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Biomedical subjects

E Laerum

Publications and source records attributed to E Laerum.

At least 19 recordsLinked to original sources
PubMed1992

Continuity of care in general practice: effect on patient satisfaction.

OBJECTIVE: To evaluate the influence of continuity of care on patient satisfaction with consultations. DESIGN: Direct and episodic specific evaluation of patient satisfaction with recent consultation. SETTING AND SUBJECTS: A representative sample of 3918 Norwegian primary care patients were asked to evaluate their consultations by filling in a questionnaire. The response rate was 78%. MAIN OUTCOME MEASURES: The patient's overall satisfaction with the consultation was rated on a six point scale. Continuity of care was recorded as the duration and intensity of the present patient-doctor relationship and as patients' perception of the present doctor being their personal doctor or not. RESULTS: The multivariate analysis indicated that an overall personal patient-doctor relationship increased the odds of the patient being satisfied with the consultation sevenfold (95% confidence interval 4.9 to 9.9) as compared with consultations where no such relationships existed. The duration of the patient-doctor relationship had a weak but significant association with patient satisfaction, while the intensity of contacts showed no such association. CONCLUSION: Personal, continuous care is linked with patient satisfaction. If patient satisfaction is accepted as an integral part of quality health care, reinforcing personal care may be one way of increasing this quality.

Adolescent↗
PubMed1992

[Specialists without qualification. An interview study among general practitioners].

50 Norwegian doctors selected at random from the population of general practitioners who were neither recognized specialists nor enrolled in the specialist training programme, were interviewed by telephone about their own postgraduate training and their attitude towards the system of specialist training for general practitioners. Their educational activities and needs differed very little from those described in previous surveys among Norwegian practitioners. All the younger doctors were determined to enroll in the specialist training programme, but many thought that this might be difficult for family reasons. Most of the doctors above the age of 40 lacked the motivation for specialist training. The doctors expressed a variety of different attitudes towards the system of specialist training, including certain conflicts of loyalties and values.

Adult↗
PubMed1992

[Hospital training--for good and for evil. An interview study among general practitioners].

50 Norwegian doctors selected at random from the population of general practitioners who were neither recognized specialists nor enrolled in the specialist training programme, were interviewed by telephone about the need for postgraduate hospital training and the obstacles involved. Most of the doctors expressed a strong need for the education provided by such training. The most important obstacles to hospital training were personal domestic reasons, concern for the functioning of the practice and concern for the emotional problems the hospital work might cause. Strategies are suggested to make it easier, in practice and emotionally, to do hospital training.

Adult↗
PubMed1992

[What is a scientific publication? On science and cultural hierarchies in medical research].

Discussions have taken place about relevant criteria for "scientific publications". That such criteria exist is apparent when faculties of medicine issue guidelines for classification and quantification of scientific publications. In this article the authors focus on lack of clarity and consistency in the prevailing classifications; for example, that the language in which it is published appears to be essential as such. Different disciplines must of necessity have a variety of forms of publication, depending on the target groups for the different publications. It is argued that classification and evaluation of scientific publications should be based on a more nauanced academic standpoint.

Classification↗
PubMed1992

Fever in general practice. I. Frequency and diagnoses.

Although fever is a common symptom, few studies have broadly addressed this as a clinical problem in general practice. The aims of this study were to determine the frequency of fever among general practice patients in two rural municipalities in Norway, the diagnoses (according to ICHPPC-2-def.) of conditions causing fever, and the receptionist's role in the management of these problems. All the general practitioners and their receptionists within the study area participated. During 4 weeks throughout 1988 all individuals attending their general practitioner had their body temperature measured with an electronic thermometer (orally > or = 7 years, rectally < 7 years). Fever was defined as an oral body temperature > or = 37.5 degrees C (rectally > or = 38.0 degrees C in those < 7 years). All telephone applications, including telephone encounters for fever, were recorded. Fever was detected in 80 (5%) of a total of 1610 direct encounters: 36% of those below 7 years of age (n = 70) were febrile. One-third of the total encounters for fever were telephone encounters (n = 36), of which 30% were managed by the receptionists. A wide range of diagnoses were made, most of which were associated with infectious diseases. The distribution of the diagnoses of primary care patients with fever is different from those admitted to hospital for fever of unknown origin. General practitioners and their receptionists should consider fever a diagnostic challenge, especially when the patient is handled over the telephone.

