DSAMís publikationsinformation om seneste resultater inden for almenmedicinsk forskning i Danmark.

Care for Overweight Children Attending the 5-year Preventive Child Health Examination in General Practice

Andersen MK, Christensen B, Søndergaard J.
Fam Pract. 2012 Aug 29.

Formålet med studiet var at analysere praktiserende lægers håndtering af klinisk vurderet overvægt i forbindelse med femårs børneundersøgelsen. De praktiserende læger indsamlede data på 1138 børn hvoraf  171 af lægerne blev vurderet som værende overvægtige. Håndteringen blev analyseret i forhold til tiltag foreslået i DSAM’s kliniske vejledning på området. Hos 58% af de børn som lægerne vurderede til at være overvægtige, blev forældrene ikke delagtiggjort i lægens overvejelser omkring barnets vækst. Kun hos et fåtal blev der lavet en aftale om opfølgende konsultation. Vejledningen om opsporing og behandling af overvægt hos førskolebørn blev sjældent anvendt og dennes anbefalinger angående vurdering af formodede årsager til overvægten blev kun fulgt i mindre grad. Selv hos de børn som lægerne vurderede til at have en vægt meget over normal blev der ikke initieret videre udredning af eventuelle tilgrundliggende lidelser eller risikofaktorer forårsaget af overvægten. Der synes således at være et potentiale for forbedring af overvægtshåndtering ved femårs børneundersøgelsen.

Abstract
Objective. The purpose of this study was to analyse general practitioners’ (GPs) care for children with a weight-for-height above normal based on the GPs’ clinical evaluation, that is, ‘GP-assessed overweight’.
Design. This study is a cross-sectional survey targeting GPs’ care for children with GP-assessed overweight at the 5-year preventive child health examination (PCHE).
Results. Out of 1138 children attending the 5-year PCHE, 171 were assessed overweight by the GP. According to the Danish body mass index (kg/m2) growth charts, 147 children were overweight. The GPs addressed their concern about the child’s weight to the parents in 58% of the 171 cases with GP-assessed overweight. The national guideline was reported consulted in 6% of the cases. Diet, physical activity and dispositions were evaluated by the GPs in 68%, 57% and 34% of cases, respectively. An appointment for a follow-up was made in 12% of cases.
Conclusion. Various care activities were carried out for most children with GP-assessed overweight at the 5-year PCHE. However, the GP did not raise concern about the child’s weight with the parents in almost one third of the children. It seems that there is a potential for improving the overweight care at the 5-year PCHE beginning with the involvement of the parents.
Key words. Child overweight, general practice, preventive child health examinations

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Evaluation of general practitioners' assessment of overweight among children attending the five-year preventive child health examination: a cross-sect

Andersen MK, Christensen B, Obel C, Søndergaard J.
Scand J Prim Health Care. 2012 Sep;30(3):176-82. doi: 10.3109/02813432.2012.704811

Formålet med undersøgelsen var at evaluere praktiserende lægers identifikation af overvægt hos børn ved femårsbørneundersøgelsen ved at sammenligne de praktiserende lægers kliniske vurdering af overvægt med overvægt defineret i forhold til pædiatriske standarddefinitioner for BMI. Praktiserende læger i Region Midtjylland indsamlede data på 1138 børn i forbindelse med femårsbørneundersøgelsen.

30 % af børn, som var overvægtige ifølge BMI, blev vurderet til at være normalvægtige af deres praktiserende læge. Selv hos de børn, hvor BMI blev anvendt i vurderingen af dets vægtstatus, var der ikke fuld overensstemmelse imellem lægens vurdering og BMI. Hos børn, hvor lægen eller dennes kollega tidligere havde observeret abnorm vægtudvikling, var der større overensstemmelse imellem lægevurderet vægtstatus og BMI-definerede vægtstatus. Brug af BMI og journalnotater må formodes at kunne forfine praktiserende lægers vurdering af overvægt hos børn.

