Biomedical subjects
Publications and source records attributed to Pål Gulbrandsen.
The present paper describes guidelines for the presentation of statistical analysis in manuscripts submitted to the Journal of the Norwegian Medical Association, in order to ensure a reasonable standard of statistic presentation in the journal. The paper is a supplement to the guidelines for authors in the journal and should not be used as replacement for statistics manuals.
BACKGROUND: Acute viral bronchiolitis is one of the most common causes of hospitalisation during infancy in our region with respiratory syncytial virus (RSV) historically being the major causative agent. Many infants with early-life RSV bronchiolitis have sustained bronchial hyperreactivity for many years after hospitalisation and the reasons for this are probably multifactorial. The principal aim of the present study was to investigate if children hospitalised for any acute viral bronchiolitis during infancy in our region, and not only those due to RSV, had more episodes of subsequent wheezing up to age seven years and reduced lung function at that age compared to children not hospitalised for acute bronchiolitis during infancy. A secondary aim was to compare the hospitalised infants with proven RSV bronchiolitis (RS+) to the hospitalised infants with non-RSV bronchiolitis (RS-) according to the same endpoints. METHODS: 57 infants hospitalised at least once with acute viral bronchiolitis during two consecutive winter seasons in 1993-1994 were examined at age seven years. An age-matched control group of 64 children, who had not been hospitalised for acute viral bronchiolitis during infancy, were recruited from a local primary school. Epidemiological and clinical data were collected retrospectively from hospital discharge records and through structured clinical interviews and physical examinations at the follow-up visit. RESULTS: The children hospitalised for bronchiolitis during infancy had decreased lung function, more often wheezing episodes, current medication and follow-up for asthma at age seven years than did the age matched controls. They also had lower average birth weight and more often first order family members with asthma. We did not find significant differences between the RSV+ and RSV- groups. CONCLUSION: Children hospitalised for early-life bronchiolitis are susceptible to recurrent wheezing and reduced pulmonary function by seven years compared to age-matched children not hospitalised for early-life bronchiolitis. We propose that prolonged bronchial hyperreactivity could follow early-life RSV negative as well as RSV positive bronchiolitis.
BACKGROUND: General opinion is that doctors are increasingly dissatisfied with their job, but few longitudinal studies exist. This study has been conducted to investigate a possible decline in professional and personal satisfaction among doctors by the turn of the century. METHODS: We have done a survey among a representative sample of 1,174 Norwegian doctors in 2002 (response rate 73 %) and compared the findings with answers to the same questions by (most of) the same doctors in 1994 and 2000. The main outcome measures were self reported levels of life satisfaction and job satisfaction according to the Job Satisfaction Scale (JSS). RESULTS: Most Norwegian doctors are happy. They reported an average life satisfaction of 5.21 in 1994 and 5.32 in 2002 on a scale from 1 (extremely dissatisfied) to 7 (extremely satisfied). Half of the respondents reported a very high level of general life satisfaction (a score of 6 or 7) while only one third said they would have reported this high level of satisfaction five years ago. The doctors thought that they had a higher level of job satisfaction than other comparable professional groups. The job satisfaction scale among the same doctors showed a significant increase from 1994 to 2002. Anaesthesiologists and internists reported a lower and psychiatrists and primary care doctors reported a higher level of job satisfaction than the average. CONCLUSION: Norwegian doctors seem to have enjoyed an increasing level of life and job satisfaction rather than a decline over the last decade. This challenges the general impression of unhappy doctors as a general and worldwide phenomenon.
BACKGROUND: The purpose of this paper is to describe the development and evaluation of the patient experiences questionnaire (PEQ) for somatic outpatients. MATERIAL AND METHODS: Literature review, focus groups, interviews with patients and clinicians, and pre-testing of questionnaire items were used. A postal survey among 12,525 patients of 23 outpatient clinics for adults in two Norwegian health regions was conducted during 2003. RESULTS: 6824 (55%) patients responded to the questionnaire. Low levels of missing data suggest that the questionnaire is acceptable to patients. Factor analysis of items deemed applicable to all patients produced three scales: clinic access (2 items), communication (6 items) and organisation (4 items). The remaining items contributed to the hypothesised scales of information (6 items), hospital standards (3 items), and pre-visit experience (3 items). With the exception of the pre-visit experience scale, the levels of Cronbach's alpha met the criterion of 0.7. The great majority of the results of validity testing were as hypothesised. Correlations between the scales ranged from 0.30 (clinic access and information) to 0.72 (communication and information). As hypothesised, scores were significantly related to responses to questions about overall satisfaction, general health, and age. INTERPRETATION: The outpatient experience questionnaire is a self-administered instrument that includes the most important aspects of experience from the outpatients' perspective. Three core dimensions for use in a shortened version have been identified.