Adolescent↗
PubMed1992

Fever in general practice. II. Reasons for encounter, management and duration of fever conditions.

A sample of 80 direct and 36 telephone encounters for fever was established in 1988 as part of a Norwegian study on fever as a clinical problem in general practice. Reasons for encounter (ICPC) and clinical examinations were recorded along with clinical laboratory tests, treatment, management and follow up (IC-Process-PC). The doctors assessed the diagnostic process by means of visual analogue scale. Duration of the fever conditions was estimated through a postal questionnaire. Patients with direct encounters presented a wide range of reasons for the encounters. Fever was the most frequent single presenting complaint (31%). The general practitioners put major emphasis on the clinical examinations. They prescribed drugs in 68% of the direct encounters. Seventy per cent of the prescriptions were general systemic anti-infectives. Penicillin accounted for 58% of antibiotics. Six (8%) patients were hospitalized, and three (4%) were referred to a specialist. The mean time until complete recovery was 15 days for direct and 19 days for telephone encounters. Fever may be a sign even when it is not a presenting complaint. Major emphasis is probably put on the clinical examination of febrile patients because of the complexity of symptoms and the wide range of diagnoses associated with fever.

Anti-Infective Agents↗
PubMed1992

Factors provoking lower urinary tract infection in women.

Our aim was to evaluate possible risk factors, other than sexual activity, for urinary tract infection (UTI) in women. A case-control study was designed. 50 cases and 50 controls were included. A larger fraction of cases than controls reported that episodes of the following preceded the UTI: voluntary deferred voiding (Odds ratio 5.0, 95% confidence interval 1.7; 20.1), cold hands (4.7, 1.3; 25.3), cold feet (5.8, 2.0; 22.8) and cold buttocks (5.5, 1.2; 51.0). Cold body parts should be further evaluated as a possible risk factor for UTI in UTI-prone women.

Acute Disease↗
PubMed1992

Age and sex: underestimated selection criteria for referral to x-ray examination of the colon?

An analysis was made of 2416 consecutive patients who underwent a double-contrast barium enema at the Central Roentgen Institute in Oslo. Age, sex, and radiological findings were registered. The age and sex distribution among patients consulting in general practice and in our study was surprisingly similar. This suggests that age as a risk factor for colorectal neoplasms did not play a prominent role among the referring doctors. Colorectal cancer was more frequent in males (4%) than females (2%) (p = 0.03). Odds ratio adjusted for age was 2.1 (1.3-3.8). This may be due to few examinations performed in old age, and different patient behaviour when experiencing colorectal symptoms. The overall polyp frequency was 11%. The frequency increased significantly from the age group 40-49.

Adult↗
PubMed1992

Symptomatic lower urinary tract infection induced by cooling of the feet. A controlled experimental trial.

We conducted an open, non-randomized experimental study as a first step to find out whether cooling of the feet may cause symptomatic lower urinary tract infection (UTI) in cystitis-prone women. Twenty-nine healthy women, aged 19-68 (mean 42.5) years, who had had three or more symptomatic episodes of UTI during the previous 12 months were included. They registered symptoms and carried out a strip urinalysis at each urination during a control period of 72 hours. Their lower legs and feet were then immersed in increasingly cold water for 30 minutes. Another 72-hour period of registration followed. Six subjects developed acute distal urinary symptoms at a mean of 55 (95% confidence interval 50 to 61) hours after the cooling, compared with none in the control period. Five of the six had bacteriologically verified lower UTI (P = 0.03 v. the control period). Cooling of the feet seems to provoke symptomatic lower UTI in cystitis-prone women.

