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Eighty-four male patients with a mean age of 56.4 years (range 34 to 65 years) were subjected to a semistructured interview 12–21 weeks after acute myocardial infarction in order to elucidate possible positive changes in family or spouse relationships induced by or following on from the disease. There were appreciable positive alterations in the love and caring domains and in communication, especially in those patients (one third of the total) who considered their total life situation to be improved after the myocardial infarction. A majority of the patients judged their family's adaptation to the myocardial infarction as good. The authors argue that it is important to discover, and reinforce, possible positive changes within the family after a myocardial infarction in one of its members and not merely to focus on negative effects. [ABSTRACT FROM PUBLISHER]

Background and Objectives: Many patients in general practice present with complex health problems. It is argued that the GP who is in a prime position to counsel patients with such problems, will, however, often perceive a lack of tools to manage them. The aim of the present study was to develop a novel instrument in terms of a patient-administered questionnaire, the Patient Perspective Survey (PPS), designed to enhance the quality of clinical communication in the consultation. It is based on a biopsychosocial patient perspective, patient centredness, patient resources, involvement and coping, and quality of life orientation.Methods: Development of the PPS has included comprehensive literature research, discussions and advice, during several phases, from groups of GPs, patients, broad panels of experts and testing in pilot studies. After many revisions, a 102-item version, consisting of a main somatic, mental and social domain axis, was evaluated by GPs and patients in 213 consultations.Results: The basic idea, theoretical elements and purpose of the PPS appeared in general to be well accepted. Seventy-five to eighty-five per cent of the patients found the questions relevant and easy to understand and there were high positive scorings regarding influence on the doctor-patient relationship, communication, resource and coping aspects, occurrence of new information and general satisfaction with the consultation. Similar scorings were obtained from the GPs' evaluation. Both parties agreed that there is a need for a shorter and more specific PPS version, and that the resource and coping dimension should be even more extended.Conclusions: We consider it well documented that there is a need for this new instrument to deal with complex health problems in general practice, and that it has promising potentials for consultation improvement. [ABSTRACT FROM AUTHOR]

Background: Registration studies have shown great variations in prescribing volume and prescribing patterns of benzodiazepines (BZDs) and minor opiates among GPs.Objectives: We aimed to form a basis for hypotheses and build theories about prescribing, in order to investigate how high-prescribing doctors can legitimize their own prescribing pattern.Methods: A qualitative interview study of doctors with previously known high, medium and low prescribing volumes was performed. The interpretation focused on the doctors' self-explanations and how they influence their daily decision of prescribing.Results and Conclusions: It was a striking feature that many of the attitudes towards the drugs were common both within and between the three groups of prescribers. All doctors regarded the task of prescribing as difficult, and the great majority strongly advocated restriction in prescribing. In order to cope with daily practice and to live with high prescribing volumes, doctors make use of effective working strategies. These strategies, of ascribing responsibility to the previous doctor, to patient autonomy and responsibility, to the patient's age and to concomitant diseases, are described in this study. An allocation of responsibility to other persons or circumstances delimits the doctors' professional discretion in this matter. Striking differences between prescriber groups were not found in the analysis, but when all small tendencies in all steps of the decision-making process were added, a clear trend was revealed. [ABSTRACT FROM AUTHOR]

Background and Objectives: The success of national breast screening programmes hinges on women's adherence. By monitoring patients' perceptions, potential barriers to attendance may be detected, measured and possibly alleviated. Consequently a new questionnaire MGQ, measuring patients' experience of and satisfaction with mammography, has been developed. As discomfort is a predictor of non-attendance, a dimension measuring physical and psychological discomfort was included.Methods: The internal structure of observed variables was tested using factor analysis as part of the validation process. The study was conducted in six radiological departments in Norway including 550 patients presenting for mammography. The analysis suggested eight factors explaining 56.7% of the variance.Results: Construct validity was supported since the factor scales covered all hypothesized dimensions and all but one subdimension. The factors were internally consistent and externally independent, indicating that distinct aspects of patients' experience with mammography may be assessed and thus possibly improved.Conclusions: A relationship between pain and re-attendance was suggested as pain and worries about the next mammography belonged to the same factor. This underlines the importance of including a discomfort dimension when monitoring patient satisfaction with mammography. [ABSTRACT FROM AUTHOR]

Nutrition affects all physiological processes occurring in our body, including those related to the function of the immune system; indeed, metabolism has been closely associated with the differentiation and activity of both innate and adaptive immune cells. While excessive energy intake and adiposity have been demonstrated to cause systemic inflammation, several clinical and experimental evidence show that calorie restriction (CR), not leading to malnutrition, is able to delay aging and exert potent anti-inflammatory effects in different pathological conditions. This review provides an overview of the ability of different CR-related nutritional strategies to control autoimmune, cardiovascular, and infectious diseases, as tested by preclinical studies and human clinical trials, with a specific focus on the immunological aspects of these interventions. In particular, we recapitulate the state of the art on the cellular and molecular mechanisms pertaining to immune cell metabolic rewiring, regulatory T cell expansion, and gut microbiota composition, which possibly underline the beneficial effects of CR. Although studies are still needed to fully evaluate the feasibility and efficacy of the nutritional intervention in clinical practice, the experimental observations discussed here suggest a relevant role of CR in lowering the inflammatory state in a plethora of different pathologies, thus representing a promising therapeutic strategy for the control of human health. [ABSTRACT FROM AUTHOR]

