Scandinavian Journal of Primary Health Care最新文献

Objective: Early identification of persons at risk for sickness absence offers an opportunity to initiate preventive measures. The aim of this study was to examine whether perceived work-related stress, measured by The Work Stress Questionnaire (WSQ), predicted registered sickness absence up to 10 years later in a general working population of women.

Design: A survey-linkage study based on the 2004-2005 wave of the Swedish 'Population Study of Women in Gothenburg (PSWG)' and 10-year follow-up in the official MiDAS sickness absence register.

Subjects: A population-based cohort of women aged 38 and 50 in 2004/2005 were invited (participation rate 59%). Participants registered as employed or self-employed were included (n = 396).

Methods: Predictors were indicators of work-related stress (WSQ). Outcomes were number of sickness absence episodes in total (examined using negative binomial regression) and sickness absence during separate time periods of follow-up (examined in logistic regression models).

Results: High perceived stress due to poor organizational climate predicted sickness absence episodes (adjusted Incidence Risk Rate (IRR_adj): 1.99 [95% CI 1.19-3.34]). The combination of stress due to both poor organizational climate and high work commitment gave an IRR_adj of 2.32 [95% CI 1.26-4.26]. Examination of specific two-year time period indicated that the results were rather consistent for up to 8 years of follow-up. Additionally, low influence at work was associated sickness absence in some of the time periods examined.

Conclusion: The findings indicate that perceived stress due to organizational factors at work, alone and in combination with the individual factor high work commitment, are long-lasting risk factors for sickness absence. Aligning with previous studies, the findings further suggest that WSQ might successfully aid identifying women with such elevated risk and adds that this is even true in a general population context. These findings merit further investigation in larger samples.

Background: Atrial fibrillation (AF) is the most common arrhythmia worldwide and the majority of AF patients are treated in primary care. In order to minimize hospitalizations and visits to emergency departments, nurse-led care was introduced in secondary care and primary health care (PHC). However, even though nurse-led care was initiated in PHC almost a decade ago, and ESC guidelines recommended patient-centered integrated care including PHC for patients, there seems to be a lack of scientific evidence regarding the effects.

Aim: To review the scientific literature regarding the effects of nurse-led AF clinics in PHC.

Methods: A systematic review of scientific literature in Medline/Cinahl. Two reviewers independently assessed the retrieved articles.

Results: Only one study was found that investigated the effectiveness of nurse-led structured AF management in PHC. The results from the study indicated positive effects; 45% reduction in all-cause mortality compared to usual care and significantly lower number of all-cause hospitalizations with nurse-led care. Several studies were found analyzing the effects of nurse-led AF-care in secondary care facilities, but only one in PHC setting. The results mainly showed that nurse-led care in AF-clinics in secondary care reduces mortality, hospitalizations and visits in emergency departments.

Conclusions: Even though only one study focused on PHC, the review indicated positive effects of nurse-led care for AF patients. However, the results are only based on studies performed in inpatient care. Hence, no firm conclusion can be drawn about nurse-led AF-clinics in PHC, and more research is clearly needed in this area.

Background: Pregnant women often navigate extensive information from healthcare professionals, social networks and online sources, which can increase anxiety. Understanding their concerns and preferred information sources is crucial for effective antenatal care.

Objective: To explore worries and information-seeking behaviour among pregnant women in Norway using social media.

Methods: An anonymous, web-based survey was conducted among 1402 pregnant women in Norway from January to March 2022, distributed via Facebook and Instagram. The survey covered 11 pregnancy worries, eight postpartum worries, information sources and thoughts regarding childbirth.

Results: Nearly, all participants had concerns, mainly about foetal anomalies (99%, n = 1381), miscarriage (95%, n = 1332) and childbirth (85%, n = 1195). Postpartum worries included physical changes (90%, n = 1266), breastfeeding (85%, n = 1187) and financial situation (74%, n = 1030). Major worries were more common among first-time mothers and women with financial insecurity. Most women sought information from quality-assured public health websites (74%, n = 1042) and healthcare personnel (56%, n = 775), with only 2% (n = 32) turning to influencers or bloggers.

Conclusions: Pregnancy and postpartum worries are widespread among pregnant women using social media, especially among first-time mothers and those with financial insecurity. Most pregnant women prefer quality-assured websites and healthcare personnel for information. Antenatal care could benefit from offering more tailored information and follow-up, particularly for first-time mothers and financially insecure women.

