Chloramphenicol eye drops in the treatment of conditions indicative of maxillary sinusitis.

BACKGROUND: Our own clinical experience of general practice over the last 15 years has indicated that chloramphenicol eye drops may have a favourable effect on many patients troubled by symptoms indicative of acute maxillary sinusitis. We wanted to conduct a pilot study to test whether this observation could be verified. MATERIAL AND METHOD: Treatment with chloramphenicol eye drops or systemic peroral antibiotics was tested on patients with symptoms indicative of acute maxillary sinusitis. The patients were randomised to two groups, one of which received systemic peroral antibiotics, the other received chloramphenicol eye drops. RESULTS: A total of 33 patients were included in the trial--27 women and six men--15 of whom were randomised to the tablet group and 18 of whom were randomised to the chloramphenicol group. The patients who were treated with tablets experienced clear improvement after an average of 5.0 days, while patients who were treated with chloramphenicol eye drops, experienced improvement after 3.7 days (p = 0.047). Of the patients in the chloramphenicol group, 14 described improvement within three days, while this applied to only five patients in the tablet group. INTERPRETATION: Treatment with chloramphenicol eye drops appears to represent a treatment option for some patients with symptoms indicative of acute maxillary sinusitis. In the pilot study, the period of treatment before symptoms improved was shorter in patients who were given eye drops than in patients who were given systemic peroral antibiotics. These promising results give grounds to undertake studies on a larger scale.

Patient perspectives on the management of COPD and Type 2 Diabetes in general practice: an interview study.

BACKGROUND: The Danish healthcare system has undergone fundamental organisational changes. In recent years, treatment of most patients with chronic obstructive pulmonary disease (COPD) and type 2 diabetes (T2D) in Denmark has been transferred from specialised hospitals to general practices, and only the most complicated cases are treated at hospital outpatients clinics or are admitted. This transfer aimed to reduce costs without compromising quality of care and ensure that the treatment was managed by general practitioners (GPs) who had personal knowledge of the patient. In this paper, we explore patients' perceptions of the quality of care provided by their GPs. METHODS: A qualitative research study was conducted with semi-structured interviews of 24 informants; nine were diagnosed with COPD and 15 were diagnosed with T2D. Snowball sampling was used for recruitment. Data were analysed using systematic text condensation. RESULTS: The interviews revealed four main themes: 1) The informants perceived the quality of their treatment in general practice to be high due to their personal relationship with their GPs. 2) The informants valued their GP's knowledge about them, their lives, and their illnesses. 3) The informants expressed a high degree of satisfaction with the quality of care received in general practice. 4) The informants expressed that geographical distance to the general practice was of minor importance to them. CONCLUSION: The patients perceived that the quality of the care and treatment they received were high following the transfer of COPD and T2D treatment to general practice. A strong, trusting relationship between the GP and the patient and the increased availability of the GP both contributed to their satisfaction with the GPs' services.

General practitioners' perceptions of treatment of chronically ill patients managed in general practice: An interview study.

BACKGROUND: Patients with chronic conditions pose a major challenge to the Danish healthcare system. Since 2018, disease management programmes for patients with chronic obstructive pulmonary disease (COPD) and type 2 diabetes (T2D) were introduced in Denmark. Treatment in hospitals should be reserved for those patients who require specialised treatment. Hence, more patients with COPD and T2D fall within the general practitioners' (GPs) responsibility. OBJECTIVES: This study explores GPs' perceptions of their role as physicians responsible for the disease management programmes on COPD and T2D and their perceptions of the quality of care provided to these patient groups. METHODS: Between November 2019 and January 2020, we conducted semi-structured interviews with 14 GPs from the five regions of Denmark. We analysed the interviews using systematic text condensation inspired by Malterud's thematic analysis. RESULTS: The GPs stated that they have been managing the care of COPD and T2D patients for over a decade, and they considered the quality of care to be high. They believed that managing patient treatment pathways in general practice settings contributes to a heightened sense of security for the patient, mainly because of the long-standing and trusting relationship between the patient and GP. CONCLUSION: According to the GPs, they continue to play an important role as treatment coordinators to ensure coherence and high quality in treating patients with COPD and type 2 diabetes.

Alcohol use and physical health in adolescence: a general population survey of 8,983 young people in North-Trøndelag, Norway (the Young-HUNT study).