Adolescent↗
PubMed1992

Uric acid and chronic musculoskeletal complaints.

The relation between chronic musculoskeletal complaints and serum uric acid was examined in 737 men and 771 women (40-42 years old). The study is cross-sectional and part of the National Health Screening Service county studies in Norway. Both men and women with chronic musculoskeletal complaints had significantly higher s-urate means than persons without such complaints. Moreover, the prevalence of chronic musculoskeletal complaints (gout excluded) changed significantly across increasing s-urate levels also within the normal distribution of s-urate. Multivariate logistic regression analysis showed that the s-urate odds ratio for chronic complaints rose in a linear manner across these s-urate levels (adjusted for 12 other independent variables that may interfere with uric acid). Such a relation has not to our knowledge been previously described.

Adult↗
PubMed1991

Controlled trial of fasting and one-year vegetarian diet in rheumatoid arthritis.

Fasting is an effective treatment for rheumatoid arthritis, but most patients relapse on reintroduction of food. The effect of fasting followed by one year of a vegetarian diet was assessed in a randomised, single-blind controlled trial. 27 patients were allocated to a four-week stay at a health farm. After an initial 7-10 day subtotal fast, they were put on an individually adjusted gluten-free vegan diet for 3.5 months. The food was then gradually changed to a lactovegetarian diet for the remainder of the study. A control group of 26 patients stayed for four weeks at a convalescent home, but ate an ordinary diet throughout the whole study period. After four weeks at the health farm the diet group showed a significant improvement in number of tender joints, Ritchie's articular index, number of swollen joints, pain score, duration of morning stiffness, grip strength, erythrocyte sedimentation rate, C-reactive protein, white blood cell count, and a health assessment questionnaire score. In the control group, only pain score improved score. In the control group, only pain score improved significantly. The benefits in the diet group were still present after one year, and evaluation of the whole course showed significant advantages for the diet group in all measured indices. This dietary regimen seems to be a useful supplement to conventional medical treatment of rheumatoid arthritis.

Adult↗
PubMed1991

[Recurrent herpes labialis and secondary bacterial infection. A study among the employees at the Ulleval hospital].

Recurrent herpes labialis is a prevalent infection. We have investigated the annual incidence and some clinical aspects of the condition, and the frequency of probable superinfection among the staff at the largest hospital in Norway. Over a period of 12 months a total of 83 (67 females and 16 males) out of 3,565 persons with a mean age of 34.3 years experienced clinical recurrence of herpes labialis, giving an annual incidence of 23 persons with one or more eruptions per 1,000 employed. The mean recurrence rate was 4.8 episodes per year. UV-light was reported as a precipitating factor by 60% and psychological stress by 30%. Seven persons reported sick leave of one to three days' duration because of the most recent eruption. In 6/83 patients the probable pathogenic bacteriae (i.e. beta-hemolytic streptococci group A in one and Staphylococcus aureus in five cases) were isolated within the first 48 h after the skin lesions occurred. After 7-9 days S aureus was found in eight persons. The mean duration in days until all skin lesions had healed was the same in patients with or without probable superinfection. Recurrent herpes labialis does not seem to be a significant health problem among the staff of Ullevål Hospital. Probable superinfections appear to occur rarely and without significantly increasing morbidity.

Adult↗
PubMed1991

Fever: knowledge, perception and attitudes. Results from a Norwegian population study.

To investigate the layman's knowledge, perception and attitudes regarding normal body temperature, fever, infections and the effect of penicillin on virus infections a representative sample of the Norwegian population (619 women and 592 men over the age of 15) was interviewed in 1988 as part of a monthly national opinion poll. One-third thought body temperatures up to 40.5 degrees C to be life-threatening, but the results do not justify the application of the term 'fever phobia' as described in other studies based on non-representative samples. More respondents were afraid of viral infections (48%) than bacterial infections (9%), which may be due to the media focus upon the HIV/AIDS epidemic. Thirty-five per cent believed penicillin to be effective against virus infections. Educational programmes on fever should also include information about virus infections and their treatment.