Background Most caregivers may visit pediatric outpatient clinics with high concern of fever and improper antipyretic use. However, studies of concern about fever in Asian countries are still limited. Objectives This study aimed to explore caregivers' attitudes, management of their child's fever, factors associated with their high concern, and expectation from medical services. Methods A cross-sectional 26-item self-administered questionnaire was used to survey caregivers of 1-month to 15-year-old febrile infants/children/teenagers visiting outpatient clinics in 9 government hospitals from July 2018 to August 2019. Results One thousand two hundred and six caregivers (67% response rate) completed self-administered questionnaire. The median age of the caregivers and the pediatric patients were 34 years (interquartile range [IQR] 28–40) and 3.3 years (IQR 1.8–6.1), respectively. Approximately 70% of them believed that fever could harm a child, resulting in brain damage or death. Also, 2% managed high doses of acetaminophen and overdosed the child. The high level of concern was significantly associated with acetaminophen overdose (P < 0.001, Kruskal–Wallis test). Caregivers of nonhealth care providers and children's history of febrile seizure were factors related to higher score of concern. Most caregivers expected definite diagnosis (70.7%), antipyretic drugs (67.4%), and blood tests (48.9%). Conclusion Caregivers' high concern of fever existed in Thailand. This may lead to unnecessary high doses of antipyretics. In clinical practice, the high concern of fever is a challenge for caregivers and pediatric health care providers. A better understanding of fever and its consequence should be advocated for proper management of the child's fever. [ABSTRACT FROM AUTHOR]

Background Most guidelines recommend a midstream urine (MSU) or a midstream clean-catch (MSCC) sample for urinalysis. However, whether this sample is better than others is still controversial. Objectives To assess the most adequate non-invasive method to collect a urine specimen for diagnosing urinary tract infections (UTI) in symptomatic non-pregnant women. Methods This review was conducted according to the Systematic Reviews of Diagnostic Test Accuracy guidelines (PROSPERO CRD42021241758). PubMed was searched paired sample studies and controlled trials. Studies comparing MSCC, MSU without cleaning, first-void urine, and random voiding samples were considered. Studies evaluating invasive methods were excluded. The main outcome was diagnostic accuracy of urine cultures. Contamination rates were evaluated. The risk of bias tool for systematic reviews on diagnostic accuracy (QUADAS-2) was assessed. Results Six studies including 1,010 patients were evaluated. Only two studies used paired samples. No study was considered as having low risk of bias. There was no difference in contamination for MSU specimens collected with or without cleansing and between random void urine collection and MSCC. In one study comparing first-void urine with MSU samples, the contamination rate was lower in the latter, but the gold standard of urine culture was only used for one sampling collection. Conclusions To the best of our knowledge, this systematic review is the first to assess the evidence available from different exclusively non-invasive urine sampling. Despite being widely recommended, our review did not find consistent evidence that asking women to provide midstream samples with or without cleansing is better. [ABSTRACT FROM AUTHOR]

Background: Quality of care remains a priority issue and is correlated with patient experience. Measuring multidimensional patient primary care experiences in multiprofessional clinics requires a robust instrument. Although many exist, little is known about their quality.Objective: To identify patient perception instruments in multiprofessional primary care and evaluate their quality.Methods: Systematic review using Medline, Pascal, PsycINFO, Google Scholar, Cochrane, Scopus, and CAIRN. Eligible articles developed, evaluated, or validated 1 or more self-assessment instruments. The instruments had to measure primary care delivery, patient primary care experiences and assess at least 3 quality-of-care dimensions. The COnsensus-based Standards for the selection of health status Measurement Instruments (COSMIN) checklist was used to assess methodological quality of included studies. Instrument measurement properties were appraised using 3 possible quality scores. Data were combined to provide best-evidence synthesis based on the number of studies, their methodological quality, measurement property appraisal, and result consistency. Subscales used to capture patient primary care experiences were extracted and grouped into the 9 Institute of Medicine dimensions.Results: Twenty-nine articles were found. The included instruments captured many subscales illustrating the diverse conceptualization of patient primary care experiences. No included instrument demonstrated adequate validity and the lack of scientific methodology for assessing reliability made interpreting validity questionable. No study evaluated instrument responsiveness.Conclusion: Numerous patient self-assessment instruments were identified capturing a wide range of patient experiences, but their measurement properties were weak. Research is required to develop and validate a generic instrument for assessing quality of multiprofessional primary care.Trial Registration: Not applicable. [ABSTRACT FROM AUTHOR]

Objectives There is increasing interest in prediction and prevention of RA. It is important to understand the views of those at risk to inform the development of effective approaches. First-degree relatives (FDRs) of RA patients are at increased risk of RA. This study assessed predictors of their interest in predictive testing for RA. Methods Questionnaires were completed by RA patients (provided with their questionnaire by a healthcare professional) and their FDRs (provided with their questionnaire by their RA proband). FDR surveys assessed interest in taking a predictive test, demographic variables, perceived RA risk, attitudes about predictive testing, autonomy preferences, illness perceptions, avoidance coping and health anxiety. Patient surveys included demographic variables, disease impact, RA duration and treatment. Ordinal logistic regression examined the association between FDRs' characteristics and their interest in predictive testing. Generalized estimating equations assessed associations between patient characteristics and FDRs' interest in predictive testing. Results Three hundred and ninety-six FDRs responded. Paired data from the RA proband were available for 292. The proportion of FDRs interested in predictive testing was 91.3%. Information-seeking preferences, beliefs that predictive testing can increase empowerment over health and positive attitudes about risk knowledge were associated with increased interest. Beliefs that predictive testing could cause psychological harm predicted lower interest. Patient characteristics of the proband were not associated with FDRs' interest. Conclusions FDRs' interest in predictive testing for RA was high, and factors associated with interest were identified. These findings will inform the development of predictive strategies and informational resources for those at risk. [ABSTRACT FROM AUTHOR]

