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  • 1. Broström, Anders
    et al.
    Sunnergren, Ola
    Årestedt, Kristofer
    Linnaeus University, Faculty of Health, Social Work and Behavioural Sciences, School of Health and Caring Sciences. Linköpings universitet.
    Johansson, Peter
    Ulander, Martin
    Riegel, Barbara
    Svanborg, Eva
    Factors associated with undiagnosed obstructive sleep apnoea in hypertensive primary care patients.2012In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 30, no 2, p. 107-113Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: In hypertensive primary care patients below 65 years of age, (i) to describe the occurrence of undiagnosed obstructive sleep apnoea (OSA), and (ii) to identify the determinants of moderate/severe OSA.

    DESIGN: Cross-sectional.

    SETTING: Four primary care health centres in Sweden.

    PATIENTS: 411 consecutive patients (52% women), mean age 57.9 years (SD 5.9 years), with diagnosed and treated hypertension (BP >140/90).

    MAIN OUTCOME MEASURES: Occurrence of OSA as measured by the apnoea hypopnoea index (AHI).

    RESULTS: Mild (AHI 5-14.9/h) and moderate/severe (AHI > 15/h) OSA were seen among 29% and 30% of the patients, respectively. Comparing those without OSA with those with mild or moderate/severe OSA, no differences were found in blood pressure, pharmacological treatment (anti-hypertensive, anti-depressive, and hypnotics), sleep, insomnia symptoms, daytime sleepiness, or depressive symptoms. Obesity (BMI > 30 kg/m2) was seen in 30% and 68% of the patients with mild and moderate/severe OSA, respectively. Male gender, BMI > 30 kg/m2, snoring, witnessed apnoeas, and sleep duration >8 hours were determinants of obstructive sleep apnoea.

    CONCLUSION: Previously undiagnosed OSA is common among patients with hypertension in primary care. Obesity, snoring, witnessed apnoeas, long sleep duration, and male gender were the best predictors of OSA, even in the absence of daytime sleepiness and depressive symptoms.

  • 2.
    Buono, Nicola
    et al.
    Univ Maastricht, Netherlands.
    Thulesius, Hans
    Univ Maastricht, Netherlands.
    Petrazzuoli, Ferdinando
    Univ Maastricht, Netherlands.
    Van Merode, Tiny
    Univ Maastricht, Netherlands.
    Koskela, Tuomas
    Univ Maastricht, Netherlands.
    Le Reste, Jean-Yves
    Univ Maastricht, Netherlands.
    Prick, Hanny
    Univ Maastricht, Netherlands.
    Soler, Jean Karl
    Univ Maastricht, Netherlands.
    40 years of biannual family medicine research meetings--the European General Practice Research Network (EGPRN).2013In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 31, no 4, p. 185-7Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To document family medicine research in the 25 EGPRN member countries in 2010.

    DESIGN: Semi-structured survey with open-ended questions.

    SETTING: Academic family medicine in 23 European countries, Israel, and Turkey.

    SUBJECTS: 25 EGPRN national representatives.

    MAIN OUTCOME MEASURES: Demographics of the general population and family medicine. Assessments, opinions, and suggestions.

    RESULTS: EGPRN has represented family medicine for almost half a billion people and > 300,000 general practitioners (GPs). Turkey had the largest number of family medicine departments and highest density of GPs, 2.1/1000 people, Belgium had 1.7, Austria 1.6, and France 1.5. Lowest GP density was reported from Israel 0.17, Greece 0.18, and Slovenia 0.4 GPs per 1000 people. Family medicine research networks were reported by 22 of 25 and undergraduate family medicine research education in 20 of the 25 member countries, and in 10 countries students were required to do research projects. Postgraduate family medicine research was reported by 18 of the member countries. Open-ended responses showed that EGPRN meetings promoted stimulating and interesting research questions such as comparative studies of chronic pain management, sleep disorders, elderly care, healthy lifestyle promotion, mental health, clinical competence, and appropriateness of specialist referrals. Many respondents reported a lack of interest in family medicine research related to poor incentives and low family medicine status in general and among medical students in particular. It was suggested that EGPRN exert political lobbying for family medicine research.