Abstract

Objective.To evaluate general practitioners’ (GPs’) assessment of potential overweight among children attending the five-year preventive child health examination (PCHE) by comparing their assessment of the children's weight-for-stature with overweight defined by body mass index (BMI) according to paediatric standard definitions.
Design. A cross-sectional survey. Data were obtained from a questionnaire survey of children's health in general and their growth in particular.
Setting:The five-year preventive child health examination (PCHE) in general practice in the Central Denmark Region.
Subjects:Children attending the five-year PCHE in general practice, regardless of their weight status.
Main outcome measures:Pediatric standard definitions for childhood overweight based on BMI were used as the gold standard for categorizing weight-for-stature. Identification of overweight was analysed with regard to sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the GPs’ assessment of weight-for-stature.
Results:A total of 165 GPs conducted 1138 PCHEs. GPs assessed that 171 children had a weight-for-stature above normal. Use of the Danish Standards (DS), i.e. the Danish national growth charts for BMI, as the gold standard yielded a sensitivity of 70.1% (95% CI 62.0–77.3) and a specificity of 92.4% (95% CI 90.6–93.9). The sensitivity was influenced by the GPs’ use of BMI and the presence of previous notes regarding abnormal weight development.
Conclusion:At the five-year PCHE almost one-third of overweight children were assessed to be normal weight by GPs. Use of BMI and presence of notes on abnormal weight in medical records were positively associated with a higher identification. Hence, utilization of medical record data and BMI charts may refine GPs’ assessment of childhood overweight.
Key words: Assessment, children, Denmark, general practice, overweight, preventive child health examination

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Self-Management in Daily Life with Psoriasis: An Integrative Review of Patient Needs for Structured Education (Review Article)

Artiklen undersøger faktorer, der kan influere på unge psoriasispatienters behov for patientundervisning. På baggrund af fundene udvikledes en model, der viser, at alder ved debut, personlige forhold, herunder sygdomsopfattelse, samt selvoplevet belastning ved at have psoriasis er nogle af de faktorer, der formentligt skal adresseres ved planlægning af patientundervisning. Næste studie omhandler kvalitative interviews med målgruppen. Vi kan allerede nu se, at det er en gruppe, der er svært belastet, når de kommer på specialafdelingerne. Sidst skal vi så lave en model for patientundervisning og pilotteste denne.

Abstract

The aim of this integrative review is to identify and discuss patient needs for education to support self-management in daily life with psoriasis. As psoriasis increasingly gains recognition as a serious chronic autoimmune skin disease with long-term impairment on the life course, and not mainly a cosmetic problem, nurses are highly challenged to develop efficient education to support patient self-management. The paper includes five stages: (1) problem identification, (2) literature search, (3) data evaluation, (4) data analysis and synthesis, and (5) presentation, based on theoretic scaffolding around the concept “need.” Nineteen of 164 original papers within nursing, medicine and psychology, and reflecting patient perspective were included. To capture the patients’ cultural understanding of the implications of the disease and care, we developed an inter-level model indicating that self-experienced burden of disease and its visibility, personal conditions such as illness perception, and the patient’s age at onset time are high-impact factors that should be addressed in future structured patient education programmes. The research on patient needs has hitherto focused on adults, but the problems and vulnerability associated with having a chronic and visible disease during adolescence must be acknowledged, and patient education initiatives designed for this young group are recommended.

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Associations between symptoms, clinical findings and the short-term prognosis among children with otitis media: A cohort study

Ryborg CT, Søndergaard J, Lous J, Munck A, Larsen PV, Thomsen JL.
Int J Pediatr Otorhinolaryngol. 2012 Nov 29. pii: S0165-5876(12)00595-2.  
doi: 10.1016/j.ijporl.2012.10.023.
Electronic address: ctryborg@health.sdu.dk

Abstract

OBJECTIVE: Otitis media (OM) is a common childhood disease and a frequent reason for seeking medical care in general practice. Only few studies have focused on what happens after diagnosis and initial treatment of OM. In particular, there is a lack of research on how different patient- and disease-related factors influence the course of OM. The aim of this study was to analyze to what extent symptoms at the time of initial diagnosis are associated with the short-term course of otitis media.

METHODS: Cohort study in general practice comprising 747 children between 0 and 7 years with a new ear symptom. At the first consultation the GPs registered symptoms, results of otoscopy and tympanometry, together with diagnosis and treatment. The children were followed up four weeks later.

RESULTS: Sleep problems at inclusion are statistically significant associated with having one or more symptom after four weeks in children between 0 and 2 years (OR: 2.02 (95% confidence interval (CI): 1.24-3.31)).

If the result of tympanometry is a flat curve, the OR for being referred is 3.24 (CI: 1.61-6.55) in children between 0 and 2 years compared to children without a flat curve. The OR for being referred in children between 2 and 7 years with a flat curve is 8.94 (CI: 4.18-19.11) when compared to children without a flat curve.

CONCLUSION: Sleep problems at inclusion were the only symptom statistically significant associated with having one or more symptoms after four weeks in children between 0 and 2 years.


Tympanometry in general practice: use, problems and solutions

Lous J, Ryborg CT, Damsgaard JJ, Munck AP.
Fam Pract. 2012 Dec;29(6):726-32. doi: 10.1093/fampra/cms045. Epub 2012 Jul 31.