AIMS: To investigate the relationship between adolescents' alcohol use and physical health. DESIGN: A total population, cross-sectional survey of adolescents, aged 13-19 years, attending secondary or high school in Nord-Trøndelag County, Norway. 8,983 youths (91%) answered the Young-Hunt questionnaire in the 1995-1997 HUNT-survey. METHOD: Self-reported data mainly analyzed by logistic regression models. Findings 80% of the respondents had tried alcohol, and 29% reported more than 10 intoxications. Ill health perception was associated with frequent alcohol intoxications. Tension symptoms had the closest relationship to frequency of intoxications in both genders. Girls that frequently used health services had frequent alcohol intoxications. FUNDING: Central Norway Regional Health and the County Council of Nord-Trøndelag. CONCLUSIONS: There is a close association of physical health complaints and alcohol intoxication frequency in Norwegian teenagers. The study's limitations were noted.

[Fewer regular general practitioners participate in out-of-hours emergency services]. / Faerre fastleger deltar i legevakt.

BACKGROUND: The aim of the study was to determine whether the official numbers of regular general practitioners (GPs) participating in out-of-hours duty have been correct. METHOD: Data were collected from the Norwegian labour and welfare organisation's (NAV's) regular GP database. This is a database with information collected from Statistics Norway and the Norwegian Social Science Data Services. RESULTS: The study has revealed an error in one of the sources used by the national health authorities to evaluate the regular GP Scheme "Fastlegeordningen". Official figures indicate that the number of regular GPs who participate in out-of-hours duty increased with 5% the first three years after implementation of the regular GP Scheme (2001-2004). New analyses show that the number of regular GPs instead decreased with 12%. INTERPRETATION: Our study uncovers weaknesses with the quality assurance of data used by the health authorities to calculate the work force needed for out-of-hours duty. This misinformation may have prevented action needed to recruit regular GPs to work in the out-of-hours emergency services, as the problem has not been recognised.

Homeopathic care for the prevention of upper respiratory tract infections in children: a pragmatic, randomised, controlled trial comparing individualised homeopathic care and waiting-list controls.

OBJECTIVE: To investigate whether individualised treatment by homeopaths is effective in preventing childhood upper respiratory tract infection (URTI). METHODS: Open, pragmatic, randomised parallel-group trial with waiting-list group as control. One hundred and sixty-nine children below the age of 10 years, recruited by post from children previously diagnosed with URTI, were randomly assigned to receive either pragmatic homeopathic care from one of five homeopaths for 12 weeks or to a waiting-list control using self-selected, conventional health care. RESULT: There was a significant difference in median total symptom score in favour of homeopathic care (24 points) compared to the control group (44 points) (p = 0.026). The difference in the median number of days with URTI symptoms was statistically significant with 8 days in the homeopathic group and 13 days in the control group (p = 0.006). There was no statistical difference in the use of conventional medication or care between the two groups. CONCLUSION: In this study, there was a clinically relevant effect of individualised homeopathic care in the prevention of URTI in children.

Family medicine research: implications for Wonca.

The purpose of the article is to illustrate where in the lifelong curriculum of family medicine ought students, trainees, and family physicians learn about research in family medicine. The role of Wonca to promote this endeavor is discussed. I describe the recruitment and training programs for family physicians and state the implication for Wonca to promote family medicine research in the undergraduate curriculum, during residency, and in the graduate study programs for experienced medical doctors. I describe the possible research fields in family medicine and the special methods that can be used to get reliable and valid answers to relevant questions in family medicine. It is time for Wonca to develop a policy for family medicine research by developing a strategy to promote it. This can be done through a Wonca policy statement about family medicine research in the medical curriculum. Wonca can, in collaboration with national colleges, arrange workshops and master classes in research; create scholarships and fellowships for international family medicine researchers; influence journals and international bodies, such as the World Health Organization, governments, and colleges about the necessity of good family medical research; describe ethical guidelines for international primary care research; and create a number of databases for researchers to use.

The use of simplified constitutional indications for self-prescription of homeopathic medicine.

OBJECTIVES: To develop simplified constitutional indications for homeopathic medicines so that parents of children with recurrent upper respiratory tract infection (URTI) could choose homeopathic medicines for their children more "accurately", and to subsequently evaluate if these choices match the prescriptions of trained homeopaths. DESIGN AND SETTING: To initially select the most commonly used homeopathic medicines for URTI, data from a survey of 1097 patients visiting 80 different Norwegian homeopaths were used. A simplified constitutional indication was then developed for the three homeopathic medicines most frequently prescribed for recurrent URTI and otitis media. The constitutional indications were developed by a group of five homeopaths and were then sent to 20 homeopaths for further evaluation. To evaluate the parents' choice of homeopathic medicines compared to the prescription by trained homeopaths, a group of 11 randomly selected homeopaths were asked to participate. They recruited parents of 70 child patients. RESULT: By using simplified constitutional indications for the three most commonly prescribed remedies, Calcarea carb, Pulsatilla and Sulphur, parents were able to choose the same homeopathic medicine as homeopaths' prescribed for 55% (95% CI 43-67) of children with URTI. There was excellent agreement between parents' choice and homeopaths' prescription for the three medicines (Kappa of 0.77, p<0.001). CONCLUSION: Simplified constitutional indications can be used to improve the quality of the choice of homeopathic medicines purchased over the counter (OTC) for self-treatment.

