development of HF.
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Scand J Prim Health Care · Mar 2020
Comparative StudyPsychosocial issues need more attention in COPD self-management education.
Objective: To find out how regularly the contents of patient education regarded as essential for COPD patients' self-management are provided by healthcare professionals in specialised healthcare (SHC) and primary healthcare (PHC) in Finland. Design: A cross-sectional study based on an e-questionnaire with 42 items on the content of self-management education of COPD patients. Setting: The study sample included all public SHC units with pulmonary outpatient clinics (n = 29) and nine out of 160 health centres in Finland. ⋯ KEY POINTSIssues vital for coping with chronic obstructive pulmonary disease (COPD), such as psychological well-being, stress and fatigue, are irregularly included in self-management education both in primary and specialised healthcare. Patient education provided by asthma/COPD nurses is more regular than patient education provided by other nurses. The distribution of work between doctors and nurses should be considered to ensure that there is no gap in COPD patients' education.
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Scand J Prim Health Care · Mar 2020
Comparative StudyWeak smoking cessation awareness in primary health care before surgery: a real-world, retrospective cohort study.
Objective: Tobacco smoking is a well-established risk factor for postoperative complications. Research on preoperative smoking cessation in primary health care is scarce. Design: This was a retrospective cohort study. ⋯ Research on preoperative smoking cessation in primary health care is scarce. We found weak smoking awareness and weak smoking cessation intervention numbers among both primary and specialized health care doctors. Our results indicate an urgent need for an efficient preoperative smoking cessation model involving both primary and specialized health care.