Objective The purpose of this review was to evaluate the effects of sling exercise on pain intensity, disability, and health-related quality of life in adults with neck pain. Methods The Cochrane Central Register of Controlled Trials, EMBASE, Physiotherapy Evidence Database (PEDro), and 6 other databases were searched from inception to July 2020. The reference lists of relevant articles to identify additional trials were also screened. Randomized controlled trials were included if they investigated the effects of sling suspension therapy in patients with neck pain, including mechanical neck disorders, cervicogenic headache, and neck disorders with radicular findings. Studies were required to be published in English or Chinese. The methodological quality and levels of evidence of studies were assessed using the PEDro scale and the Grading of Recommendations Assessment, Development and Evaluation approach, respectively. The random-effects model was used to perform meta-analyses. Results Eleven randomized controlled trials were included (n = 595). The mean total PEDro score was 4.64 (SD = 1.21) of 10, which indicated a fair methodological quality. The intervention groups showed significant improvements in pain intensity (SMD = −1.23; 95% CI = −1.88 to −0.58) immediately postintervention compared with the control groups. No significant effects were found for disability, cervical range of motion, and health-related quality of life. However, sensitivity analyses revealed significant short-term improvements in pain intensity, disability, and cervical range of motion and sustained effects on disability at intermediate-term follow - up. Conclusion Sling exercise appears to be beneficial for improvements in pain intensity (moderate- to low-level evidence) among patients with neck pain. However, no definitive conclusion could be made regarding the effect of sling exercise for neck pain due to methodological limitations and high heterogeneity in the included studies. Impact This review provides overall moderate- to very low-level evidence for health care professionals who may consider including sling exercise in the intervention program for patients with neck pain. [ABSTRACT FROM AUTHOR]

Context The impact of various dietary interventions on rheumatoid arthritis (RA), characterized by immune-inflammatory response, has been subject to increased attention. Objective A systematic review was conducted to update the current knowledge on the effects of nutritional, dietary supplement, and fasting interventions on RA outcomes. Data Sources Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, with prespecification of all methods, Medline and Embase were systematically searched for relevant articles. Data Extraction Data were extracted by 2 independent reviewers. Results A total of 70 human studies were identified. Administration of omega-3 polyunsaturated fatty acids at high doses resulted in a reduction in RA disease activity and a lower failure rate of pharmacotherapy. Vitamin D supplementation and dietary sodium restriction were beneficial on some RA outcomes. Fasting resulted in significant but transient subjective improvements. While the Mediterranean diet demonstrated improvements in some RA disease activity measures, outcomes from vegetarian, elimination, peptide, or elemental diets suggested that responses are very individualized. Conclusion Some dietary approaches may improve RA symptoms and thus it is recommended that nutrition should be routinely addressed. [ABSTRACT FROM AUTHOR]

Background: Improving individuals' experience of care is now a critical goal of health care systems. Although a number of instruments have been developed to measure experience of care, few instruments measure family caregivers' experience of interprofessional care for patients and families.Objective: To develop the Japanese version of the Caregivers' Experience Instrument (J-IEXPAC CAREGIVERS) and to investigate its validity in assessing quality of integrated care for both patients with chronic conditions and their family caregivers, from the caregivers' perspective, in Japan.Methods: We used a cross-sectional questionnaire survey to test the validity and internal consistency of J-IEXPAC CAREGIVERS. Four hundred family caregivers were recruited in three municipalities. We evaluated the feasibility, structural validity, internal consistency and hypothesis testing for construct validity of the scale.Results: A total of 274 (68.5%) questionnaires were analysed. Confirmatory factor analysis showed acceptable model fit for the hypothesized two-factor model according to fit indices, as identified for the original version: attention for the patient and attention for the caregiver. Cronbach's alpha for score in J-IEXPAC CAREGIVERS with 12 items was high (0.92). Spearman's rank correlation coefficient between overall caregiver satisfaction and J-IEXPAC CAREGIVERS score was 0.71. Family caregivers who experienced home-visit services had significantly (P = 0.001) higher total scores than those who did not.Conclusions: This pilot study showed that the J-IEXPAC CAREGIVERS is valid and reliable. This scale can be useful for evaluating quality of integrated care, with focus on family caregivers and patients with chronic conditions in Japan. [ABSTRACT FROM AUTHOR]

Background: In Germany, almost 50% of prescriptions for benzodiazepines and drugs as Zolpidem and Zopiclone are as out-of-pocket (OOP) prescriptions-requiring patients to buy the drug at their own expense-although almost 90% of the population has statutory health insurance covering medication costs.Objective: To understand why general practitioners (GPs) choose this prescribing method since needed medications are insurance covered, and unnecessary drugs should not be prescribed at all.Methods: In this qualitative study, 17 semi-structured interviews with GPs were conducted, audio recorded and transcribed verbatim. Transcripts were analysed with grounded theory to extract a model explaining the described behaviour.Results: Knowing the significant medical risks and insecurity about regulations makes GPs wish to avoid hypnotics and sedatives. They achieve this by 'Creating a barrier' (central phenomenon) and employing the strategy 'Using an out-of-pocket prescription', which not only generates costs for the patient but also reduces the physicians´ legal and financial accountability. The perceived patient type, expected problem duration and diagnosis influence the decision about the prescription form: patients with an alcohol or drug addiction or those with 'uncomplicated' insomnia are more likely to receive an OOP prescription. Patients with any psychiatric diagnosis will likely receive a statutory health insurance prescription.Discussion: Current regulations do not provide guidance to GPs regarding hypnotics and sedatives. A clear regulatory framework and guidelines could possibly reduce physicians' defensive attitudes about these drugs and their use of OOP prescriptions. The approach to use OOP prescriptions as a barrier to reduce patients' medication use lacks evidence regarding effectiveness. [ABSTRACT FROM AUTHOR]