    CONCLUSION: Since 1974, EGPRN organizes biannual conferences that unite and promote primary care practice, clinical research and academic family medicine in 25 member countries.

  • 3.
    Harris, Michael
    et al.
    University of Bath, UK.
    Frey, Peter
    Universität Bern, Switzerland.
    Esteva, Magdalena
    Majorca Primary Health Care Department, Spain;Instituto de Investigación sanitaria Illes Balears (idISBA), Spain.
    Gašparović Babić, Svjetlana
    University of Rijeka, Croatia.
    Marzo-Castillejo, Mercè
    Institut Català de la Salut, Spain.
    Petek, Davorina
    University of Ljubljana, Slovenia.
    Petek Ster, Marija
    University of Ljubljana, Slovenia.
    Thulesius, Hans
    Lund University, Sweden.
    How the probability of presentation to a primary care clinician correlates with cancer survival rates: a European survey using vignettes.2017In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 35, no 1, p. 27-34Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: European cancer survival rates vary widely. System factors, including whether or not primary care physicians (PCPs) are gatekeepers, may account for some of these differences. This study explores where patients who may have cancer are likely to present for medical care in different European countries, and how probability of presentation to a primary care clinician correlates with cancer survival rates.

    DESIGN: Seventy-eight PCPs in a range of European countries assessed four vignettes representing patients who might have cancer, and consensus groups agreed how likely those patients were to present to different clinicians in their own countries. These data were compared with national cancer survival rates.

    SETTING: A total of 14 countries.

    SUBJECTS: Consensus groups of PCPs.

    MAIN OUTCOME MEASURES: Probability of initial presentation to a PCP for four clinical vignettes.

    RESULTS: There was no significant correlation between overall national 1-year relative cancer survival rates and the probability of initial presentation to a PCP (r  = -0.16, 95% CI -0.39 to 0.08). Within that there was large variation depending on the type of cancer, with a significantly poorer lung cancer survival in countries where patients were more likely to initially consult a PCP (lung r = -0.57, 95% CI -0.83 to -0.12; ovary: r = -0.13, 95% CI -0.57 to 0.38; breast r = 0.14, 95% CI -0.36 to 0.58; bowel: r = 0.20, 95% CI -0.31 to 0.62).

    CONCLUSIONS: There were wide variations in the degree of gatekeeping between countries, with no simple binary model as to whether or not a country has a "PCP-as-gatekeeper" system. While there was case-by-case variation, there was no overall evidence of a link between a higher probability of initial consultation with a PCP and poorer cancer survival. KEY POINTS European cancer survival rates vary widely, and health system factors may account for some of these differences. The data from 14 European countries show a wide variation in the probability of initial presentation to a PCP. The degree to which PCPs act as gatekeepers varies considerably from country to country. There is no overall evidence of a link between a higher probability of initial presentation to a PCP and poorer cancer survival.

  • 4.
    Hedin, Katarina
    et al.
    Lund University, Sweden;Region Kronoberg, Sweden.
    Strandberg, Eva Lena
    Lund university, Sweden;Blekinge County Council, Sweden.
    Gröndal, Hedvig
    Uppsala university, Sweden.
    Brorsson, Annika
    Lund university, Sweden;Ctr Primary Hlth Care Res, Malmö, Sweden.
    Thulesius, Hans
    Lund university, Sweden;Region Kronoberg, Sweden.
    André, Malin
    Linköping Univ, Sweden;Uppsala University, Sweden.
    Management of patients with sore throats in relation to guidelines: an interview study in Sweden.2014In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 32, no 4, p. 193-9Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To explore how a group of Swedish general practitioners (GPs) manage patients with a sore throat in relation to current guidelines as expressed in interviews.