Abstract

OBJECTIVES: The diagnosis in children with middle ear symptoms is often difficult. Tympanometry is recommended as a supplementary diagnostic tool with a high predictive value for fluid or no fluid in the middle ear. The aim of this study was to examine how tympanometry was used in Danish general practice in 2009, to report common problems general practitioners (GPs) and GP nurses encounter in tympanometry and to evaluate the effect of a practical and theoretical course.

METHODS: A 1-year registration of the use of tympanometry in the Danish National Health Service Register in two regions with 40% of all Danish GPs and a survey among 197 participants in a course on diagnosis of otitis media and tympanometry in children were used. The Danish National Health Insurance covers 100% of GPs because they administer reimbursement for their activities, including tympanometry.

RESULTS: During the year 2009, 1433 GPs in 702 clinics were on the list. A total of 417 clinics performed 35 529 tympanometries. Some 285 clinics (40.6%) did not perform tympanometry in 2009. The active clinics performed

42 tympanometries per GP. A 1-day course improved the knowledge and practical skills of the participating GPs and nurses. A majority (70%) stated in a self-reported questionnaire that tympanometry often provided important information, especially about middle ear fluid, and 48% reported that tympanometry several times during the past 2 weeks had changed their management of a middle ear problem. Few had not used their tympanometer during the 2 weeks preceding the survey. The response rate was 72%.

CONCLUSIONS: The use of tympanometry is very skewed. A 6-hour course could improve GPs' care of patients with middle ear problems by using tympanometry.


The effect of preventive consultations on young adults with psychosocial problems: a randomized trial

Freund KS, Lous J.
Educ Res. 2012 Oct;27(5):927-45. doi: 10.1093/her/cys048. Epub 2012 Apr 2.

Abstract

Patients with many problems often face difficulties in modifying their behavior as desired. Uncovered basic needs may be an important barrier. This research tests the effect of patient-centered consultations for 20- to 44-year-old patients with multiple psychosocial and lifestyle problems. We focus on resources and barriers for obtaining self-chosen goals within life circumstances and lifestyle. At 28 general practitioners, 2056 patients aged

20-44 years were screened with a 33-item problem-score on resources, network, lifestyle and social conditions. The 30% who had most problems were invited to complete a more comprehensive questionnaire at home. Intervention was preventive consultation with a 3-month follow-up. A total of 495 patients were randomized. One-year questionnaire follow-up showed significant improvement in Short Form Health-related Quality of Life Mental

(MCS-SF12) in the intervention group (7.3) compared with the control group (3.0); the difference was 4.3 (95% confidence interval 1.6-7.0, P = 0.002).

The number of problems was reduced significantly more in the intervention than in the control group (1.8 versus 0.8, P = 0.03). Preventive consultation focusing on resources and barriers to self-chosen goals may improve MCS-SF12 and decrease the number of problems in patients with many psychosocial and lifestyle problems. This may be an indicator of improved specific self-efficacy and a key to lifestyle changes.


Social marginalization reduces use of ENT physicians in primary care

Lous J, Friis K, Vinding AL, Fonager K.
Int J Pediatr Otorhinolaryngol. 2012 Mar;76(3):370-3. doi:
10.1016/j.ijporl.2011.12.011. Epub 2012 Jan 5.
jlous@health.sdu.dk 

Abstract

OBJECTIVE: The aim of this study was to explore the association between social marginalization of the mothers and their children's use of the healthcare system and ear-nose-throat (ENT) physicians in the year 2009 in a region of Denmark.

METHODS: A regional register-based cross-sectional study of use of healthcare services among children (n=10,232) of marginalized mothers and children (n=101,582) of non-marginalized mothers in the North Denmark Region. Social marginalization was defined as having received public social benefits for more than 80% of the year.

RESULTS: Children with a marginalized mother had more chronic medical diagnoses (OR=1.22, 95% confidence interval 1.17-1.28), they had more frequently been in contact with their general practitioner during the year, and they used the healthcare system more often than children of non-marginalized mothers, except in the case of ENT specialists (OR=0.90, 0.85-0.95), and they had more seldom tympanostomy tubes inserted (OR=0.75, 0.66-0.87). The distance between ENT-clinic and place of residence of the patients had only a small effect on the use of ENT-physician, and only significant in the non-marginalized.

CONCLUSIONS: Children of marginalized mothers used the healthcare system more than other children, except in case of ENT-physicians. They had fewer ENT-consultations and had less frequently inserted tympanostomy tubes when they attended the surgery.


Invitation til disputatsforsvar

Onsdag d. 30. januar 2013 kl. 13.30 ved forskningslektor, ph.d. Annette Sofie Davidsen, Forskningsenheden for Almen Praksis, Københavns Universitet

Afhandlingen har titlen:
Samtale og forståelse i almen praksis – samt metoder til undersøgelse heraf.

Se invitationen

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