OBJECTIVE: To explore the level of job satisfaction among general practitioners (GPs) and to compare it with that of hospital doctors. DESIGN: Postal questionnaire among Norwegian doctors in 2002 and similar data from 1994 and 2000 for most of the respondents. MATERIAL: A total of 295 GPs out of 1174 doctors completed the questionnaire (73% response rate). Main outcome measures. Self-reported levels of job satisfaction according to the Job Satisfaction Scale (JSS). RESULTS: Norwegian GPs reported a high level of job satisfaction with a mean score on the JSS of 52.6 (10 is minimum and 70 maximum). The reported level of satisfaction was highest for their opportunities to use their abilities, cooperation with colleagues and fellow workers, variation in work, and freedom to choose own method of working. The GPs' level of job satisfaction remained stable in 1994, 2000, and 2004 in spite of major health reforms. GPs report a higher level of job satisfaction than hospital doctors. CONCLUSIONS: In spite of international discussions on unhappy doctors and doctors' discontent, Norwegian GPs do report a high and stable level of job satisfaction.
BACKGROUND: It has not been established whether birth plans are helpful or not for pregnant women. We tested an original Norwegian version of a birth plan that gives women much room for expressing their wishes and expectations in their own words. MATERIAL AND METHODS: A questionnaire survey to pregnant women who used the Norwegian birth plan during the period 1 February through 30 September 2002, all living in five communities within one county and planning to give birth at a nearby university hospital. A control group of women living in other communities who gave birth at the same hospital were given a copy of the birth plan in the maternity ward. We asked about their total experience, feeling of safety, and the quality of information given, specifically during each of these stages: pregnancy, childbirth and the neonatal period. Respondents also evaluated the use of the birth plan, those in the control group with hypothetical questions. RESULTS: 189 out of 283 (67%) in the intervention group and 111 out of 271 (41%) in the control group responded. The groups were not significantly different with regard to age, proportion of married women, educational attainment, parity, or native tongue. Women in the intervention group felt significantly less safe at childbirth than those in the control group. In both groups the women evaluated the information given about the neonatal period as significantly less satisfactory than the information about pregnancy and childbirth. The birth plan was evaluated positively, though women in the control group given hypothetical questions were more enthusiastic about it. INTERPRETATION: The Norwegian birth plan did not positively influence the experience of safety during pregnancy, childbirth, or the neonatal period.
BACKGROUND: Medical certificates form the basis for important decisions in society, e.g. the issuing of a driver's licence or the granting of a disability pension. We wanted to know how often doctors deliberately write favourable certificates as seen from the patient's point of view, and why doctors do so. MATERIAL AND METHODS: Questionnaire survey to a representative sample of 1605 Norwegian doctors. Doctors who answered yes to the question above gave information about the frequency of such writing of various types of certificates and their reasons for doing so. RESULTS: 1175 (73%) doctors responded. 39% confirmed deliberately writing in favour of their patients. For most types of certificates, a frequency of less than once a year was most common. 55% admitted writing favourably in disability pension certificates more than once a year, 69% so in referrals. The most common reasons given were securing just treatment and quick access to treatment. Many doctors emphasised that by answering yes, they meant that they were indeed writing expert judgments based on correct facts. INTERPRETATION: Medical certificates deliberately written in favour of the patient is not uncommon. This should lead to a critical discussion of the need for such certificates and medical diagnoses as a basis for resource allocation, rather than the tightening of control over the practice of doctors.
BACKGROUND: Doctors' ability to predict the duration of their patients' certified sickness absence is important for follow-up efforts aimed at patients with increased probability of long-term absence. OBJECTIVES: The aim of this study was to examine the accuracy of doctors' predictions of their patients' sickness absence status 4 weeks ahead, and which factors were associated with it. METHODS: A questionnaire survey was carried out in primary health care concerning 796 patients certified sick within 140 days after the start of absence. The episodes of absence were labelled short-standing (up to 2 weeks) and long-standing (from 3 to 20 weeks), at the time of consultation. The doctors' prediction of the patients' absence status 4 weeks ahead, diagnoses, work ability, clinical information sources used and the presence of non-medical factors that could have influenced the doctors' work ability assessments were collected. The predictions were compared with the patients' absence status 4 weeks later by positive predictive values (PPVs) for the statements 'returned to work' and 'still certified sick'. Factors associated with the accuracy of the predictions were analysed by multiple logistic regression analyses. RESULTS: The doctors accurately predicted return to work in 84% [95% confidence interval (CI) 79-87] of the cases in short-standing episodes, and in 53% (43-62) in long-standing episodes. The corresponding PPVs for still certified sick were 72% (62-80) and 91% (85-94). In short-standing episodes, the doctors' probability of making accurate predictions was higher for respiratory disorders [odds ratio (OR) 2.84; 95% CI 1.36-5.90], than for the reference category 'all other disorders', and lower for mental disorders (0.46; 0.24-0.89). In long-standing episodes, the probability was lower for musculoskeletal disorders (0.33; 0.12-0.86) and injuries (0.12; 0.03-0.48). Neither the age nor gender of patients or doctors, nor the degree of work ability reduction, nor other factors were associated with the accuracy of the predictions. CONCLUSIONS: The doctors' predictions were highly accurate for return to work in short-standing episodes, and for still certified sick in long-standing episodes. Diagnoses were associated with the accuracy; other factors, including the doctors' work ability assessments, were not.