Background: In 2019, around 4.95 million global deaths were linked to bacterial antimicrobial resistance (AMR). Managing urinary tract infections (UTIs) in nursing homes involves prevention, diagnosis, and treatment. This is often complex and cause excessive antibiotic use, increasing AMR. Infection prevention and antimicrobial stewardship (AMS) are complementary strategies for reducing AMR. Studies show that nursing home staff can safely reduce antibiotic prescriptions for UTIs using these strategies and that cross-sectoral collaboration with general practice is important in UTI management. However, the impact of combining infection prevention with AMS and general practice is unknown.

Objective: To explore the perceived impact of a new cross-sectorial intervention combining prevention and AMS on UTI management in nursing homes.

Methods: The intervention included a 3-h seminar for general practice and nursing home staff, and a reflection sheet to assess residents. We held 9 seminars in the Capital Region of Denmark in 2022 and conducted 15 semi-structured online and phone interviews with participants.

Results: Our findings indicate that the intervention clarified workflows, encouraged nursing staff to adhere to agreements, and increased trust and respect between nursing homes and general practice. A reflection sheet was essential in linking planned changes to actual implementation. The sheet helped restructure UTI management, leading to perceived improved patient assessment and fewer UTI-related inquiries to general practice.

Conclusion: Our findings suggest that the intervention had a positive impact on experienced care quality, workload, and cross-sector collaboration. However, physical attendance at the seminar limits the large-scale implementation of the intervention.

Telemedicine in primary health care is expected to address many of the issues currently challenging service delivery. However, the impact and effect will depend on who will use the new technology.

Objective: The objective of the study was to investigate differences between users and non-users of telemedicine integrated into traditional office-based primary health care.

Methods: Quantitative registry-based population study in two regions in the southeast part of Sweden (n = 73,486), comparing users with non-users of telemedicine across the variables sex, age, socioeconomic status (SES), morbidity and health care seeking behaviour (HSB). Two study periods of six months were used (September 2019-February 2020 for Region Östergötland, and September 2021-February 2022 for Region Kalmar County) to collect user data. A reference period of 36 months (September 2016-August 2019) was used, to collect data on HSB.

Results: Users were more often women under the age of 60 and had higher morbidity (measured as resource utilisation) than non-users (p < .001). In contrast, no statistically significant differences were seen between the two groups regarding SES, measured as Care Need Index (CNI). Regarding HSB, a proxy measure (health record entries) showed more entries for users than non-users.

Conclusions: Our findings suggest that users are more likely to be women and below the age of 60. Likewise, users also tend to have a greater need for health care services compared to non-users, and they seek health care more often compared to non-users. No differences regarding SES were found.

Background and aims: Alcohol use disorder (AUD) and hazardous alcohol use are common but underdiagnosed in primary health care (PHC). This study aimed to explore general practitioners' (GPs') experiences and perceptions of using B-Phosphatidylethanol (PEth), a specific quantitative biomarker for alcohol use, in their clinical work with patient consultations and treatment follow-up in Swedish PHC.

Design, participants, and setting: Individual interviews were conducted with GPs and resident GPs (n 20) in Swedish PHC and analysed using qualitative content analysis.

Findings: The overarching theme PEth testing in primary health care-a game changer and a challenge illustrated that PEth testing has improved the prerequisites for the GP-patient interaction while making it more complex. Four categories underpinned this theme: Comprehending the context, describing the challenges in the GP-patient interaction when hazardous alcohol use or AUD was suspected; Getting the pieces in place, illustrating the struggle of integrating PEth testing into clinical practice and how it diminished the role of alcohol history taking; The challenges and facilitators of the conversation, comprising both the difficulties in informing about PEth testing and the positive impact on the interaction, and Considerations based on the PEth test results, emphasising the consequences of elevated PEth test results and their influence on physicians' motivation to using PEth.

Conclusions: PEth is an important tool in the identification of hazardous alcohol use. Emerging ethical dilemmas regarding patient information on PEth testing and management of medical and medico-legal obligations when test results indicate high alcohol use need to be addressed in future guidelines for clinical management of PEth.