Attitude to Health↗
PubMed1991

Fever: management and self-medication. Results from a Norwegian population study.

A representative sample of the Norwegian population was interviewed in 1988 as part of a monthly national opinion poll to investigate lay management and self-medication of fever. Six hundred and nineteen women and 592 men over the age of 15 were interviewed in their homes. Approximately one-fifth reported inappropriate measuring of body temperature. A variety of management and self-medication was found. In cases of common cold or influenza with fever, 35% would use antipyretics. Forty per cent would start to use antipyretics at a temperature below 39.0 degrees C. Forty-four per cent did not know any antipyretic brand names at all. The results indicate a need for more definite and consistent information to make fever management and self-medication more rational. Such information should be discussed and given by general practitioners, nurses at child welfare centers and pharmacists.

Adult↗
PubMed1991

Positive psychological and life-style changes after myocardial infarction: a follow-up study after 2-4 years.

An interview study of 84 males recruited from a post-infarction anticoagulant trial revealed a number of positive changes regarding life-style and factors related to quality of life 3-5 months after the index infarction. In the present study we investigated the extent to which such changes persist after 2-4 (additional) years. Seventy-four of 75 survivors responded to a postal questionnaire. The answers concerning the total life situation, as compared with the last month before the myocardial infarction, were as follows (response after 3-5 months in brackets): improved 29% (33%), unchanged/uncertain 47% (47%) and deteriorated 24% (20%). There were still appreciable positive changes at follow-up regarding smoking, physical activity, alcohol consumption and stress at work. Similar changes or a slight reduction were observed in previously reported positive scoring of factors related to quality of life. The same applied to the two General Health Questionnaire scorings. We conclude that positive changes in psychosocial and life-style factors as seen shortly after myocardial infarction generally seem to persist after 2-4 years.

Adult↗
PubMed1991

Bacteriological findings in urine specimens from women. Association with urinary tract symptoms and sampling methods.

Urine sampling techniques were recorded in 147 women who brought a sample of urine voided at home to the general practitioner's surgery. Seventy-two women had lower urinary tract symptoms, and 75 had no symptoms at all. Eighty-nine (61%) had taken a midstream specimen, 77 (52%) had cleansed the periurethral area, and 15 (10%) had held the labia apart during micturition. Combinations of these techniques were used by 71 women while 40 (27%) had used no specific technique. The bacterial content of the urine (defined as the number of different bacterial strains found) was not reduced by either cleansing or by taking a midstream specimen, but it was significantly reduced in the women who had held the labia apart during voiding (p less than 0.05). Urine samples from women with symptoms had significantly lower bacterial content than those from patients who were free of symptoms (p less than 0.01). Women should be encouraged to ensure the free flow of urine by holding the labia apart during urine sampling.

Adult↗
PubMed1990

Home-voided urine specimens in women. Diagnostic agreement with clean-catch midstream specimens.

One hundred and fifty women who brought a home-voided urine sample to a general practitioner were asked at the same consultation to provide another sample under controlled conditions. Seventy-three women had lower urinary tract symptoms and 77 were asymptomatic. The two samples were analysed for pyuria (greater than or equal to 5 leucocytes/HPF) and bacteriuria (greater than or equal to 10(4) v. greater than or equal to 10(5) cfu/ml). The agreement when diagnosing pyuria and bacteriuria was estimated by Kappa (K). The home-voided sample was taken with adequate sampling technique by only 12% of women. Moreover, its bladder incubation time was twice that of the surgery sample (5.4 h v. 2.4 h). There was, however, no difference in the distribution of pyuria or bacteriuria between the paired samples. Agreement, which was high for the diagnosis of pyuria (K = 0.80), was significantly lower for the diagnosis of bacteriuria (K = 0.52, P less than 0.01). A home-voided sample seems sufficient in the diagnosis of the dysuria-pyuria syndrome in women.

Adolescent↗