    DESIGN: Qualitative content analysis was used to analyse semi-structured interviews.

    SETTING: Swedish primary care.

    SUBJECTS: A strategic sample of 25 GPs.

    MAIN OUTCOME MEASURES: Perceived management of sore throat patients.

    RESULTS: It was found that nine of the interviewed GPs were adherent to current guidelines for sore throat and 16 were non-adherent. The two groups differed in terms of guideline knowledge, which was shared within the team for adherent GPs while idiosyncratic knowledge dominated for the non-adherent GPs. Adherent GPs had no or low concerns for bacterial infections and differential diagnosis whilst non-adherent GPs believed that in patients with a sore throat any bacterial infection should be identified and treated with antibiotics. Patient history and examination was mainly targeted by adherent GPs whilst for non-adherent GPs it was often redundant. Non-adherent GPs reported problems getting patients to abstain from antibiotics, whilst no such problems were reported in adherent GPs.

    CONCLUSION: This interview study of sore throat management in a strategically sampled group of Swedish GPs showed that while two-thirds were non-adherent and had a liberal attitude to antibiotics one-third were guideline adherent with a restricted view on antibiotics. Non-adherent GPs revealed significant knowledge gaps. Adherent GPs had discussed guidelines within the primary care team while non-adherent GPs had not. Guideline implementation thus seemed to be promoted by knowledge shared in team discussions.

  • 5.
    Lendahls, Lena
    et al.
    University of Kalmar, School of Human Sciences.
    Edvardsson, Ingrid
    Håkansson, Anders
    When do adolescents become smokers?2008In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 1, p. 1-6Article in journal (Refereed)
  • 6.
    Liira, Helena
    et al.
    University of Western Australia, Australia;University of Helsinki, Finland.
    Koskela, Tuomas
    University of Tampere, Finland.
    Thulesius, Hans
    Region Kronoberg, Sweden;Lund university, Sweden.
    Pitkälä, Kaisu
    University of Helsinki, Finland.
    Encouraging primary care research: evaluation of a one-year, doctoral clinical epidemiology research course.2016In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 34, no 1, p. 89-96Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: Research and PhDs are relatively rare in family medicine and primary care. To promote research, regular one-year research courses for primary care professionals with a focus on clinical epidemiology were started. This study explores the academic outcomes of the first four cohorts of research courses and surveys the participants' perspectives on the research course.

    DESIGN: An electronic survey was sent to the research course participants. All peer-reviewed scientific papers published by these students were retrieved by literature searches in PubMed.

    SETTING: Primary care in Finland.

    SUBJECTS: A total of 46 research course participants who had finished the research courses between 2007 and 2012.

    RESULTS: Of the 46 participants 29 were physicians, eight nurses, three dentists, four physiotherapists, and two nutritionists. By the end of 2014, 28 of the 46 participants (61%) had published 79 papers indexed in PubMed and seven students (15%) had completed a PhD. The participants stated that the course taught them critical thinking, and provided basic research knowledge, inspiration, and fruitful networks for research.

    CONCLUSION: A one-year, multi-professional, clinical epidemiology based research course appeared to be successful in encouraging primary care research as measured by research publications and networking. Activating teaching methods, encouraging focus on own research planning, and support from peers and tutors helped the participants to embark on research projects that resulted in PhDs for 15% of the participants.

    KEY POINTS: Clinical research and PhDs are rare in primary care in Finland, which has consequences for the development of the discipline and for the availability of clinical lecturers at the universities. A clinical epidemiology oriented, one-year research course increased the activity in primary care research. Focus on own research planning and learning the challenges of research with peers appeared to enhance the success of a doctoral research course. A doctoral research course encouraged networking, and the course collaboration sometimes led to paper co-authoring. In the Nordic countries, the primary care health professionals are used to working in multi-professional teams. A multi-professional strategy also seems fruitful in doctoral research education.

