Shakira Milton, Finlay Macrae, Jennifer G McIntosh, Sibel Saya, Pavithran Alphonse, Thivagar Yogaparan, Napin Karnchanachari, Kitty Novy, Peter Nguyen, Phyllis Lau, Jon Emery
Objectives: Australian guidelines recommend people aged 50-70 years old consider taking low-dose aspirin to reduce their risk of colorectal cancer. The aim was to design sex-specific decision aids (DAs) with clinician and consumer input, including expected frequency trees (EFTs) to communicate the risks and benefits of taking aspirin.
Methods: Semi-structured interviews were conducted with clinicians. Focus groups were conducted with consumers. The interview schedules covered ease of comprehension, design, potential effects on decision-making, and approaches to implementation of the DAs. Thematic analysis was employed; independent coding by 2 researchers was inductive. Themes were developed through consensus between authors.
Results: Sixty-four clinicians were interviewed over 6 months in 2019. Twelve consumers aged 50-70 years participated in two focus groups in February and March 2020. The clinicians agreed that the EFTs would be helpful to facilitate a discussion with patients but suggested including an additional estimate of the effects of aspirin on all-cause mortality. The consumers felt favourable about the DAs and suggested changes to the design and wording to ease comprehension.
Conclusion: DAs were designed to communicate the risks and benefits of low-dose aspirin for disease prevention. The DAs are currently being trialled in general practice to determine their impact on informed decision-making and aspirin uptake.
{"title":"Designing a decision aid for cancer prevention: a qualitative study.","authors":"Shakira Milton, Finlay Macrae, Jennifer G McIntosh, Sibel Saya, Pavithran Alphonse, Thivagar Yogaparan, Napin Karnchanachari, Kitty Novy, Peter Nguyen, Phyllis Lau, Jon Emery","doi":"10.1093/fampra/cmad042","DOIUrl":"10.1093/fampra/cmad042","url":null,"abstract":"<p><strong>Objectives: </strong>Australian guidelines recommend people aged 50-70 years old consider taking low-dose aspirin to reduce their risk of colorectal cancer. The aim was to design sex-specific decision aids (DAs) with clinician and consumer input, including expected frequency trees (EFTs) to communicate the risks and benefits of taking aspirin.</p><p><strong>Methods: </strong>Semi-structured interviews were conducted with clinicians. Focus groups were conducted with consumers. The interview schedules covered ease of comprehension, design, potential effects on decision-making, and approaches to implementation of the DAs. Thematic analysis was employed; independent coding by 2 researchers was inductive. Themes were developed through consensus between authors.</p><p><strong>Results: </strong>Sixty-four clinicians were interviewed over 6 months in 2019. Twelve consumers aged 50-70 years participated in two focus groups in February and March 2020. The clinicians agreed that the EFTs would be helpful to facilitate a discussion with patients but suggested including an additional estimate of the effects of aspirin on all-cause mortality. The consumers felt favourable about the DAs and suggested changes to the design and wording to ease comprehension.</p><p><strong>Conclusion: </strong>DAs were designed to communicate the risks and benefits of low-dose aspirin for disease prevention. The DAs are currently being trialled in general practice to determine their impact on informed decision-making and aspirin uptake.</p>","PeriodicalId":12209,"journal":{"name":"Family practice","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2024-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11167968/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9287465","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Irène Supper, Johanna Gratadour, Mathilde François, Nemat Jaafari, Rémy Boussageon
Background: Conflicting international guidelines exist on the management of sore throat by antibiotics.
Objectives: To assess with the Appraisal of Guidelines for Research and Evaluation II (AGREE) instrument the quality of guidelines for uncomplicated acute group A beta-haemolytic streptococcal (GABHS) sore-throat. To make a sensitivity analysis restricted to guidelines with a rigour of development score higher than 60% and to describe their recommendations on scores, tests, and antibiotic therapy, including their justification.
Methods: A guideline literature review of acute GABHS sore throat, published between January 2000 and December 2019 in primary care and secondary care. The PubMed database, the Canadian Medical Association Infobase on Clinical Practice Guidelines and the International Network Guidelines were used. The quality of guidelines was assessed using the AGREE II instrument. The guidelines were classified into 2 categories: high-quality guidelines had to rate >60% for the rigour of development score, the others were classified as low-quality guidelines.
