Effect of requiring a general practitioner at scenes of serious injury: A systematic review.

BACKGROUND: In Norway, each municipality is responsible for providing first line emergency healthcare, and it is mandatory to have a primary care physician/general practitioner on call continuously. This mandate ensures that a physician can assist patients and ambulance personnel at the site of severe injuries or illnesses. The compulsory presence of the general practitioner at the scene could affect different parts of patient treatment, and it might save resources by obviating resources from secondary healthcare, like pre-hospital anaesthesiologists and other specialized resources. This systematic review aimed to examine how survival, time spent at the scene, the choice of transport destination, assessment of urgency, the number of admissions, and the number of cancellations of specialized pre-hospital resources were affected by the presence of a general practitioner at the scene of a suspected severe injury. METHODS: We searched for published and planned systematic reviews and primary studies in the Cochrane Library, Medline, Embase, OpenGrey, GreyLit and trial registries. The search was completed in December 2017. Two individuals independently screened the references and assessed the eligibility of all potentially relevant studies. RESULTS: The search for systematic reviews and primary studies identified 5981 articles. However, no studies met the pre-defined inclusion criteria. CONCLUSION: No studies met our inclusion criteria; consequently, it remains uncertain how the presence of a general practitioner at the injury scene might affect the selected outcomes.

Manual work as predictor for disability pensioning with osteoarthritis among the employed in Norway 1971-1990.

BACKGROUND: Manual work is reported to be a risk factor for becoming a disability pensioner due to osteoarthritis. This association may be due to covariation with other variables. We wanted to assess if manual work remained a risk factor after adjusting for number of hours worked, income, level of education, gender and marital status, and if the risk associated with manual work was equal in the 1970s and the 1980s. METHODS: In a prospective study, data on all new disability pensioners with osteoarthritis in Norway during the two follow-up periods, 1971-1980 and 1981-1990, were analysed by logistic regression. The study include data on all subjects living in Norway and registered as 50-56 years old and employed either in the census collected in 1970 or in the census of 1980. RESULTS: Manual workers have nearly twice the probability of becoming a disability pensioner with osteoarthritis compared to professionals after adjusting for part-time work, income, level of education, marital status and gender. Adjusted for other risk factors, the probability of becoming a disability pensioner with osteoarthritis was three times higher in the 1980s compared to the 1970s. CONCLUSION: The relatively strong association between manual work and disability pensioning with osteoarthritis suggests difficulties in adjusting manual work patterns for a person with osteoarthritis, which may have increased during the study period as implied by the separate effect of the 1980s.

Socioeconomic factors and disability retirement from back pain: a 1983-1993 population-based prospective study in Norway.

STUDY DESIGN: A prospective observational study with an 11-year follow-up period was performed. OBJECTIVE: To investigate the influence of education and socioeconomic position on the incidence of permanent disability retirement from back pain. SUMMARY OF BACKGROUND DATA: Early retirement because of back pain is the extreme end point of a disabling process that is a great burden to the individual and costly for the society. Groups of employees at particular risk for permanent back pain disability need to be identified. METHODS: All employed men and women in Norway between the ages of 20 and 53 years in 1980 were included (n = 1,333,556). Outcome measures were disability retirement from inflammatory back pain (ICD-9 code 720) and noninflammatory back pain (ICD-9 codes 721 to 724). RESULTS: The 11-year cumulative incidence was 0.15% (n = 1990) for disability retirement from inflammatory back pain and 1. 64% (n = 21,829) for noninflammatory back pain and was somewhat higher in women than in men. Each year of formal education was independently associated with decreased risk for disability retirement from noninflammatory back pain (odds ratio [OR] = 0.78; 95% confidence interval [CI] = 0.77-0.79) and from inflammatory back pain (OR = 0.83; 95% CI = 0.81-0.86). Whereas disability from inflammatory back pain was moderately associated with socioeconomic status, there was a consistent upward trend in the association between disability retirement from noninflammatory back pain and lower socioeconomic position. The OR for unskilled workers was 3.1 (95% CI = 2.6-3.7) for men and 2.1 (95% CI = 1.7-2.5) for women, as compared with that of higher professionals. Stepwise analyses suggest that the effect of education is not mediated by socioeconomic status. CONCLUSIONS: The consistent upward trend in the relation of disability retirement to lower levels of education and socioeconomic position, even for inflammatory back pain, shows that factors related to the occupational and social environment play an important role in the disabling process. The stepwise, monotonic relation between socioeconomic position and disability retirement from back pain, even at the higher end of the socioeconomic scale, suggests that the relation between social class and back pain disability cannot be explained solely in terms of manual versus nonmanual jobs.

Becoming a disability pensioner with rheumatoid arthritis in Norway 1971-1990.

OBJECTIVE: Physically demanding occupations have been associated with becoming a disability pensioner with rheumatoid arthritis (DPRA), but not with the disease of RA. The association with becoming DPRA probably reflects that patients with RA have difficulties in maintaining employment in a physically demanding occupation. However, the attitudes of the employers concerning employment of persons with RA might vary. For example, the patient's age may influence the strength of the association between a physically demanding occupation and becoming DPRA. We assessed whether the association between the predictors and becoming DPRA was stronger for the youngest or the oldest age group. METHODS: The study was prospective with data on persons in Norway 30-56 years old either in the census of 1970 or 1980. All new cases of DPRA during the 2 followup periods 1971-80 and 1981-90 were identified and analyzed by logistic regression. RESULTS: For women the predictors employment, low level of education, and period ( 1981-90 compared to 1971-80) were more strongly associated with becoming DPRA for the youngest compared to the oldest persons, while manual work and part time work were not predictors of becoming DPRA. For men, all the predictors in the study were more strongly associated with becoming DPRA for the youngest compared to the oldest age group. CONCLUSION: The higher risk of becoming DPRA was associated with most predictors for persons aged 30-39 years than the group aged 50-56 years. Our results appear to indicate that the consequences of having RA in the labor market are greater for the youngest age group.