Scandinavian Journal of Primary Health Care最新文献

Background: In Sweden 70,000 people suffer fragility fractures annually, including 16,000 hip fractures with one-year mortality of up to 25%. Strategies to prevent falls, improve physical function, and enhance bone strength have shown mixed results.

Aim: To evaluate the incidence of hip and other fragility fractures following a fracture prevention intervention and assess baseline risk factors for long-term fracture outcomes.

Methods: 1,233 rural Swedish women aged 70-100 years in 2002 were followed until 2021 after a primary care-based, non-randomized graded fracture prevention intervention 2002-2004 that included physical activity, fall prevention, and pharmacological treatment tailored to hip fracture risk. Fractures were identified through radiology reports 2002-2021.

Results: The most common fractures occurred in the hip with 236 women sustaining 268 hip fractures with highest incidence in women aged 90-94 years. One-year hip fracture mortality was 27%. Hip fractures occurred in 17.7% of the intervention group (77/434) and 19.9% of controls (159/799, p = 0.36). Repeated fragility fractures occurred in 14.1% of the intervention group and 18.6% of controls (OR 0.71; 95% CI 0.53-1.0, p = 0.047), particularly when one fracture involved the hip (OR 0.54 (95% CI 0.31-0.95), p = 0.037). Increasing age (HR 1.8-4.0), height >167 cm (HR 1.6; 95% CI 1.1-2.2), and weight <60 kg (HR 1.5; 95% CI 1.1-2.0) were significant baseline risk factors.

Conclusions: We noticed a non-significant reduction in hip fractures after 20 years, yet repeated fractures were less frequent in the intervention group suggesting a potential long-term benefit. Older, taller and lighter women were at greater risk for hip fracture.

Purpose: A trusting relationship between employee and manager is crucial for constructive dialogue regarding work ability. However, employees may sometimes experience collaboration as unpleasant if the dialogue with their manager is not constructive. The aim of the study was to explore how employees on sick leave experience manager involvement in the RTW through a three-party meeting using the Demand and Ability Protocol (DAP) in primary healthcare.

Materials and methods: Data included 20 semi-structured individual interviews with employees diagnosed with common mental disorders or musculoskeletal disorders who had participated in a DAP dialogue. Thematic analysis was used to analyse the data.

Results: Employees wanted to reach out to their manager but had challenges getting the message through about their reduced work ability. During sick leave, the structured DAP held within primary healthcare was experienced as a helpful measure to foster collaboration with the manager. The dialogue helped explore the balance between workplace demands and the employee's capabilities. This enabled both parties to share their view and the rehabilitation coordinator could guide towards potential adaptations. Employees found that the increased mutual understanding fostered by the DAP helped pave the way for ongoing collaboration in the RTW process.

Conclusions: The results underscore the importance of facilitating collaboration between employees and managers before, during, and after sick leave. The DAP can support the development of a trust-based relationship that enables all involved stakeholders to articulate needs, propose measures, and make informed decisions that enhance efforts throughout the RTW process.

Background: There is a lack of data on the prevalence of conflicts of interest (COI) declared in systematic reviews over time.

Methods: PubMed was searched for systematic reviews on interventions for chronic obstructive pulmonary disease, type 2 diabetes mellitus, hypertension, dementia, major depression, and osteoarthritis from 2010 and 2019. Selection was conducted by two independent authors, with disagreements resolved in consensus. COI and funding disclosures were extracted. COI were categorised using a specific framework.

Results: 746 systematic reviews were included. One third involved pharmacological interventions. Systematic reviews from China increased from 4% to 21% between 2010 and 2019; Cochrane reviews decreased from 19% to 4%.Systematic reviews presenting a COI statement increased from 79% to 94%. Those with at least one author declaring individual financial COI decreased from 22% to 17% but remained at 22-23% when excluding systematic reviews from China. Almost 1 in 3 systematic reviews on pharmacological interventions and invasive procedures declared individual financial COI for 2019. Individual intellectual COI were declared in 2.5% and other types of COI were very rare.Systematic reviews presenting a funding statement increased from 65% to 81%; industry funding decreased from 6% to 3.4%. Adding industry funding to the prevalence of systematic reviews declaring financial COI only made a marginal difference.

Conclusions: The proportion of systematic reviews on interventions for common diagnoses declaring individual financial COI remained consistent at approximately one in five for both 2010 and 2019, underscoring the need for further research into the implications of this finding.

Aim: Multimorbidity is a major public health concern. According to previous studies, multimorbidity has been shown to be associated with health-related quality of life (HRQoL). However, existing data concerning high income countries are mainly based on cross-sectional studies. Consequently, longitudinal investigations have been called for. There exist several definitions of multimorbidity in previous population studies, and usually definition is based on self-reported symptoms or diseases or included only few diagnoses. This study aimed to examine how the number of doctor-diagnosed chronic diseases influences HRQoL over time in a population-based setting.