Introduction: Clinical practice guidelines recommend comprehensive treatment for tobacco dependence including pharmacotherapies and behavioral interventions. Group counseling may deliver unique treatment aspects not available with other modalities. This manuscript provides a narrative review of group treatment outcomes from real-world practice settings and complements recent meta-analyses of randomized controlled trials (RCTs). Our primary goals were to determine whether group treatments delivered in these settings have yielded similar quit rates compared to individual treatment and to provide recommendations for best practices and policy.Methods: Group treatment was defined as occurring in a clinical or workplace setting (ie, not provided as part of a research study), led by a professionally trained clinician, and offered weekly over several weeks. English language PubMed articles from January 2000 to July 2017 were searched to identify studies that included outcomes from both group and individual treatment offered in real-world settings. Additional data sources meeting our criteria were also included. Reports not using pharmacotherapy and research studies (eg, RCTs) were excluded. The primary outcome was short-term, carbon monoxide (CO)-validated point prevalence abstinence (4-week postquit date).Results: The review included data from 11 observational studies. In all cases, group treatment(s) had higher 4-week CO-validated quit rates (range: 35.5%-67.3%) than individual treatment(s) (range: 18.6%-53.3%).Conclusions: Best practice group treatments for tobacco dependence are generalizable from research to clinical settings and likely to be at least as effective as intensive individual treatment. The added advantages of efficiency and cost-effectiveness can be significant. Group treatment is feasible in various settings with good results.Implications: A major barrier to achieving high rates of tobacco abstinence is under-utilization of evidence-based treatment interventions. This review demonstrates the effectiveness and utility of group treatment for tobacco dependence. Based on the available data described in this narrative review in conjunction with existing RCT data, group treatment for tobacco dependence should be established and available in all behavioral health and medical settings. Group tobacco treatment is now one of the mandated reimbursable tobacco treatment formats within the US health care system, creating enormous opportunities for widespread clinical reach. Finally, comprehensive worksite group programs can further extend impact. [ABSTRACT FROM AUTHOR]

Background there is little research on how people with dementia are involved in treatment decisions at diagnosis. Objective to measure shared decision making when starting cholinesterase inhibitors, investigate associations with contextual factors and explore satisfaction and experience of the diagnostic meeting. Setting nine UK memory clinics in two geographical locations. Subjects 74 people receiving dementia diagnoses (with 69 companions) and 21 doctors. Methods we video-recorded 74 memory clinic consultations and rated doctor-shared decision making behaviours using the Observing Patient Involvement in Decision Making scale (OPTION-5 scale). Patients and companions rated their satisfaction and experience. Mixed-effects regressions investigated involvement and (i) number people present, meeting length, capacity, cognitive functioning, diagnosis; and (ii) patient/companion satisfaction and consultation experience. Results mean consultation time was 26.7 min. Mean OPTION-5 score was 22.5/100 (Standard Deviation = 17.3). Doctors involved patients in decisions more often when patients had mixed dementia (β = 10.13, 95% confidence interval 1.25–19.0, P = 0.025) and in shorter meetings (β = −0.51, 95% CI −0.87 to −0.15, P = 0.006). Patient and companion satisfaction were high and not associated with whether doctors invited patient involvement. Half of patients and one-third companions were uncertain about the meeting outcome, experienced communication barriers and negative emotions. Conclusions consultations scored low on shared decision making, but were comparable to other settings and were not lower with more cognitively impaired patients. Negative patient and companion experiences reflect the importance of supporting healthcare providers to address patient and companion emotions and need for information. [ABSTRACT FROM AUTHOR]

Background While qualitative studies suggested that continuity of care by primary care physicians (PCPs) facilitated consultations for psychological problems, there was limited quantitative evidence. This survey compared management of psychological distress between patients with and without a regular PCP. Methods A questionnaire survey was conducted with 1626 adult primary care attenders from 13 private and 6 public clinics in Hong Kong. Management of psychological distress between respondents with a regular PCP and those without were compared. Effects of demographic factors were adjusted for by multivariable logistic regression. Results Among the 1626 respondents, 650 (40.0%) reported that they had ever experienced psychological distress. Of the 650 respondents experienced distress, 307 (47.2%) had a regular PCP. A significantly higher proportion of patients with a regular PCP than those without reported: (i) their PCPs sometimes/often asked about psychological problems [37.7 versus 20.1%, adjusted OR = 2.241]; (ii) they sometimes/often mentioned their psychological problems to PCPs [45.2 versus 24.9%, adjusted OR = 2.503]; and (iii) their distress had been treated by PCPs [22.1 versus 13.4%, adjusted OR = 1.702]. Conclusion Patients with a regular PCP have around double odds of receiving mental health care. Continuity of care by PCPs should be emphasized in mental health care delivery. [ABSTRACT FROM AUTHOR]