Randomized controlled trials on treatment by homeopaths and self-treatment with homeopathic medicines: design and protocol.

BACKGROUND AND OBJECTIVE: This study investigates (1) whether treatment by homeopaths is more efficacious than self-selected conventional health care and (2) whether self-treatment with self-selected homeopathic medicines is more efficacious than placebo in preventing childhood upper respiratory tract infections (URTIs). DESIGN: A four-arm randomized controlled trial involving two independent investigations, one open and pragmatic (evaluating the effect of treatment by homeopaths including homeopathic medicines) and one double-blinded (evaluating the effect of self-treatment with homeopathic medicine). PATIENTS: The planned sample size is 420 children below the age of 10, recruited by a postal invitation to all children diagnosed with URTIs when attending a casualty department in Trondheim, Norway. INTERVENTIONS: The children are randomly assigned to receive either (1) self-selected homeopathic medicine or placebo (270 patients), (2) treatment by one of four different homeopaths who could prescribe any homeopathic medicine (75 patients), or (3) waiting list control using self-selected conventional health care (75 patients). MAIN OUTCOME MEASURE: Total URTI symptom scores from patients' diary over 12 weeks. PLAN: The results of these two studies (available at the end of 2004) have the potential to provide information about the efficacy of treatment by homeopaths independently from the efficacy of homeopathic medicines in children with URTIs.

Risk factors for suicidal thoughts in adolescence--a prospective cohort study: the Young-HUNT study.

OBJECTIVES: Examining the associations between health and lifestyle factors recorded in the participants' early teens and development of suicidal thoughts recorded 4 years later. DESIGN: Population-based prospective cohort study. SETTINGS: All students in the two relevant year classes in Nord-Trøndelag County were invited, 80% attended both waves of data collection. PARTICIPANTS: 2399 secondary school students who participated in the Young-HUNT1 study in 1995-1997 (13-15 years old) were included in a follow-up study 4 years later (17-19 years old). PRIMARY OUTCOME MEASURE: Suicidal thoughts reported at age 17-19 years. RESULTS: 408 (17%, 95% CI 15.5% to 18.5%) of the adolescents reported suicidal thoughts at follow-up, 158 (14.2%, CI 13.6% to 16.4%) boys and 250 (19.5%, CI 18.8% to 22.0%) girls. Baseline anxiety and depressive symptoms (adjusted OR (aOR) 1.9, CI 1.4 to 2.6), conduct problems (aOR 1.8, CI 1.3 to 2.6), overweight (aOR 1.9 CI 1.4 to 2.4), and muscular pain and tension (aOR 1.8, CI 1.4 to 2.4), were all associated with reporting suicidal thoughts at follow-up. CONCLUSIONS: One in six young adults experienced suicidal thoughts, girls predominating. Suicidal thoughts were most strongly associated with symptoms of anxiety/depression, conduct problems, pain/tension and overweight reported when participants were 13-15 years old. Specific preventive efforts in these groups might be indicated. Future research should investigate whether similar associations are seen with suicide/suicidal attempts as endpoints.

The influence of behavioural and health problems on alcohol and drug use in late adolescence - a follow up study of 2 399 young Norwegians.