  • 7.
    Lindow, Thomas
    et al.
    Region Kronoberg, Sweden;Lund University, Sweden.
    Kron, Josefine
    Region Kronoberg, Sweden.
    Thulesius, Hans
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry. Region Kronoberg, Sweden.
    Ljungström, Erik
    Region Skåne, Sweden.
    Pahlm, Olle
    Lund University, Sweden.
    Erroneous computer-based interpretations of atrial fibrillation and atrial flutter in a Swedish primary health care setting2019In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 37, no 4, p. 426-433Article in journal (Refereed)
    Abstract [en]

    Objective: To describe the incidence of incorrect computerized ECG interpretations of atrial fibrillation or atrial flutter in a Swedish primary care population, the rate of correction of computer misinterpretations, and the consequences of misdiagnosis. Design: Retrospective expert re-analysis of ECGs with a computer-suggested diagnosis of atrial fibrillation or atrial flutter. Setting: Primary health care in Region Kronoberg, Sweden. Subjects: All adult patients who had an ECG recorded between January 2016 and June 2016 with a computer statement including the words 'atrial fibrillation' or 'atrial flutter'. Main outcome measures: Number of incorrect computer interpretations of atrial fibrillation or atrial flutter; rate of correction by the interpreting primary care physician; consequences of misdiagnosis of atrial fibrillation or atrial flutter. Results: Among 988 ECGs with a computer diagnosis of atrial fibrillation or atrial flutter, 89 (9.0%) were incorrect, among which 36 were not corrected by the interpreting physician. In 12 cases, misdiagnosed atrial fibrillation/flutter led to inappropriate treatment with anticoagulant therapy. A larger proportion of atrial flutters, 27 out of 80 (34%), than atrial fibrillations, 62 out of 908 (7%), were incorrectly diagnosed by the computer. Conclusions: Among ECGs with a computer-based diagnosis of atrial fibrillation or atrial flutter, the diagnosis was incorrect in almost 10%. In almost half of the cases, the misdiagnosis was not corrected by the overreading primary-care physician. Twelve patients received inappropriate anticoagulant treatment as a result of misdiagnosis.

  • 8. Lindström, Kjell
    et al.
    Ekedahl, Anders
    University of Kalmar, School of Pure and Applied Natural Sciences.
    Carlsten, Anders
    Mårtensson, Jan
    Department of Nursing Science, School of Health Sciences, Jönköping,.
    Mölstad, Sigvard
    Department of Health and Society, Linköping University, Linköping,.
    Can selective serotonin inhibitor drugs in elderly patients in nursing homes be reduced?2007In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 25, no 1, p. 3-8Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To investigate whether treatment with selective serotonin reuptake inhibitors (SSRIs) could be withdrawn for elderly residents who had been on treatment for at least one year and to evaluate a method for systematic drug review. DESIGN: Open, prospective, interventional study. SETTING: Four counties in Sweden. SUBJECTS: Elderly residents at 19 nursing homes, with ongoing treatment with SSRIs for more than one year. MAIN OUTCOME MEASURES: Clinical evaluation, registration of drugs used and rating with Montgomery-Asberg Depression Rating Scale (MADRS). A semi-structured telephone interview with 15 participating physicians and 19 nurses. RESULTS: About one-third of all 822 residents in the nursing homes had ongoing antidepressant treatment, predominantly with SSRIs; 75% of them had been treated with SSRIs for at least one year and 119 (60%) of these were considered eligible for the study. The intervention was judged successful in 52% of these residents of whom 88% had a MADRS rating of less than 20 points. The GPs and the nurses experienced the method as practicable. CONCLUSIONS: Withdrawal of SSRI treatment was successful in the majority of cases. The MADRS may be a valuable addition to clinical evaluation when deciding whether to end or continue SSRI treatment.