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BACKGROUND: The alcohol drinking habits in the Norwegian population has changed. We do not know whether this applies to doctors as well. In general, a possible association between job satisfaction and alcohol drinking habits has not been shown for doctors. MATERIAL AND METHODS: Cross-sectional questionnaire surveys of representative samples of Norwegian doctors in 1985, 1993 and 2000. RESULTS: 33% of the doctors drank alcohol more often than once weekly in 2000, versus 22% in 1985. The pace of change accelerated between 1993 and 2000, compared to 1985 to 1993. The proportion of doctors with a modified AUDIT score of 6 or more increased from 12% to 15% from 1993 to 2000, and the proportion with a modified AUDIT score of 13 or more increased from 0.6% to 1.3%. We found no correlation between job satisfaction and drinking habits. INTERPRETATION: The change in drinking habits among Norwegian doctors is similar to the change in the population at large. More frequent moderate consumption of alcohol has not been accompanied by less frequent consumption of larger amounts of alcohol.
BACKGROUND: Doctors increasingly act as gatekeepers. We have studied the effect that this function has on the doctors themselves. MATERIAL AND METHODS: Analysis of 24 questions from large surveys of representative samples of Norwegian doctors in 1993 and 2000. RESULTS: Six out of seven doctors sometimes or often met unrealistic demands from patients. More than one third experienced stress because of patient expectations about help for non-medical problems. Nearly 50% had adjusted medical certificates in order to help the patient. More than 50% sometimes or often gave more weight to patients' wishes than to their own medical judgement. 86% had chosen to come in for work themselves when they would have certified as sick a patient with the same symptoms and working situation. The proportions were significantly smaller among older doctors and doctors with a high level of job satisfaction. INTERPRETATION: The gatekeeper role has important influence on doctors' job satisfaction. A possible generation effect may imply that society will meet problems more often in the future when assigning gatekeeper functions to doctors.
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BACKGROUND: The trends in medical publishing are towards electronic versions and the use of the English language. The objective of this study was to compare general practitioners' ability to retain information when reading on paper versus on screen, and in their mother tongue versus in the English. MATERIAL AND METHODS: Randomized controlled trial of 114 Scandinavian general practitioners. They read a review article for 10 minutes either on paper/in English, on screen/in English, on paper/in their mother tongue, or on screen/in their mother tongue. Afterwards they completed a questionnaire with six open questions from the article. The main outcome measure was sum score on a scale from 0 (no correct answers) to 13 (all questions answered correctly). RESULTS: We found no difference between readers of paper and screen versions (median (interquartile range) 4 (2-6) vs. 4 (2-5), p = 0.97). Those who read their mother tongue scored significantly higher than those who read English (4 (3-6) vs. 3 (2-4), p = 0.01). INTERPRETATION: The medium (paper vs. screen) does not influence the ability of general practitioners to retain medical information. Doctors best retain medical information when reading it in their mother tongue.
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CONTEXT: To compare family physicians' ability to retain information when reading a review article on paper vs on screen, and in their mother tongue vs in English. METHODS: Randomized trial of 114 Scandinavian family physicians who read a review article in October or November 2000 from the Journal of Trauma for 10 minutes either on paper and in English, on screen and in English, on paper in their mother tongue, or on screen in their mother tongue. To assess comprehension, they immediately completed a questionnaire with 6 open questions about 13 key facts from the review article. Sum score was on a scale from 0 (no correct answers) to 13 points (all questions answered correctly). RESULTS: There was no significant difference between readers of paper vs screen versions, with a median (interquartile range [IQR]) of 4 (2-6) vs 4 (2-5), respectively (P =.97). Physicians who read in their mother tongue scored significantly higher than those who read in English, with a median (IQR) of 4 (3-6) vs 3 (2-4) (P =.01). CONCLUSION: The medium (paper vs screen) did not influence the ability of family physicians to retain medical information. They best retained medical information when reading in their mother tongue.
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