BACKGROUND: Both early alcohol debut, behavioural and health problems are reported to enhance adolescence substance use. This prospective study investigate the influence of behavioural and health problems on adolescents' alcohol and drug use. METHOD: Prospective population based cohort study of 2 399 adolescents attending the Young-HUNT study, aged 13-15 at baseline in 1995/97, and 17-19 at follow-up 4 years later. Exposure variables were self reported conduct problems, attention problems, anxiety and depressive symptoms, and muscular pain and tension. Outcome variables at follow-up were frequent alcohol use and initiation of drug use. Associations were estimated by logistic regression models, influence of gender and drinking status at baseline were controlled for by stratification. RESULTS: At follow-up 19% of the students drank alcohol once a week or more frequently. Baseline conduct problems (OR 2.2, CI 1.7-3.0) and attention problems (OR 1.5, CI 1.2-2.0) increased the risk for frequent alcohol use at follow-up in the total population. Girls who had experienced alcohol-intoxications at baseline showed strong association between baseline problems and frequent alcohol use at follow-up. Conduct problems (OR 2.5, CI 1.3-4.8), attention problems (OR 2.1, CI 1.2-3.4), anxiety/depressive symptoms (OR 1.9, CI 1.1-3.1) and muscular pain and tension (OR 1.7, CI 1.0-2.9) all were associated with frequent alcohol use among early intoxicated girls.14% of the students had tried cannabis or other drugs at follow-up. Conduct problems at baseline increased the odds for drug use (OR 2.6, CI 1.9-3.6). Any alcohol intoxications at baseline, predicted both frequent alcohol use (boys OR 3.6, CI 2.4-5.2; girls OR 2.8, CI 1.9-4.1), and illegal drug use (boys OR 4.7; CI 3.2-7.0, girls OR 7.7, CI 5.2-11.5) within follow-up. CONCLUSIONS: Conduct problems in high-school more than doubles the risk for both frequent alcohol use and initiation of drug use later in adolescence. The combination of health problems and alcohol intoxication in early adolescence was closely associated with more frequent drinking later in adolescence among girls.Overall, early alcohol intoxication was closely associated with both frequent alcohol use and drug use at follow up in both genders.

Alcohol intoxication and mental health among adolescents--a population review of 8983 young people, 13-19 years in North-Trøndelag, Norway: the Young-HUNT Study.

BACKGROUND: The aims of this study were to describe alcohol use among Norwegian teenagers and investigate the associations between mental health problems and alcohol intoxications with focus on age and gender. METHODS: Population based, cross-sectional survey addressing all adolescents aged 13-19 years, attending secondary or high school in North - Trøndelag County, Norway. 8983 youths (91%) answered the Young-HUNT questionnaire in the 1995-1997 survey. Logistic regression models were used to study associations. RESULTS: 80% of the respondents reported that they had tried drinking alcohol, and 57% had been intoxicated at least once. The proportion of the students, which had tried alcohol, was equal in both genders and increased with age. Attention problems and conduct problems were strongly associated with frequent alcohol intoxications in both genders. Anxiety and depressive symptoms among girls were also related to high numbers of intoxications CONCLUSION: Gender differences in number of alcohol intoxications were small. There was a close association between both conduct and attention problems and high alcohol consumption in both genders. Girls with symptoms of anxiety and depression reported more frequent alcohol intoxications.

Is the traditional family doctor an anachronism?

KEY MESSAGES: The polyclinics debate should recognise the need to balance the benefits of long-term personal doctor-patient relationship with the broader improved health outcomes from evidence based inputs from multidisciplinary teams in primary care. There is increasing evidence from the international health literature that a focus on integrated health systems is the key to better health outcomes both at the individual and population levels, in addition to being more cost effective. Although there is some evidence that other healthcare professionals such as nurse practitioners can deliver equally high health outcomes for patients, the GP role is not an anachronism and even seems increasingly more important in the 21st century given the increasing complexity of primary care and long term conditions.

An exploratory study of the contextual effect of homeopathic care. A randomised controlled trial of homeopathic care vs. self-prescribed homeopathic medicine in the prevention of upper respiratory tract infections in children.

OBJECTIVES: The aim of this study was to explore the contextual effect of homeopathic consultation by investigating the effect of homeopathic care compared to self-treatment with self prescribed homeopathic medicine in the prevention of childhood upper respiratory tract infections (URTI). METHODS: Randomised parallel group trial with 208 children below the age of 10. The children were randomly assigned to receive either homeopathic care (HC: individual homeopathic consultations with any homeopathic medicine in any potency being prescribed) or one of three self-prescribed homeopathic medicines (SPH) in C-30 administered twice weekly, for 12 weeks. RESULTS: There were no significant differences in clinical effects between SPH and HC for primary outcomes. Mean URTI scores over 12 weeks were 39.0 in the HC group and 43.9 in the SPH group (p=0.782, difference -5.0 points (95% C.I.; -20.5 to +10.5)). The mean number of days where the parents rated their child as 'ill with URTI' was 10.0 in the HC group and 13.7 in the SPH group (p=0.394). There was a trend in favour of HC for other outcomes. CONCLUSIONS: In this innovative and exploratory study, there was no evidence for a clinically relevant effect of homeopathic care vs. a homeopathic medicine given by the child's parents and based on a pre-agreed homeopathic treatment protocol.