  • 9.
    Melin, Eva O.
    et al.
    Lund University, Sweden;Region Kronoberg, Sweden.
    Svensson, Ralph
    Linnaeus University, Faculty of Health and Life Sciences, Department of Psychology.
    Thulesius, Hans
    Region Kronoberg, Sweden;Lund University, Sweden.
    Psychoeducation against depression, anxiety, alexithymia and fibromyalgia: a pilot study in primary care for patients on sick leave2018In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 36, no 2, p. 123-133Article in journal (Refereed)
    Abstract [en]

    Objectives: Feasibility testing of a psychoeducational method - The Affect School and Script Analyses (ASSA) - in a Swedish primary care setting. Exploring associations between psychological, and medically unexplained physical symptoms (MUPS). Design: Pilot study. Setting: Three Swedish primary care centers serving 20,000 people. Intervention: 8 weekly 2-hour sessions with a 5-7 participant group led by two instructors - followed by 10 individual hour-long sessions. Subjects: Thirty-six patients, 29 women (81%), on sick-leave due to depression, anxiety, or fibromyalgia. Outcome measures: Feasibility in terms of participation rates and expected improvements of psychological symptoms and MUPS, assessed by self-report instruments pre-, one-week post-, and 18 months post-intervention. Regression coefficients between psychological symptoms and MUPS. Results: The entire 26-hour psychoeducational intervention was completed by 30 patients (83%), and 33 patients (92%) completed the 16-hour Affect School. One-week post-intervention median test score changes were significantly favorable for 27 respondents, with p < .05 after correction for multiple testing for 9 of 11 measures (depression, anxiety, alexithymia, MUPS, general health, self-affirmation, self-love, self-blame, and self-hate); 18 months post intervention the results remained significantly favorable for 15 respondents for 7 of 11 measures (depression, alexithymia, MUPS, general health, self-affirmation, self-love, and self-hate). Conclusions: A psychoeducational method previously untested in primary care for mostly women patients on sick-leave due to depression, anxiety, or fibromyalgia had >80% participation rates, and dear improvements of self-assessed psychological symptoms and MUPS. The ASSA intervention thus showed adequate feasibility in a Swedish primary care setting.

  • 10.
    Streit, Sven
    et al.
    University of Bern, Switzerland.
    Gussekloo, Jacobijn
    Leiden University Medical Center, Netherlands.
    Burman, Robert A
    Vennesla Primary Health Care Centre, Norway.
    Collins, Claire
    Irish College of General Practitioners, Ireland.
    Kitanovska, Biljana Gerasimovska
    University St. Cyril and Metodius, Macedonia.
    Gintere, Sandra
    Riga Stradiņs University, Latvia.
    Gómez Bravo, Raquel
    University of Luxembourg, Luxembourg.
    Hoffmann, Kathryn
    Medical University of Vienna, Austria.
    Iftode, Claudia
    Sano Med West Private Clinic , Romania.
    Johansen, Kasper L
    Danish College of General Practitioners , Denmark.
    Kerse, Ngaire
    University of Auckland, New Zealand.
    Koskela, Tuomas H
    University of Tampere, Finland.
    Peštić, Sanda Kreitmayer
    University of Tuzla, Bosnia and Herzegovina.
    Kurpas, Donata
    Wroclaw Medical University, Poland.
    Mallen, Christian D
    Keele University, UK.
    Maisonneuve, Hubert
    University of Geneva, Switzerland.
    Merlo, Christoph
    Institute of Primary and Community Care Lucerne (IHAM), Switzerland.
    Mueller, Yolanda
    Institute of Family Medicine Lausanne (IUMF), Switzerlan.
    Muth, Christiane
    Institute of General Practice Goethe-University, Germany.
    Ornelas, Rafael H
    Hospital Israelita Albert Einstein, Brazil.
    Šter, Marija Petek
    University of Ljubljana, Slovenia.
    Petrazzuoli, Ferdinando
    SNAMID (National Society of Medical Education in General Practice), Italy;Lund University, Sweden.
    Rosemann, Thomas
    University of Zurich, Switzerland.
    Sattler, Martin
    SSLMG - Societé Scientifique Luxembourgois en Medicine generale, Luxembourg.
    Švadlenková, Zuzana
    Ordinace Řepy, s.r.o, Prague, Czech Republic.
    Tatsioni, Athina
    University of Ioannina, Greece.
    Thulesius, Hans
    Lund University, Sweden;Region Kronoberg, Sweden.
    Tkachenko, Victoria
    Institute of Family Medicine at Shupyk National Medical Academy of Postgraduate Education, Ukraine.
    Torzsa, Peter
    Semmelweis University, Hungary.
    Tsopra, Rosy
    LIMICS-INSERM, France;St James's University Hospital, UK.
    Tuz, Canan
    Kemaliye Town Hospital, Turkey;Erzincan University, Turkey.
    Verschoor, Marjolein
    University of Bern, Switzerland.
    Viegas, Rita P A
    NOVA Medical School, Portugal.
    Vinker, Shlomo
    Tel Aviv University, Israel.
    de Waal, Margot W M
    Leiden University Medical Center, Netherlands.
    Zeller, Andreas
    University of Basel, Switzerland.
    Rodondi, Nicolas
    University of Bern, Switzerland;Bern University Hospital, Switzerland.
    Poortvliet, Rosalinde K E
    Leiden University Medical Center, Netherlands.
    Burden of cardiovascular disease across 29 countries and GPs' decision to treat hypertension in oldest-old.2018In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 36, no 1, p. 89-98Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: We previously found large variations in general practitioner (GP) hypertension treatment probability in oldest-old (>80 years) between countries. We wanted to explore whether differences in country-specific cardiovascular disease (CVD) burden and life expectancy could explain the differences.