Results: Significant heterogeneity between the 15 guidelines concerned the scores of the 6 assessment domains. Among them, 6 guidelines presented a score above 60% with regards to the rigor of development domain and used a systematic literature search method, citing meta-analyses of recent randomised clinical trials. Most of the 6 high-quality guidelines no longer recommended the systematic use of diagnostic scores and tests, nor antibiotic therapy to prevent acute rheumatic fever or loco-regional complications, except for high-risk patients.
Conclusion: Major discrepancies emphasise the need for only high-quality guidelines, based on adequately assessed evidence. Restricted antibiotic prescriptions to severe cases or high-risk patients would avoid antibiotic resistance.
背景关于使用抗生素治疗咽喉炎的国际指南存在冲突:使用研究与评估指南评估 II (AGREE) 工具评估无并发症急性 A 组β-溶血性链球菌(GABHS)咽喉炎指南的质量。进行敏感性分析,仅限于制定严谨性得分高于 60% 的指南,并描述其关于评分、检测和抗生素治疗的建议,包括其合理性:对 2000 年 1 月至 2019 年 12 月间发表的初级医疗和二级医疗急性 GABHS 咽喉痛的指南文献进行回顾。使用了PubMed数据库、加拿大医学会临床实践指南信息库和国际网络指南。指南质量采用 AGREE II 工具进行评估。指南被分为两类:高质量指南的制定严谨性得分必须大于60%,其他指南被归类为低质量指南:结果:15 份指南在 6 个评估领域的得分存在显著差异。其中,6 份指南在制定的严谨性方面得分超过 60%,并采用了系统的文献检索方法,引用了近期随机临床试验的荟萃分析。在这 6 份高质量指南中,除高风险患者外,大多数都不再建议系统地使用诊断评分和测试,也不再建议使用抗生素治疗来预防急性风湿热或局部区域并发症:结论:这些重大差异表明,只有基于经过充分评估的证据的高质量指南才是必要的。对严重病例或高危患者限制抗生素处方可避免抗生素耐药性。
{"title":"A critical appraisal of acute sore throat guidelines using the AGREE II instrument: a scoping review.","authors":"Irène Supper, Johanna Gratadour, Mathilde François, Nemat Jaafari, Rémy Boussageon","doi":"10.1093/fampra/cmad060","DOIUrl":"10.1093/fampra/cmad060","url":null,"abstract":"<p><strong>Background: </strong>Conflicting international guidelines exist on the management of sore throat by antibiotics.</p><p><strong>Objectives: </strong>To assess with the Appraisal of Guidelines for Research and Evaluation II (AGREE) instrument the quality of guidelines for uncomplicated acute group A beta-haemolytic streptococcal (GABHS) sore-throat. To make a sensitivity analysis restricted to guidelines with a rigour of development score higher than 60% and to describe their recommendations on scores, tests, and antibiotic therapy, including their justification.</p><p><strong>Methods: </strong>A guideline literature review of acute GABHS sore throat, published between January 2000 and December 2019 in primary care and secondary care. The PubMed database, the Canadian Medical Association Infobase on Clinical Practice Guidelines and the International Network Guidelines were used. The quality of guidelines was assessed using the AGREE II instrument. The guidelines were classified into 2 categories: high-quality guidelines had to rate >60% for the rigour of development score, the others were classified as low-quality guidelines.</p><p><strong>Results: </strong>Significant heterogeneity between the 15 guidelines concerned the scores of the 6 assessment domains. Among them, 6 guidelines presented a score above 60% with regards to the rigor of development domain and used a systematic literature search method, citing meta-analyses of recent randomised clinical trials. Most of the 6 high-quality guidelines no longer recommended the systematic use of diagnostic scores and tests, nor antibiotic therapy to prevent acute rheumatic fever or loco-regional complications, except for high-risk patients.</p><p><strong>Conclusion: </strong>Major discrepancies emphasise the need for only high-quality guidelines, based on adequately assessed evidence. Restricted antibiotic prescriptions to severe cases or high-risk patients would avoid antibiotic resistance.</p>","PeriodicalId":12209,"journal":{"name":"Family practice","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2024-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9624585","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ruibo Wang, Han Tang, Panpan Cui, Ruofei Du, Panpan Wang, Qiaozhi Sun, Hang Fu, Hongmei Lu, Xuekun Li, Tiange Zhang, Changying Chen
Background: Lymphoma has become 1 of the 10 most common cancers with increased prevalence in young- and middle-aged adults in China. This poses a tremendous burden on patients and their families and brings great challenges to maintaining the balance of family functioning in young- and middle-aged patients.
Objective: This cross-sectional study aimed to analyse the influence of resourcefulness on the family functioning of Chinese young- and middle-aged lymphoma patients.