Background: In addition to peripheral neuropathy of various kinds, diabetes can also cause central neuropathy, which among other things can manifest itself as premature cognitive dysfunction, often linked to vascular dysfunction. Although the link between diabetes and cognitive dysfunction was discovered more than 100 years ago and has important clinical implications, this diabetes complication remains relatively unknown. Recent years have seen research that has clarified cerebral insulin resistance and defective insulin signaling as examples of pathogenic factors behind this cognitive impairment in diabetes.

Method: We provide a narrative review of select and contemporary publications with relevance for the interface between diabetes/prediabetes and cognitive function.

Results: Recently published studies show that physical activity can reverse insulin resistance in the brain as well as cognitive impairment and pathological appetite regulation. Pharmacological interventions with, for example, nasal insulin, GLP-1 receptor agonists, SGLT-2 inhibitors, or PPAR-γ agonists have also shown promising results.

Conclusion: Optimization of lifestyle factors (e.g. physical activity), as well as several pharmaceutical agents already in clinical use against diabetes, have shown promising results in improving cognitive function in diabetic patients. An important task for primary health care, where most patients with type 2 diabetes are diagnosed, treated, and followed, is to increase awareness and early detection of cognitive dysfunction in these patients for optimizing risk factor control.

Aim: To investigate the association between Systematic Coronary Risk Evaluation 2 (SCORE2) and subclinical damage in two vascular beds: atherosclerosis in the coronary arteries and aortic arterial stiffness, in a large population-based cohort without cardiovascular disease or diabetes.

Methods: Design: A cross-sectional study based on Swedish CArdio Pulmonary bioImaging Study (SCAPIS) data. Study population: A population-based cohort of 3087 participants aged 50-64.

Outcome: Pulse Wave Velocity (PWV) was measured, and aortic arterial stiffness was defined as PWV≥ 10 m/s. Coronary artery calcium score (CACS) was determined by coronary computed tomography and clinically significant coronary calcification was defined as CACS > 100.

Results: The prevalence of arterial stiffness was 6.6% in the low-moderate SCORE2 risk group, 31.0% in the high-risk group, and 53.3% in the very high-risk group. The prevalence of coronary calcification was 4.5%, 18.5% 23.0%, respectively. There was a modest overlap between arterial stiffness and coronary calcification in all SCORE2 risk groups. When comparing the high SCORE2 risk group with the low-moderate risk group, the Odds ratio (OR) was 6.4, 95% confidence interval (CI 5.1-8.0) for arterial stiffness and 4.8 (CI 3.7-6.3) for coronary calcification. When comparing the very high SCORE2 risk group to the low-moderate group, the OR was 16.2 (CI 11.3-23.1) for arterial stiffness and 6.4 (CI 4.2-9.7) for coronary calcification.

Conclusion: Our study shows that high cardiovascular risk according to SCORE2 is associated with increased arterial stiffness and significant coronary calcification in a population without prevalent cardiovascular disease or diabetes. This knowledge can be useful in primary care, where SCORE2 is frequently used as a risk prediction tool. The modest overlap between arterial stiffness and coronary calcification suggests that CACS and PWV describe different types of vascular damage.

Background: Research has shown that physical activity on prescription (PAP), used in Swedish healthcare, increases patients' physical activity, but data are lacking regarding the long-term effects of PAP on exercise capacity. Therefor exercise capacity was evaluated in patients with metabolic risk factors, after 4.5 years of PAP treatment provided by physiotherapists in primary healthcare.

Method: This study included 98 patients (49% women; mean age, 56 years) with metabolic risk factors, who were still physically inactive after a previous 6-month PAP treatment. The patients received physiotherapist-provided PAP treatment for 4.5 years, including 11 follow-ups and 6 exercise capacity tests.

Results: After 4.5 years, 41 patients completed the final exercise capacity test (58% drop-out rate). Compared to baseline, the whole cohort exhibited a significantly increased exercise capacity (9.1 W, p = 0.014) with a small effect size (r = 0.27), with no significant differences associated with age or gender.

Conclusion: The increased exercise capacity may indicate positive effects on longevity, and consolidates previous findings that long-term behavior change is possible among physically inactive patients. It also demonstrates the feasibility of continuous exercise capacity testing with physiotherapist support in an ordinary primary care setting. The drop-out rate and lack of control group complicate the interpretation of the effects of PAP treatment on the increased exercise capacity. Further research should strive for an RCT study design.