Background: Accurate health information exchange (HIE) is pivotal for good quality of care. However, patients with intellectual disabilities (ID) face challenges in processing and exchanging health information around GP consultations. Knowledge of HIE barriers and facilitators, including the roles of carers, may help to improve GP care for people with ID.Objective: To gain more insight into HIE barriers and facilitators for ID patients in GP care.Methods: A qualitative study exploring GP consultation experiences of people with ID (n = 35), professional carers (n = 20) and relatives (n = 15). Transcripts from interviews and focus groups were analyzed using a framework analysis approach.Results: Analyses resulted in four themes: (i) Recognizing patient health needs; (ii) Impaired doctor-patient communication; (iii) Carers' mediating roles during consultations; and (iv) Patients' autonomy and self-determination. Barriers related to communication skills, lack of time, continuity of carers and physicians, information alignment between relative or professional carer and the GP, and information transfer and recording within the patient network. Facilitating factors related mainly to carer interventions, personal connections with patients and GP communication with patients and carers outside the consultation.Conclusion: There is considerable HIE potential in patients themselves, as well as in their network, although many barriers have to be overcome to profit from this. GP practices are recommended to adjust consultations and communication practices and to facilitate deployment of the patient's network, while still considering patient autonomy. [ABSTRACT FROM AUTHOR]

Background: While the overall incidence of acute myocardial infarction in Norway decreased in 2001–2009, this was not observed for younger adults. Smoking cessation, physical activity and healthy diet are associated with reduced risk of recurrent cardiovascular events and mortality among individuals with established coronary heart disease (CHD). Aims: We investigated whether adults in their 40s with or without CHD had 1) attempted to improve their health behaviour during the previous year, and 2) had confidence in their ability to improve their health behaviour over the next five years. Methods: Study participants were 22,019 40–49 year olds from the Hordaland Health Study. Associations between improvements and intentions regarding health behaviours and prevalent CHD were assessed with logistic regression analyses. Results: One hundred and seventy-five (0.8%) participants reported to have CHD. After controlling for demographic, lifestyle and psychosocial variables, attempts to improve health behaviour during the prior year were associated with a threefold increased odds of prevalent CHD (odds ratio 3.07; 95% confidence interval, 1.91–4.95). Confidence in improving health behaviour during the subsequent five years was not associated with increased odds of prevalent CHD. Conclusions: Adults in their 40s with CHD were more likely to have attempted to improve their health behaviour during the past year compared with those without CHD. Healthcare providers should take advantage of these positive attitudes to encourage further positive improvements. [ABSTRACT FROM AUTHOR]

There is little research in Southeast Asia focusing on patients' experiences of seeking psychological treatment for chronic pain. Objective This study aims to understand the experiences of patients seeking psychological treatment for chronic pain in this region. Setting Outpatient pain clinic at a tertiary hospital in Singapore. Subjects People with experiences of attending psychological treatment for chronic pain, including some who were not receiving this type of treatment. Study design and methods Fifteen inductive semi-structured interviews were conducted to explore patients' experiences regarding psychological treatment for their chronic pain. Thematic analysis was then applied. Results Three main themes were identified: 'Expectations and Realities of Health Professionals,' 'Patients' Attitudes and Beliefs,' and 'Practical and Social Factors.' From the patients' perspectives, an empathetic health professional who was willing to listen contributed to a positive treatment seeking experience. Patients felt that health professionals' lack of knowledge about appropriate treatment contributed to their frustration. Patients could not understand how psychological treatment was related to pain treatment and queried why they were 'paying just to talk.' Conversely, their experiences were quite positive, and they found psychological treatments helpful when they participated in them. Conclusion Education for both patients and health professionals unfamiliar with psychological treatments for pain may improve access to these treatments. [ABSTRACT FROM AUTHOR]

Background. Patient feedback surveys are increasingly seen as a key component of health care quality monitoring and improvement. Objective. The study objective was to describe the development and initial psychometric evaluation of a fixed-length questionnaire about the experiences of patients receiving physical therapist treatment in postacute outpatient settings. Design. This was an instrument development study with validity and reliability testing. Methods. A total of 465 participants attending 3 rehabilitation centers for musculoskeletal conditions completed the questionnaire. A cognitive pretest was applied to the draft version (n=94), and a revised version was evaluated for test-retest reliability (n = 90). Analyses to evaluate variance and nonresponse rates for items, the factor structure of the questionnaire, and the metric properties of multi-item scales were conducted. Results. Exploratory factor analyses yielded evidence for a 7-factor structure of the questionnaire, with 3 factors that may be conceptually viewed as professionals' attitudes and behavior (providing information and education, sensitivity to patients' changes, and emotional support) and 4 factors that conceptually reflect organizational environment (duration of attendance, interruptions during care delivery, waiting times, and patient safety). Item-scale correlations ranged from .70 to .93. The percentage of scaling success was 100% for all of the scales. Cronbach alpha coefficients ranged from .70 to .87. Intraclass correlation coefficients ranged from .57 to .80 (median = .68). Limitations. Generalization to other patients is not known. Conclusions. The questionnaire has test-retest reliability, and the scales have internal consistency and convergent and discriminant validity. All of the scales are distinct and unidimensional. [ABSTRACT FROM AUTHOR]