Methods: A total of 172 Chinese young- and middle-aged patients with lymphoma were recruited from the oncology departments of two tertiary hospitals in Zhengzhou, Henan, China. They were invited to complete a survey that included a demographic questionnaire, the Resourcefulness Scale and the Chinese Version Family Adaptability and Cohesion Scale II. Multiple linear regression was used to analyse the related factors for family functioning.
Results: The multiple regression analysis revealed that the main influencing factors of family cohesion were resourcefulness (β = 0.338, 95% CI (0.072, 0.173)), spouse caregiver (β = 0.376, 95% CI (1.938, 10.395)), and cancer stage (β = -0.274, 95% CI (-3.219, -1.047)). Resourcefulness (β = 0.438, 95% CI (0.096, 0.181)), spouse caregiver (β = 0.340, 95% CI (1.348, 8.363)), and family per capita monthly income (β = 0.157, 95% CI (0.066, 2.243)) were the influencing factors of family adaptability.
Conclusions: Healthcare professionals and family scholars should value young- and middle-aged lymphoma patients' family functioning throughout the cancer treatment process, and family interventions should be designed by healthcare providers based on patients' resourcefulness. Moreover, healthcare providers need to pay attention to the risk factors of patients' family cohesion and adaptability, such as low family per capita monthly income, and consider employing corresponding measures to help them.
背景:淋巴瘤已成为中国十大常见癌症之一,在中青年中的发病率呈上升趋势。这给患者及其家庭带来了巨大的负担,也给维持中青年患者家庭功能的平衡带来了巨大的挑战:本横断面研究旨在分析足智多谋对中国中青年淋巴瘤患者家庭功能的影响:方法:从河南郑州两家三甲医院的肿瘤科共招募了172名中国中青年淋巴瘤患者。他们受邀填写了一份调查问卷,其中包括一份人口统计学问卷、足智多谋量表和中文版家庭适应性与凝聚力量表 II。采用多元线性回归分析家庭功能的相关因素:多元回归分析表明,家庭凝聚力的主要影响因素是资源丰富度(β = 0.338,95% CI (0.072,0.173))、配偶照顾者(β = 0.376,95% CI (1.938,10.395))和癌症分期(β = -0.274,95% CI (-3.219,-1.047))。资源丰富度(β = 0.438,95% CI (0.096,0.181))、配偶照顾者(β = 0.340,95% CI (1.348,8.363))和家庭人均月收入(β = 0.157,95% CI (0.066,2.243))是家庭适应性的影响因素:医护人员和家庭学者应重视中青年淋巴瘤患者在整个癌症治疗过程中的家庭功能,医护人员应根据患者的机智设计家庭干预措施。此外,医护人员需要关注影响患者家庭凝聚力和适应力的风险因素,如家庭人均月收入较低等,并考虑采取相应的措施帮助他们。
{"title":"The influence of resourcefulness on the family functioning of young- and middle-aged lymphoma patients in China: a cross-sectional study.","authors":"Ruibo Wang, Han Tang, Panpan Cui, Ruofei Du, Panpan Wang, Qiaozhi Sun, Hang Fu, Hongmei Lu, Xuekun Li, Tiange Zhang, Changying Chen","doi":"10.1093/fampra/cmad093","DOIUrl":"10.1093/fampra/cmad093","url":null,"abstract":"<p><strong>Background: </strong>Lymphoma has become 1 of the 10 most common cancers with increased prevalence in young- and middle-aged adults in China. This poses a tremendous burden on patients and their families and brings great challenges to maintaining the balance of family functioning in young- and middle-aged patients.</p><p><strong>Objective: </strong>This cross-sectional study aimed to analyse the influence of resourcefulness on the family functioning of Chinese young- and middle-aged lymphoma patients.</p><p><strong>Methods: </strong>A total of 172 Chinese young- and middle-aged patients with lymphoma were recruited from the oncology departments of two tertiary hospitals in Zhengzhou, Henan, China. They were invited to complete a survey that included a demographic questionnaire, the Resourcefulness Scale and the Chinese Version Family Adaptability and Cohesion Scale II. Multiple linear regression was used to analyse the related factors for family functioning.</p><p><strong>Results: </strong>The multiple regression analysis revealed that the main influencing factors of family cohesion were resourcefulness (β = 0.338, 95% CI (0.072, 0.173)), spouse caregiver (β = 0.376, 95% CI (1.938, 10.395)), and cancer stage (β = -0.274, 95% CI (-3.219, -1.047)). Resourcefulness (β = 0.438, 95% CI (0.096, 0.181)), spouse caregiver (β = 0.340, 95% CI (1.348, 8.363)), and family per capita monthly income (β = 0.157, 95% CI (0.066, 2.243)) were the influencing factors of family adaptability.</p><p><strong>Conclusions: </strong>Healthcare professionals and family scholars should value young- and middle-aged lymphoma patients' family functioning throughout the cancer treatment process, and family interventions should be designed by healthcare providers based on patients' resourcefulness. Moreover, healthcare providers need to pay attention to the risk factors of patients' family cohesion and adaptability, such as low family per capita monthly income, and consider employing corresponding measures to help them.</p>","PeriodicalId":12209,"journal":{"name":"Family practice","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2024-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139466264","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Integrated care has been proven to be effective among stroke survivors. However, in China, these services mainly focus on connecting the healthcare system (acute, primary medical, and skilled) at the individual level. Closer health and social care integration is a new concept.