Methods: At 31 and 46 years, participants (n = 3573) of the Northern Finland Birth Cohort 1966 answered 15-Dimensional HRQoL questionnaire (15D). Mean 15D-Scores (varies between 0 and 1) were counted according to the number of 43 chosen chronic diseases. These diseases were found and the definition of multimorbidity was measured by a method using both self-reported doctor-diagnosed and register-based chronic diseases.

Results: In both genders, the mean difference of 15D-Scores increased monotonously in line with the increasing number of new emerging diseases diagnosed for 15 years of follow-up from the age of 31-46 years (p < .05). Furthermore, the more diseases the patient had at the age of 31, the more mean 15D-Scores decreased when having more new emerging diseases at the age of 46.

Conclusions: In general, HRQoL decreased during 15-year follow-up for everyone. Furthermore, decrease in the quality of life is significantly associated with multimorbidity in this longitudinal setting.

This study offers novel insights into parents' experiences of healthcare interactions during weight-related visits. Data were collected through the More and Less Europe study, a randomized controlled trial evaluating a parent support program for children (aged 2-6 years) with overweight or obesity in Sweden, Romania, and Spain to capture parents' experiences of healthcare interactions. Semi-structured interviews were conducted with 45 Swedish parents (71% mothers, 60% with university degree, 51% of migrant background) of 45 children (mean age 7.1 years, SD 1.3, 76% girls) who received standard treatment for overweight or obesity. The interviews were analyzed thematically, identifying two themes: (1) Support or blame, with subthemes Validating family-centeredness, Overly generic advice, and Stigma and the sense of failing; (2) The place and role of the child, with subthemes Neutral, honest, and direct communication, Not for children's ears, and Framing the message with care. While some parents described supportive interactions, others expressed disappointment with generic advice and inadequate support. Some recalled stigmatization, sometimes in the child's presence, raising concerns about the child's well-being. Approaches to preparing children for visits ranged from neutral to direct explanations. Parents expressed contrasting views on children's presence during weight-related discussions: while some felt such discussions would harm their child, others supported children's presence in open and age-appropriate discussion. This study fills a critical gap in obesity management communication by highlighting parental concerns about children's exposure to weight-related discussions. Addressing these concerns is essential to reducing weight stigma in healthcare and protecting children from harmful experiences.

Purpose: This study aimed to investigate the factors associated with blood pressure control in a primary healthcare population with hypertension.

Materials and methods: We used baseline data from a recent Swedish randomized controlled trial where 400 patients diagnosed with hypertension from 10 primary health care centers were included. The participants underwent blood pressure measurements, blood sampling and completed questionnaires on quality of life, physical activities, tobacco- and alcohol use, medication, and comorbidities. Logistic regression analyses were used to estimate odds ratios (OR) and 95% confidence intervals (CI) for factors associated with blood pressure control (<140/90 mmHg).

Results: The mean age of the participants was 69 years. The results showed blood pressure control in 41% of the cases. The factors that had the highest ORs for achieving blood pressure control were previous myocardial infarction (OR 2.44; CI 1.08-5.53), diabetes diagnosis (OR 2.26; CI 1.31-3.88), and use of ≥2 blood pressure medications (OR 1.62; CI 1.07-2.46). Family history of hypertension was negatively associated with blood pressure control (OR 0.29; CI 0.38-0.88) (univariate analyses).

Conclusions: Our study found an association between the use of ≥2 antihypertensive medications and blood pressure control. Despite current treatment guidelines for hypertension, the use of single-drug therapy remains common. By shifting from single drug to combination therapy, focusing on patients with a family history of hypertension and those without comorbidities, the proportion achieving blood pressure control could increase significantly.

Trial registration: ClinicalTrials.gov (NCT04407962).

Background: Timely healthcare seeking with colorectal cancer (CRC) symptoms is crucial for treatment options. This study aims to 1. compare CRC symptom reporting and contact to the general practitioner (GP) in the Danish population in 2012 and 2022, 2. analyze the associations between sex, age and GP contact in 2012 and 2022, and 3. explore considerations about GP contact in 2022.

Methods: Nationwide surveys on symptoms and GP contact in 2012 and 2022 with 100,000 randomly selected adults invited in each. Four CRC symptom categories, GP contact, and six predefined considerations about GP contact were analyzed by descriptive statistics and multivariable logistic regression models.

Results: We included 47,423 individuals in 2012, and 28,328 in 2022. Symptom reporting was similar in the two cohorts, whereas GP contact increased significantly. Abdominal pain prompted the highest GP contact in both years (36.1% in 2012; 44.3% in 2022), while changed bowel habits prompted the lowest (20.4% and 24.8%, respectively). Men had lower odds of GP contact than women for most symptom categories, and odds of seeking healthcare increased with age. Among those with no GP contact, half reported either knowing the cause of their symptom or expecting it to resolve on its own. Among those who reported rectal bleeding and no GP contact, 17% described embarrassment.