    DESIGN: This is a survey study using case-vignettes of oldest-old patients with different comorbidities and blood pressure levels. An ecological multilevel model analysis was performed.

    SETTING: GP respondents from European General Practice Research Network (EGPRN) countries, Brazil and New Zeeland.

    SUBJECTS: This study included 2543 GPs from 29 countries.

    MAIN OUTCOME MEASURES: GP treatment probability to start or not start antihypertensive treatment based on responses to case-vignettes; either low (<50% started treatment) or high (≥50% started treatment). CVD burden is defined as ratio of disability-adjusted life years (DALYs) lost due to ischemic heart disease and/or stroke and total DALYs lost per country; life expectancy at age 60 and prevalence of oldest-old per country.

    RESULTS: Of 1947 GPs (76%) responding to all vignettes, 787 (40%) scored high treatment probability and 1160 (60%) scored low. GPs in high CVD burden countries had higher odds of treatment probability (OR 3.70; 95% confidence interval (CI) 3.00-4.57); in countries with low life expectancy at 60, CVD was associated with high treatment probability (OR 2.18, 95% CI 1.12-4.25); but not in countries with high life expectancy (OR 1.06, 95% CI 0.56-1.98).

    CONCLUSIONS: GPs' choice to treat/not treat hypertension in oldest-old was explained by differences in country-specific health characteristics. GPs in countries with high CVD burden and low life expectancy at age 60 were most likely to treat hypertension in oldest-old. Key Points  • General practitioners (GPs) are in a clinical dilemma when deciding whether (or not) to treat hypertension in the oldest-old (>80 years of age).  • In this study including 1947 GPs from 29 countries, we found that a high country-specific cardiovascular disease (CVD) burden (i.e. myocardial infarction and/or stroke) was associated with a higher GP treatment probability in patients aged >80 years.  • However, the association was modified by country-specific life expectancy at age 60. While there was a positive association for GPs in countries with a low life expectancy at age 60, there was no association in countries with a high life expectancy at age 60.  • These findings help explaining some of the large variation seen in the decision as to whether or not to treat hypertension in the oldest-old.

  • 11.
    Thulesius, Hans
    Lund university, Sweden;Region Kronoberg, Sweden.
    Work incentives, chronic illnesses and how sickness certificates are written affect sickness absence.2019In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 37, no 1, p. 1-2Article in journal (Refereed)
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