Objective: This study aimed to compare health-related outcomes 6 months after the implementation of the 2 integrated care models.
Methods: It was a 6-month follow-up of an open, prospectively study comparing the outcomes of a model of integrated health and social care (IHSC) versus a usual integrated healthcare (IHC) model. Outcomes were measured by Short-Form Health Survey-36 (SF-36), Modified Barthel Index (MBI), and Caregiver Strain Index (CSI) at 3 and 6 months, respectively.
Results: There were no statistically significant differences in MBI scores between patients in the 2 models either after 3 months or at the end of intervention. The same trend was not seen in Physical Components Summary, an integral component of SF-36. Patients in IHSC model scored statistically significant higher points in Mental Components Summary, another integral part of SF-36 than patients in IHC model after 6 months. Average scores of CSI were statistically significant lower for IHSC model than for IHC model after 6 months.
Conclusion: The findings suggest the need to improve the scales of integration and recognize the vital role played by social care services when designing or improving an integrated care for older people with stroke.
{"title":"Health-related outcomes 6 months after integrated care of older people with stroke in 2 different primary care settings.","authors":"Xuehuan Feng, Aiwen Deng, Jianhao Chen, Ribo Xiong","doi":"10.1093/fampra/cmad021","DOIUrl":"10.1093/fampra/cmad021","url":null,"abstract":"<p><strong>Background: </strong>Integrated care has been proven to be effective among stroke survivors. However, in China, these services mainly focus on connecting the healthcare system (acute, primary medical, and skilled) at the individual level. Closer health and social care integration is a new concept.</p><p><strong>Objective: </strong>This study aimed to compare health-related outcomes 6 months after the implementation of the 2 integrated care models.</p><p><strong>Methods: </strong>It was a 6-month follow-up of an open, prospectively study comparing the outcomes of a model of integrated health and social care (IHSC) versus a usual integrated healthcare (IHC) model. Outcomes were measured by Short-Form Health Survey-36 (SF-36), Modified Barthel Index (MBI), and Caregiver Strain Index (CSI) at 3 and 6 months, respectively.</p><p><strong>Results: </strong>There were no statistically significant differences in MBI scores between patients in the 2 models either after 3 months or at the end of intervention. The same trend was not seen in Physical Components Summary, an integral component of SF-36. Patients in IHSC model scored statistically significant higher points in Mental Components Summary, another integral part of SF-36 than patients in IHC model after 6 months. Average scores of CSI were statistically significant lower for IHSC model than for IHC model after 6 months.</p><p><strong>Conclusion: </strong>The findings suggest the need to improve the scales of integration and recognize the vital role played by social care services when designing or improving an integrated care for older people with stroke.</p>","PeriodicalId":12209,"journal":{"name":"Family practice","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2024-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9369489","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Loneliness is a global issue, and primary care physicians play an important role in assessing and intervening with loneliness. This study aimed to examine the association between having a usual source of care (USC) or a good quality of primary care, and loneliness.
Methods: This cross-sectional study was conducted in Japan in 2022. A total of 6,000 residents were randomly sampled from the general population, aged 20-74 years. The outcome was the total score of the University of California, Los Angeles (UCLA) 3-item loneliness scale. The exposure included USC and the Person-Centered Primary Care Measure (PCPCM), which assesses the quality of primary care. We conducted a linear regression analysis to adjust for age, sex, educational status, annual household income, self-rated health, living status (whether alone or not), and the existence of physical health problems.