BACKGROUND Although a large body of literature has been devoted to examining the relationship between eicosapentaenoic and docosahexaenoic acids (EPA+DHA) and blood pressure, past systematic reviews have been hampered by narrow inclusion criteria and a limited scope of analytical subgroups. In addition, no meta-analysis to date has captured the substantial volume of randomized controlled trials (RCTs) published in the past 2 years. The objective of this meta-analysis was to examine the effect of EPA+DHA, without upper dose limits and including food sources, on blood pressure in RCTs. METHODS Random-effects meta-analyses were used to generate weighted group mean differences and 95% confidence intervals (CIs) between the EPA+DHA group and the placebo group. Analyses were conducted for subgroups defined by key subject or study characteristics. RESULTS Seventy RCTs were included. Compared with placebo, EPA+DHA provision reduced systolic blood pressure (−1.52mm Hg; 95% confidence interval (CI) = −2.25 to −0.79) and diastolic blood pressure (−0.99mm Hg; 95% CI = −1.54 to −0.44) in the meta-analyses of all studies combined. The strongest effects of EPA+DHA were observed among untreated hypertensive subjects (systolic blood pressure = −4.51mm Hg, 95% CI = −6.12 to −2.83; diastolic blood pressure = −3.05mm Hg, 95% CI = −4.35 to −1.74), although blood pressure also was lowered among normotensive subjects (systolic blood pressure = −1.25mm Hg, 95% CI = −2.05 to −0.46; diastolic blood pressure = −0.62mm Hg, 95% CI = −1.22 to −0.02). CONCLUSIONS Overall, available evidence from RCTs indicates that provision of EPA+DHA reduces systolic blood pressure, while provision of ≥2 grams reduces diastolic blood pressure. [ABSTRACT FROM AUTHOR]

Objectives Several research groups established functional tests to obtain performance data for mobility-related activities in patients with low back pain (LBP). In our study we aimed to assess the construct validity and associations with other measures of a battery of functional tests in relationship to physical performance on the one hand and physical capacity and variables of pain, disability and psychological variables on the other. Design Eight physical performance tests of everyday activities such as climbing stairs, picking up an object from the floor, bending forward, and sitting up from supine position etc. were evaluated in 106 patients with LBP and 106 control subjects. Results Distribution of results in each test demonstrated a marked overlap in a number of tests between those with and those without back pain. In a factor analysis we found pronounced differences in the factorial structure of the data between patients and control subjects as well in the bivariate correlations between functional test results. There was a strong relationship between self-report disability rating ( FFbH- R) and physical performance tests especially in patients whereas physical capacity tests had less relationship in patients and not at all in the control subjects. Conclusion In contrast to the past and present literature, our results suggest that physical performance tests have an inherent problem to sharply differentiate patients with back pain from healthy controls and problems with inter-rater reliability. Physical performance seems to be more a matter of patients' perception of generalized disability than of restricted function. [ABSTRACT FROM AUTHOR]

Background: The aim was to study the impact of psychosocial risk factors on long-term sickness absence due to mental health problems (LSA-MH) or musculoskeletal disorders (LSA-MSD) in 2983 Belgian middle-aged workers. Methods: Data were collected from 1372 male and 1611 female workers in the Belstress III study. Considered psychosocial risk factors were job demands, job control, social support, job strain, efforts, rewards, effort–reward imbalance and bullying. Prospective registered sickness absence data were collected during 12 months follow-up; the causes for long-term sickness absence episodes of at least 15 consecutive days were obtained by contacting the general practitioner of the worker. Multiple logistic regression models were used to investigate the relationship between the psychosocial risk factors and LSA-MH and LSA-MSD. Results: Higher levels of rewards at baseline were independently and significantly associated with a lower risk for LSA-MH. Higher levels of control were associated with a lower risk for LSA-MSD during follow-up. Higher job demands and efforts were significantly related to a lower risk for LSA-MSD. Finally, bullying was significantly and independently related to both LSA-MH and LSA-MSD during the follow-up period. Conclusions: These results suggest that psychosocial risk factors are related to LSA-MH and LSA-MSD, of which especially bullying seems to be a potent stressor. [ABSTRACT FROM AUTHOR]

Background: Retirement is a life-course transition in late adult life that is marked by major changes that may affect healthy lifestyles. Our aim is to give an overview of the current knowledge on changes in smoking, alcohol consumption, physical activity and dietary habits during the transition to retirement. This may provide clues to a better targeting and timing of preventive activities at older age. Methods: Literature search in Medline, Scopus, Embase, PsycInfo, Social SciSearch and SciSearch limited to English-language papers published between 2001 and May 2013. Results of 20 original papers are summarized in a narrative review. Results: Some studies report an increase in alcohol consumption after retirement, whereas others found a decrease or no change at all. Those who retired involuntarily tended to increase their alcohol consumption, whereas retirees who quit voluntarily did not change their alcohol consumption. Leisure-time physical activity seems to increase slightly after retirement, especially moderately intensive physical activity. This increase does not compensate the loss of work-related physical activity such as the work itself or work-related transportation. The studies on changes in smoking and dietary habits were too limited to draw conclusions. Conclusions: The transition to retirement is accompanied with both favourable and unfavourable lifestyle changes, depending on the type of lifestyle, lifestyle indicator and the personal situation of the retiree. The (pre-)retirement period may well offer a suitable opportunity for preventive action, for example in pre-retirement programmes, planning or other retirement-related support. [ABSTRACT FROM AUTHOR]