Conclusion: Despite the increased focus on CRC, many individuals with CRC symptoms reported that they knew the cause and expected it to go away on its own, indicating that they might not associate it with serious disease.

Objective: Explore treatment trajectories over a two-year follow-up among patients with musculoskeletal disorders (MSDs) in Norway and investigate the associations with education and country of origin.

Design: Register-based cohort study.

Settings: Data were obtained from three national registers, the Norwegian Control and Payment of Health Reimbursements Database (KUHR), the Norwegian Patient Registry (NPR) and Statistics Norway (SSB).

Subjects: Patients diagnosed with MSDs in 2015 in primary healthcare according to the International Classification of Primary Care, second edition (ICPC-2).

Main outcome measures: Treatment trajectory classes of healthcare use over a 2-years follow-up were generated using group-based multi-trajectory modelling, for all patients registered with MSDs and three common diagnoses: spine pain, osteoarthritis and fibromyalgia.

Results: From the analysis, four treatment trajectory classes of healthcare use were identified for MSD patients overall; low (75%), stable (10%), descending (9%) and high use (5%). The pattern was almost similar for the three diagnostic groups. High use was primarily caused by consistent high use of physiotherapy. For MSD patients overall, low education increased the probability of being in the low and stable use classes, while high education increased the probability of being in the descending use class. Patients with Norway as country of origin, were less likely to be in the class with low use and more likely to be in the class with descending use.

Conclusion: Using nationwide register data and group-based multi-trajectory modelling show that about 75% of all patients with MSD, consulting primary healthcare in Norway, were classified as low users of healthcare services and 5% were classified as high users. Overall, both education and country of origin were associated with the treatment trajectory classes. However, high use was not associated with neither education nor country of origin.

Background: The majority of individuals in Sweden with type 2 diabetes have their sole health care provider in primary health care. Metformin treatment often causes gastrointestinal side-effects. Our aim was to construct and validate a questionnaire assessing gastrointestinal symptoms before and after starting metformin treatment for type 2 diabetes.

Methods: In the Interaction Between Metformin and Microbiota (MEMO) study, 54 participants rated six gastrointestinal symptoms at baseline and after 2 months of metformin treatment in a questionnaire (measured change, i.e. the difference between assessments at these two time points), as well as direct assessment of perceived change in symptoms after 2 months in a separate validation questionnaire (reported change, i.e. how participants themselves have perceived the change between the same two time points). Spearman's ρ was calculated and reported with its 95% CI.

Results: The agreement between reported and measured change of symptoms, measured as Spearman's ρ, was above 0.4 for 4 out of 6 symptoms (poor appetite 0.60 [95% CI 0.39-0.75], loose stool or diarrhea 0.58 [95% CI 0.37-0.74], flatulence 0.45 [95% CI 0.21-0.64], and abdominal pain 0.45 [95% CI 0.20-0.65]). The agreement was lower for nausea and vomiting, although these were numerically above 75% in agreement, likely due to few symptomatic participants overall.

Conclusion: For common side-effect symptoms associated with metformin treatment, our study shows that symptom change measured as the difference between assessments at two different time-points was in overall agreement, validating the usability of the constructed questionnaire for metformin side-effects.

Background: In Denmark, transgender and nonbinary (TNB) individuals must consult their General Practitioner (GP) to access gender-affirming healthcare (GAHC). TNB individuals report unmet health needs and higher incidences of mental health challenges compared to cisgender peers. Cultural safety, involving a 'safe space,' could reduce healthcare inequities.

Objectives: This study aims to identify the factors, according to TNB individuals in Denmark, that create, maintain, and disrupt a 'safe space' in general practice.

Method: Twelve semi-structured qualitative interviews with TNB individuals aged 20 to 43 were conducted, transcribed verbatim, and analysed using Systematic Text Condensation.

Main findings: Participants felt unsafe with GPs due to negative experiences related to being transgender, leading to healthcare avoidance. They valued GPs who respected chosen names, showed interest in transgender care, and were upfront about limitations. A significant issue was lack of GP knowledge on transgender healthcare, often requiring participants to educate their GPs. Participants emphasised the need for doctors to avoid assumptions about patients based on gender identity. Participants did not believe that a 'safe space' can be realised but wish for a 'safer space'.

Conclusion: Trans individuals feel unsafe when consulting their GP due to past and present negative experiences, which leads to healthcare avoidance. A 'safer space' encompasses; respecting chosen names, showing an interest in transgender care, listening and meeting patients on their terms. The study highlights the importance of educating GPs on respectful interactions, suggesting that adopting the concept of a 'safer space' as a medical term could improve healthcare for TNB individuals.