Results: Of the 6,000 residents, 1,277 responded to the survey. The median score of the UCLA 3-item loneliness scale was 6.0 and the mean total score of the PCPCM was 2.62. Of the 1,277 individuals, 713 (55.8%) had USC. Having USC was significantly associated with lower scores on the UCLA 3-item loneliness scale; the coefficient was -0.34 (95% confidence interval (CI): -0.57 to -0.12). Also, the total PCPCM score was significantly associated with lower loneliness scores; the coefficient was -0.56 (P < 0.001, 95% CI: -0.78 to -0.35).
Conclusions: Having USC and a better quality primary care were associated with a lower loneliness score. The quality of primary care could be a factor to mitigate patient loneliness.
{"title":"Usual source and better quality of primary care are associated with lower loneliness scores: a cross-sectional study.","authors":"Makoto Kaneko, Satoru Shinoda, Izumi Nakayama, Juan Xu, Susumu Yagome, Atsushi Goto","doi":"10.1093/fampra/cmad049","DOIUrl":"10.1093/fampra/cmad049","url":null,"abstract":"<p><strong>Background: </strong>Loneliness is a global issue, and primary care physicians play an important role in assessing and intervening with loneliness. This study aimed to examine the association between having a usual source of care (USC) or a good quality of primary care, and loneliness.</p><p><strong>Methods: </strong>This cross-sectional study was conducted in Japan in 2022. A total of 6,000 residents were randomly sampled from the general population, aged 20-74 years. The outcome was the total score of the University of California, Los Angeles (UCLA) 3-item loneliness scale. The exposure included USC and the Person-Centered Primary Care Measure (PCPCM), which assesses the quality of primary care. We conducted a linear regression analysis to adjust for age, sex, educational status, annual household income, self-rated health, living status (whether alone or not), and the existence of physical health problems.</p><p><strong>Results: </strong>Of the 6,000 residents, 1,277 responded to the survey. The median score of the UCLA 3-item loneliness scale was 6.0 and the mean total score of the PCPCM was 2.62. Of the 1,277 individuals, 713 (55.8%) had USC. Having USC was significantly associated with lower scores on the UCLA 3-item loneliness scale; the coefficient was -0.34 (95% confidence interval (CI): -0.57 to -0.12). Also, the total PCPCM score was significantly associated with lower loneliness scores; the coefficient was -0.56 (P < 0.001, 95% CI: -0.78 to -0.35).</p><p><strong>Conclusions: </strong>Having USC and a better quality primary care were associated with a lower loneliness score. The quality of primary care could be a factor to mitigate patient loneliness.</p>","PeriodicalId":12209,"journal":{"name":"Family practice","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2024-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11167986/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9360964","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Elif Sedanur Utlu, Mustafa Bayraktar, Bahadır Utlu
Objective: As digital display devices become more and more indispensable, associated health problems have started to increase. We aimed to investigate the frequency and relationship of digital display device usage behaviours and dry eye syndrome (DES) in medical students.
Methods: An observational, cross-sectional study was conducted on medical school students who voluntarily participated in our study online, about the duration and variety of their digital screen use, usage patterns, and protective measures, together with the Ocular Surface Disease Index (OSDI) questionnaire. Where necessary, the Schirmer-I, tear break-up time, and fluorescein staining tests were carried out.
Results: Of the 255 participants, 75.3% (n = 192) were female, 63.1% (n = 161) had no refractive vision defects, and 45.9% used smartphones for more than 5 h a day. According to the OSDI scores for DES screening, only 36.1% of the participants were normal, 17.3% had mild DES, 20.4% had moderate DES, and 26.3% had severe DES. A positive correlation was found between digital display usage time in hours per day and a high OSDI score. As the distance between the eye and the screen decreased, the DES score increased, which is significant for computer, e-book, and tablet use (P < 0.005). The DES rate of the 25 participants who underwent further evaluation was 40% for the tear break-up time test and 52% for the fluorescein staining test.
Conclusion: The high prevalence of DES due to digital screen use among medical school students highlights the importance of DES screening as a preventive measure in family medicine.