Background. Communication in clinical encounters is vital in ensuring a positive experience and outcome for both patient and clinician. Objective. The purpose of this study was to measure verbal communication between physical therapists and patients with back pain during their initial consultation and trial management of the data using a novel, Web-based application. Design. A cross-sectional study was conducted. Methods. Nine musculoskeletal physical therapists and 27 patients with back pain participated in this study. Twenty-five initial consultations were observed, audio recorded, and categorized using the Medical Communications Behavior System. Data were managed using Synote, a freely available application enabling synchronization of audio recordings with transcripts and coded notes. Results. In this sample, physical therapists spoke for 49.5% of the encounter and patients for 33.1%. Providers and patients spent little time overtly discussing emotions (1.4% and 0.9%, respectively). More-experienced clinicians used more "history/ background probes," more "advice/suggestion," and less "restatement" than less-experienced staff, although they demonstrated a greater prevalence of talking concurrently and interrupting patients (7.6% compared with 2.6%). Limitations. Although studies measuring actual behavior are considered to be the gold standard, audio recordings do not enable nonverbal behaviors to be recorded. Conclusion. This study investigated a method for measuring the verbal content of clinical encounters in a physical therapy outpatient setting. The study has directly contributed to developing a research-friendly version of the application (ie, Synote Researcher). Given the pivotal role of communication in ensuring a positive experience and outcome for both patient and provider, investing time in further developing communication skills should be an on-going priority for providers. Further work is needed to explore affective behaviors and the prevalence of interrupting patients, considering differences in sex and provider experience. [ABSTRACT FROM AUTHOR]

Objective To develop and establish the psychometric properties of an instrument to measure face validity, feasibility and utility of patient questionnaires used during health care. Design Our instrument, QQ-10, is a 10-item self-completed questionnaire, which was developed during the evaluation of another questionnaire (ePAQ-PF), to assess patients' views on questionnaire use during health care. Setting Urogynaecology Department, Royal Hallamshire Hospital, Sheffield, UK. Participants The Sheffield maternity patient user group identified 10 key themes relating to patients' views on using questionnaires; these themes translated into 10 statements, each using the same 5-point Likert response scale. Intervention Not applicable. Outcome Measures Principal component analysis established the factor structure of our instrument. Internal reliability was assessed using Cronbach's alpha. Construct validity was assessed using Spearman's rho. Results Factor analysis yielded two meaningful factors: Value and Burden, both achieving Cronbach's alpha scores >0.7. Significant correlations were found between scores for Value and communication experience and between scores for Burden and barriers to health care. Conclusions Our instrument offers a valid, reliable measure of patients' views relating to value and burden of using health-related quality of life questionnaires. Its two domains show good internal reliability and with its free text items, it may offer a valuable, standardized assessment of face validity and utility of other questionnaires used in health care. [ABSTRACT FROM AUTHOR]

Background. Many women have low back pain (LBP) or pelvic girdle pain (PGP) during pregnancy, but there is limited evidence of effective primary and secondary preventive strategies. Objective. The purpose of this study was to investigate whether a group-based exercise program can reduce the prevalence and severity of LBP and PGP in pregnant women. Design. An observer-blinded randomized controlled trial with equal assignments to a training group and a control group was conducted. Setting. The study was conducted in primary care maternity units in 2 suburban municipalities in the southeastern part of Norway. Patients. The participants were 257 pregnant women who were healthy and between 18 and 40 years of age before gestation week 20. Intervention. The training group received supervised exercises in groups once a week, and the control group received standard care. Measurements. The main outcome measures were self-reported LBP and selfreported PGP. Secondary outcome measures were pain intensity in the morning and evening, disability, and 8-Item Short-Form Health Survey (SF-8) Physical Component Summary (PCS) and Mental Component Summary (MCS) scores. Follow-up measurements were performed at gestation weeks 24, 28, 32, and 36. Results. Overall, there was no effect of the program on the prevalence of PGP (odds ratio=1.03, 95% confidence interval [CI]=0.66 to 1.59) or LBP (odds ratio=0.77, 95% CI=0.50 to 1.19). For the secondary outcomes, the estimated mean differences between the groups were -0.4 (95% CI=-0.8 to 0.1) for pain intensity in the morning, -0.4 (95% CI=-1.0 to 0.2) for pain intensity in the evening, -1.0 (95% CI=-2.2 to 0.0) for disability, 1.8 (95% CI=0.0 to 3.7) for the SF-8 PCS, and 0.6 (95% CI=-2.2 to 1.4) for the SF-8 MCS. Limitations. Due to low statistical power, the estimates for the primary outcomes are imprecise. Conclusions. Supervised group exercise did not reduce the prevalence of LBP or PGP in pregnancy. [ABSTRACT FROM AUTHOR]

