Comparison of phenoxymethylpenicillin, amoxicillin, and doxycycline for erythema migrans in general practice. A randomized controlled trial with a 1-year follow-up.

OBJECTIVES: To compare the three most commonly used antibiotics for erythema migrans (EM) in Norwegian primary care. METHODS: A randomized, parallel, controlled trial was carried out. Treatments were open to the patients, but blinded for the GPs and investigators. Patients eligible for inclusion were aged ≥18 years and clinically diagnosed with EM. Block randomization was processed in blocks of six. Patients were assigned to receive one of three antibiotic treatments for 14 days: phenoxymethylpenicillin (PCV), amoxicillin, or doxycycline. The primary outcome was the duration of EM in days in the three treatment groups. Patients kept a diary for the 14 days of treatment, in which they registered concomitant symptoms and side effects. The patients consulted their GP after 14 days of treatment and had a 1-year follow-up to monitor any development of disseminated Lyme borreliosis (LB). EMs with a duration of more than 14 days were followed until resolution. ClinicalTrials.govNCT01368341 and EU Clinical Trials Register 2010-023747-15. RESULTS: One hundred and eighty eight patients (PCV: n = 56, amoxicillin: n = 64, doxycycline: n = 68) were included by 44 Norwegian general practitioners (GPs) from June 2011 to November 2013. Follow-up was completed by December 2014. The median duration of EM was altogether 14 days (range 3-293). For the PCV group median duration was 14 days (range 5-91), for amoxicillin 13 days (range 4-179) and for doxycycline 14 days (range 3-293). The duration of EM did not differ significantly between the three antibiotic groups (p 0.277). None of the patients developed disseminated LB within the 1-year follow-up. CONCLUSIONS: We did not find 14 days of PCV, doxycycline, and amoxicillin treatments to differ in effectiveness or safety in the treatment of clinically diagnosed EM in primary care.

Work ability and duration of certified sickness absence.

AIMS: The aim of this study was to examine the association between assessed work ability and the duration of certified sickness absence. METHODS: A total of 549 patients and 52 doctors provided questionnaire data about 549 episodes of absence. The episodes were classified as new, one month, or three months according to their duration at the time of questionnaire completion. Their duration after that was used as outcome. Uni-and multivariate Cox regression analyses were performed. RESULTS: In the multivariate analyses, a "very much reduced" work ability assessed by patients was associated with a longer duration than a "moderately reduced" work ability, in both one- and three-month episodes. Musculoskeletal and psychological disorders were associated with a longer duration, and respiratory disorders with a shorter duration than other disorders in new episodes. Patient age above 50 years was associated with a longer duration than lower age in new and three-month episodes. The doctors' use of referral and tests in the consultations, and the presence of non-medical factors as judged by the patients, were associated with a longer duration than the absence of those factors in new episodes. The patients' degree of job satisfaction, and non-medical factors as judged by doctors. were significantly associated with duration only in univariate Cox regression analyses in new episodes. Work demands were not significantly associated with duration in any of the analyses. CONCLUSIONS: Work ability assessed by patients may be a useful prognostic indicator of duration in prolonged episodes of certified sickness absence. Further studies using other outcomes, such as disability pensioning, would be of interest to enlighten the concepts of work ability.

Work ability assessed by patients and their GPs in new episodes of sickness certification.

BACKGROUND: Sickness certification legislation demands that work ability is reduced due to disease or injury. Most sickness certificates are issued by GPs. Assessment of work ability might introduce conflict in the doctor-patient relationship. OBJECTIVES: The aim of this study was to compare the level of work ability assessments by patients and their GPs in new episodes of sickness certification, and to explore how medical conditions and work demands are associated with the assessments. METHODS: Forty nine GPs supplied data about 408 patients certified sick <8 days before questionnaires were filled in. A total of 268 (66%) patients completed corresponding questionnaires. Patients and GPs independently answered the following question using a five-point scale: "To what degree is your (the patient's) ability to perform your (his or her) ordinary, remunerative work reduced today?" RESULTS: Work ability was assessed by patients as very much or much reduced in 66%, moderately reduced in 23% and not much or hardly reduced at all in 11% of the cases. Corresponding assessments made by GPs were 71, 27 and 2%. Patients and GPs agreed well on their assessments (+/- 1 answer category) in 81% (216/266) of the cases. The patients assessed work ability as more reduced the more stressful or physically strenuous their jobs were, and the older their GPs were. The GPs assessed work ability as more reduced the more their assessments were based on clinical findings. CONCLUSIONS: The agreement between work ability assessments made by patients and GPs was high, despite patients' assessments being associated with work demands and GPs' with medical conditions.

[Work ability and gender--physicians' assessment of sick-listed patients]. / Arbeidsevne og kjønn--legers vurderinger av sykmeldte.

Medical assessments might be influenced by the patient's gender and work situation. This article explorers the relationship between physicians' assessments of work ability in sick-listed patients, and gender of the sick-listed and the physicians. We conducted a questionnaire survey among 52 primary care physicians and 442 of their sick-listed full-time employed patients in Aust-Agder county. The relationship between physician assessment of the patients' work ability and gender were analysed by full/part-time sick-leave, new/extended sick-leave, patient's workload, and the physician's gender. Multivariate analyses were done in two-level logistic regression models. 60% of sick-listed women were assessed as having "very much" or "much" reduced work ability, against 71% of sick-listed men (p < 0.01). Women received part-time sickness certification more often than men, 27% vs. 11% (p < 0.001). These relationships were only found for extended sick-leaves, and were significant also after adjustment for physician's gender and patient work-load. Male physicians assessed work ability as more reduced among sick-listed men than among sick-listed women. Primary care physicians assessed work ability as less reduced among women than men. Women more often received part-time sickness certification. Possibly, the physicians' gender influenced their assessment of work ability, but this should be confirmed by more studies.

[Accident in Vågå in 1988]. / Ulykker i Vågå 1988.

All accidents treated by the Primary Health Services in Vågå Municipality in 1988, were registered. There were altogether 498 accidents (124 accidents per 1,000 inhabitants per year). 418 injured persons were treated by the local health service, 80 were referred to hospital. The major mechanism of injury was falling (38%). The accidents occurred most frequently at home (38%), at the sports-ground/outdoors (23%) or at work (17%). 11 injuries were very serious, none were lethal. 44 occurred during skiing. Our work to prevent accidents will give priority to: the mother and child clinic; environmental health; skiing accidents.

[Hemoglobin, sedimentation and community health legislation. Frequency of tests and fees at the Vaga community health center during 1983-87]. / Hemoglobin, senkning og kommunehelseloven. Prøvehyppighet og avlønning ved Vågå Helsesenter 1983-87.

On the basis of laboratory records and doctors' list of appointments, we analyzed the number of hemoglobin tests and sedimentation rates performed at Vågå community health centre during the period 1983-87. In 1983 the doctors worked on a "fee for service" basis. Since 1984 they have been paid a fixed salary. Individual doctors showed little variation in their use of tests, but there were considerable differences between doctors. The average number of tests per patient was stable and seemed independent of how the doctors were reimbursed.