目的:随着数字显示设备变得越来越不可或缺,相关的健康问题也开始增多。我们旨在调查医学生使用数码显示设备的行为与干眼症(DES)的频率和关系:方法:我们对自愿在线参与研究的医学院学生进行了一项横断面观察研究,了解他们使用数字屏幕的时间和种类、使用模式和保护措施,并进行了眼表疾病指数(OSDI)问卷调查。必要时,还进行了施尔默-I、泪液破裂时间和荧光素染色测试:在255名参与者中,75.3%(n = 192)为女性,63.1%(n = 161)无屈光性视力缺陷,45.9%每天使用智能手机超过5小时。根据DES筛查的OSDI评分,只有36.1%的参与者视力正常,17.3%有轻度DES,20.4%有中度DES,26.3%有重度DES。研究发现,每天使用数字显示屏的时间(小时)与 OSDI 高分之间存在正相关。随着眼睛与屏幕之间距离的减少,DES 分数也随之增加,这对电脑、电子书和平板电脑的使用有显著影响(P < 0.005)。在接受进一步评估的 25 名参与者中,泪液破裂时间测试的 DES 发生率为 40%,荧光素染色测试的 DES 发生率为 52%:结论:医学院学生因使用数字屏幕而导致DES的高发病率凸显了DES筛查作为家庭医学预防措施的重要性。
{"title":"Dry eye in primary care: the relationship between digital display device usage and dry eye syndrome (DES) in medical students.","authors":"Elif Sedanur Utlu, Mustafa Bayraktar, Bahadır Utlu","doi":"10.1093/fampra/cmac155","DOIUrl":"10.1093/fampra/cmac155","url":null,"abstract":"<p><strong>Objective: </strong>As digital display devices become more and more indispensable, associated health problems have started to increase. We aimed to investigate the frequency and relationship of digital display device usage behaviours and dry eye syndrome (DES) in medical students.</p><p><strong>Methods: </strong>An observational, cross-sectional study was conducted on medical school students who voluntarily participated in our study online, about the duration and variety of their digital screen use, usage patterns, and protective measures, together with the Ocular Surface Disease Index (OSDI) questionnaire. Where necessary, the Schirmer-I, tear break-up time, and fluorescein staining tests were carried out.</p><p><strong>Results: </strong>Of the 255 participants, 75.3% (n = 192) were female, 63.1% (n = 161) had no refractive vision defects, and 45.9% used smartphones for more than 5 h a day. According to the OSDI scores for DES screening, only 36.1% of the participants were normal, 17.3% had mild DES, 20.4% had moderate DES, and 26.3% had severe DES. A positive correlation was found between digital display usage time in hours per day and a high OSDI score. As the distance between the eye and the screen decreased, the DES score increased, which is significant for computer, e-book, and tablet use (P < 0.005). The DES rate of the 25 participants who underwent further evaluation was 40% for the tear break-up time test and 52% for the fluorescein staining test.</p><p><strong>Conclusion: </strong>The high prevalence of DES due to digital screen use among medical school students highlights the importance of DES screening as a preventive measure in family medicine.</p>","PeriodicalId":12209,"journal":{"name":"Family practice","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9103820","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Esmee M Hogervorst, Ilse N Ganzevoort, Marjolein Y Berger, Gea A Holtman
Background: Irritable bowel syndrome (IBS) is the most common functional gastrointestinal disorder in children. However, in primary care, it is still unknown whether there are differences in the prognosis of children with IBS compared to other diagnostic subgroups. Therefore, our aim was to describe the course of symptoms and health-related quality of life (HRQoL) for children with chronic gastrointestinal symptoms who either do or do not fulfil the Rome criteria for IBS in primary care. Second, we compared the diagnosis of the general practitioner (GP) with the Rome criteria.
Methods: We conducted a prospective cohort study with 1-year follow-up, including children aged 4-18 years with chronic diarrhoea and/or chronic abdominal pain in primary care. During follow-up, the Rome III questionnaire, Child Health Questionnaire, and symptom questionnaires were completed.
Results: A total of 60/104 children (57.7%) fulfilled the Rome criteria for IBS at baseline. Compared to children without IBS, children with IBS were more commonly referred to secondary care, used more laxatives, and more often developed chronic diarrhoea and low physical HRQoL during 1 year. The diagnosis "IBS" from the GP matched the Rome criteria for only 10% of children, as most were diagnosed with "Constipation."
Conclusions: There seems to be a difference in the treatment and prognosis of symptoms and HRQoL between children with and without IBS in primary care. This suggests that it is relevant to differentiate between these groups. The evaluation and use of feasible criteria to define IBS in different healthcare settings remains subject for further studies.
{"title":"Irritable bowel syndrome in children with chronic gastrointestinal symptoms in primary care.","authors":"Esmee M Hogervorst, Ilse N Ganzevoort, Marjolein Y Berger, Gea A Holtman","doi":"10.1093/fampra/cmad070","DOIUrl":"10.1093/fampra/cmad070","url":null,"abstract":"<p><strong>Background: </strong>Irritable bowel syndrome (IBS) is the most common functional gastrointestinal disorder in children. However, in primary care, it is still unknown whether there are differences in the prognosis of children with IBS compared to other diagnostic subgroups. Therefore, our aim was to describe the course of symptoms and health-related quality of life (HRQoL) for children with chronic gastrointestinal symptoms who either do or do not fulfil the Rome criteria for IBS in primary care. Second, we compared the diagnosis of the general practitioner (GP) with the Rome criteria.</p><p><strong>Methods: </strong>We conducted a prospective cohort study with 1-year follow-up, including children aged 4-18 years with chronic diarrhoea and/or chronic abdominal pain in primary care. During follow-up, the Rome III questionnaire, Child Health Questionnaire, and symptom questionnaires were completed.</p><p><strong>Results: </strong>A total of 60/104 children (57.7%) fulfilled the Rome criteria for IBS at baseline. Compared to children without IBS, children with IBS were more commonly referred to secondary care, used more laxatives, and more often developed chronic diarrhoea and low physical HRQoL during 1 year. The diagnosis \"IBS\" from the GP matched the Rome criteria for only 10% of children, as most were diagnosed with \"Constipation.\"</p><p><strong>Conclusions: </strong>There seems to be a difference in the treatment and prognosis of symptoms and HRQoL between children with and without IBS in primary care. This suggests that it is relevant to differentiate between these groups. The evaluation and use of feasible criteria to define IBS in different healthcare settings remains subject for further studies.</p>","PeriodicalId":12209,"journal":{"name":"Family practice","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2024-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11167984/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9724972","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Word cloud analysis of Family Practice. Does the journal fulfil its editorial policy?","authors":"Robert L Atenstaedt","doi":"10.1093/fampra/cmad020","DOIUrl":"10.1093/fampra/cmad020","url":null,"abstract":"","PeriodicalId":12209,"journal":{"name":"Family practice","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2024-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10801029","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ian Morgan, Chris Dowrick, Sara Macdonald, Scott Wilkes, Stuart Watson
Background: Recent evidence suggests that the first consultation with a general practitioner (GP) for symptoms of depression may be more than just a vehicle for assessment and management planning (as current guidelines imply).
Objectives: To identify what patients find helpful, or otherwise, in their first consultation for low mood with a GP.
Methods: A cross-sectional questionnaire and interview study of patients with low mood who had recently consulted their GP, in the North of England. Patients were asked to complete a questionnaire regarding the consultation, and a Patient Health Questionnaire-9 (PHQ-9), within 2 weeks. They were also invited to take part in a face-face interview with a researcher. Both sources of data were subjected to qualitative thematic analysis.
Results: Thirty-seven questionnaires were returned; 5 interviews took place. The majority of participants felt better after consulting a GP for the first time for low mood. The factors most commonly cited as helpful were "being listened to" and "understanding or empathy from the GP." Others included "admitting the problem," "being reassured of normality," and "being provided with optimism or hope for change." The most commonly reported difficulty was the patients' struggle to express themselves. Patients often felt that GP follow-up was inadequate.
Conclusions: These results suggest that the therapeutic benefit of the GP consultation is under-recognized in current guidelines. The results of our study will provide crucial information as to how such consultations can be tailored to improve patient satisfaction.
{"title":"The first consultation for low mood in general practice: what do patients find helpful?","authors":"Ian Morgan, Chris Dowrick, Sara Macdonald, Scott Wilkes, Stuart Watson","doi":"10.1093/fampra/cmad016","DOIUrl":"10.1093/fampra/cmad016","url":null,"abstract":"<p><strong>Background: </strong>Recent evidence suggests that the first consultation with a general practitioner (GP) for symptoms of depression may be more than just a vehicle for assessment and management planning (as current guidelines imply).</p><p><strong>Objectives: </strong>To identify what patients find helpful, or otherwise, in their first consultation for low mood with a GP.</p><p><strong>Methods: </strong>A cross-sectional questionnaire and interview study of patients with low mood who had recently consulted their GP, in the North of England. Patients were asked to complete a questionnaire regarding the consultation, and a Patient Health Questionnaire-9 (PHQ-9), within 2 weeks. They were also invited to take part in a face-face interview with a researcher. Both sources of data were subjected to qualitative thematic analysis.</p><p><strong>Results: </strong>Thirty-seven questionnaires were returned; 5 interviews took place. The majority of participants felt better after consulting a GP for the first time for low mood. The factors most commonly cited as helpful were \"being listened to\" and \"understanding or empathy from the GP.\" Others included \"admitting the problem,\" \"being reassured of normality,\" and \"being provided with optimism or hope for change.\" The most commonly reported difficulty was the patients' struggle to express themselves. Patients often felt that GP follow-up was inadequate.</p><p><strong>Conclusions: </strong>These results suggest that the therapeutic benefit of the GP consultation is under-recognized in current guidelines. The results of our study will provide crucial information as to how such consultations can be tailored to improve patient satisfaction.</p>","PeriodicalId":12209,"journal":{"name":"Family practice","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2024-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10769618","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Anaemia and vitamin D insufficiency (VDI) are among the most common nutritional problems. Anaemia screening is routinely performed; however, screening for VDI is not usually recommended.
Objectives: To study the association between anaemia and VDI and identify the risk factors for VDI.
Methods: We conducted a cross-sectional study of 120 infants aged 6-12 months attending a well-child clinic at Songklanagarind Hospital between December 2020 and November 2021. Sociodemographic data and 24-h food records were also collected. Blood samples were obtained for complete blood count and 25-hydroxyvitamin D [25(OH)D] levels. Logistic regression analysis was used to determine risk factors for VDI.
Results: The mean 25(OH)D level was 22.2 ± 8.9 ng/mL in anaemic infants and 27.2 ± 9.6 ng/mL in non-anaemic infants (P value 0.01). The median (IQR) Hb level was 11.1 g/dL (10.3, 11.4) in the VDI group and 11.4 g/dL (11, 12.1) in the non-VDI group (P value 0.002). The proportion of breastfed infants was higher in infants with anaemia (80%) (P < 0.001) and VDI (85.3%) (P < 0.001). Sunlight exposure <15 min/day (odds ratio [OR] 3.84; 95% confidence interval [CI]: 1.23-12.00; P = 0.020) was a risk factor, and vitamin D intake (OR 0.37; 95% CI: 0.20-0.74; P = 0.004) was a protective factor for VDI.
Conclusion: Infants with anaemia, short duration of sunlight exposure, breastfeeding, low vitamin D intake, and low iron intake were more likely to be vitamin D insufficient. However, after adjustment in the multivariate analyses, only sunlight exposure and vitamin D intake were significantly associated with vitamin D insufficiency.
{"title":"Association between anaemia and vitamin D insufficiency among 6- to 12-month-old infants: implications for clinical practice.","authors":"Sasivara Boonrusmee, Staporn Kasemsripitak, Thitiporn Navykarn, Somchit Jaruratanasirikul","doi":"10.1093/fampra/cmad033","DOIUrl":"10.1093/fampra/cmad033","url":null,"abstract":"<p><strong>Background: </strong>Anaemia and vitamin D insufficiency (VDI) are among the most common nutritional problems. Anaemia screening is routinely performed; however, screening for VDI is not usually recommended.</p><p><strong>Objectives: </strong>To study the association between anaemia and VDI and identify the risk factors for VDI.</p><p><strong>Methods: </strong>We conducted a cross-sectional study of 120 infants aged 6-12 months attending a well-child clinic at Songklanagarind Hospital between December 2020 and November 2021. Sociodemographic data and 24-h food records were also collected. Blood samples were obtained for complete blood count and 25-hydroxyvitamin D [25(OH)D] levels. Logistic regression analysis was used to determine risk factors for VDI.</p><p><strong>Results: </strong>The mean 25(OH)D level was 22.2 ± 8.9 ng/mL in anaemic infants and 27.2 ± 9.6 ng/mL in non-anaemic infants (P value 0.01). The median (IQR) Hb level was 11.1 g/dL (10.3, 11.4) in the VDI group and 11.4 g/dL (11, 12.1) in the non-VDI group (P value 0.002). The proportion of breastfed infants was higher in infants with anaemia (80%) (P < 0.001) and VDI (85.3%) (P < 0.001). Sunlight exposure <15 min/day (odds ratio [OR] 3.84; 95% confidence interval [CI]: 1.23-12.00; P = 0.020) was a risk factor, and vitamin D intake (OR 0.37; 95% CI: 0.20-0.74; P = 0.004) was a protective factor for VDI.</p><p><strong>Conclusion: </strong>Infants with anaemia, short duration of sunlight exposure, breastfeeding, low vitamin D intake, and low iron intake were more likely to be vitamin D insufficient. However, after adjustment in the multivariate analyses, only sunlight exposure and vitamin D intake were significantly associated with vitamin D insufficiency.</p>","PeriodicalId":12209,"journal":{"name":"Family practice","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2024-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9247852","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}