Background. Many women have low back pain (LBP) or pelvic girdle pain (PGP) during pregnancy, but there is limited evidence of effective primary and secondary preventive strategies. Objective. The purpose of this study was to investigate whether a group-based exercise program can reduce the prevalence and severity of LBP and PGP in pregnant women. Design. An observer-blinded randomized controlled trial with equal assignments to a training group and a control group was conducted. Setting. The study was conducted in primary care maternity units in 2 suburban municipalities in the southeastern part of Norway. Patients. The participants were 257 pregnant women who were healthy and between 18 and 40 years of age before gestation week 20. Intervention. The training group received supervised exercises in groups once a week, and the control group received standard care. Measurements. The main outcome measures were self-reported LBP and selfreported PGP. Secondary outcome measures were pain intensity in the morning and evening, disability, and 8-Item Short-Form Health Survey (SF-8) Physical Component Summary (PCS) and Mental Component Summary (MCS) scores. Follow-up measurements were performed at gestation weeks 24, 28, 32, and 36. Results. Overall, there was no effect of the program on the prevalence of PGP (odds ratio=1.03, 95% confidence interval [CI]=0.66 to 1.59) or LBP (odds ratio=0.77, 95% CI=0.50 to 1.19). For the secondary outcomes, the estimated mean differences between the groups were -0.4 (95% CI=-0.8 to 0.1) for pain intensity in the morning, -0.4 (95% CI=-1.0 to 0.2) for pain intensity in the evening, -1.0 (95% CI=-2.2 to 0.0) for disability, 1.8 (95% CI=0.0 to 3.7) for the SF-8 PCS, and 0.6 (95% CI=-2.2 to 1.4) for the SF-8 MCS. Limitations. Due to low statistical power, the estimates for the primary outcomes are imprecise. Conclusions. Supervised group exercise did not reduce the prevalence of LBP or PGP in pregnancy. [ABSTRACT FROM AUTHOR]

Introduction. This is an international study of the epidemiology of family medicine (FM) in three practice populations from the Netherlands, Malta and Serbia. Diagnostic associations between common reasons for encounter (RfEs) and episodes titles are compared and similarities and differences are described and analysed. Methodology. Participating family doctors (FDs) recorded details of all their patient contacts in an ‘episode of care (EoC)’ structure using the International Classification of Primary Care (ICPC). RfEs presented by the patient and episode titles (diagnostic labels of EoCs) were classified with ICPC. The relationships between RfEs and episode titles were studied with Bayesian methods. Results. Distributions of diagnostic odds ratios (ORs) from the three population databases are presented and compared. Conclusions. ICPC, the RfE and the EoC data model are appropriate tools to study the process of diagnosis in FM. Distributions of diagnostic associations between RfEs and episode titles in the Transition Project international populations show remarkable similarities and congruencies in the process of diagnosis from both the RfE and the episode title perspectives. The congruence of diagnostic associations between populations supports the use of such data from one population to inform diagnostic decisions in another. Differences in the magnitude of such diagnostic associations are significant, and population-specific data are therefore desirable. We propose that both an international (common) and a local (health care system specific) content of FM exist and that the empirical distributions of diagnostic associations presented in this paper are a reflection of both these effects. We also observed that the frequency of exposure to such diagnostic challenges had a strong effect on the confidence intervals of diagnostic ORs reflecting these diagnostic associations. We propose that this constitutes evidence that expertise in FM is associated with frequency of exposure to diagnostic challenges. [ABSTRACT FROM PUBLISHER]

Objective. To assess the effectiveness of interventions in community and workplace settings to reduce sickness absence and job loss in workers with musculoskeletal disorders (MSDs).Methods. Relevant randomized controlled trials (RCTs) and cohort studies, published since 1990, were identified by screening citations from 35 earlier systematic reviews and by searching MEDLINE and Embase until April 2010. Effects were estimated by intervention category and other features, including study quality.Results. Among 42 studies (including 34 RCTs), 27 assessed return to work (RTW), 21 duration of sickness absence and 5 job loss. Interventions included exercise therapy, behavioural change techniques, workplace adaptations and provision of additional services. Studies were typically small {median sample 107 [inter-quartile range (IQR) 77–148]} and limited in quality. Most interventions appeared beneficial: the median relative risk (RR) for RTW was 1.21 (IQR 1.00–1.60) and that for avoiding MSD-related job loss was 1.25 (IQR 1.06–1.71); the median reduction in sickness absence was 1.11 (IQR 0.32–3.20) days/month. However, effects were smaller in larger and better-quality studies, suggesting publication bias. No intervention was clearly superior, although effort-intensive interventions were less effective than simple ones. No cost–benefit analyses established statistically significant net economic benefits.Conclusion. As benefits are small and of doubtful cost-effectiveness, employers’ practice should be guided by their value judgements about the uncertainties. Expensive interventions should be implemented only with rigorous cost–benefit evaluation planned from the outset. Future research should focus on the cost-effectiveness of simple, low-cost interventions, and further explore impacts on job retention. [ABSTRACT FROM PUBLISHER]

Background. Physical therapists' management of patients with nonspecific low back pain (NSLBP) has been found to be associated with their beliefs and attitudes toward NSLBP, as well as with guideline recommendations. Greater knowledge of physical therapists' experiences and feelings of treating patients with NSLBP may help to explain these associations and increase our understanding of some of the challenges physical therapists face when treating patients with NSLBP in clinical practice. Objectives. The objective of this study was to understand more about how the personal experiences and feelings of physical therapists might influence their decision making when treating patients with NSLBP. Design. This was a qualitative study using a phenomenological hermeneutical approach and practitioner-as-researcher model. Methods. Eleven semistructured interviews with physical therapists were conducted and analyzed using the hermeneutical circle to identify key themes relating to their experiences and feelings in treating patients with NSLBP. Results. Three linked themes emerged: (1) physical therapists believe that NSLBP has an underlying mechanical and recurring nature, (2) physical therapists' attitude toward managing NSLBP is to empower patients to exercise and self-manage their pain and functional problems, and (3) physical therapists experience feelings of tension between the advice and treatment they feel is best for their patient and the patient's own beliefs and attitudes. Conclusions. The experiences and feelings of physical therapists treating patients with NSLBP include conflict among their pain beliefs, attitudes, and working partnerships with patients. Treatment decisions may be influenced when physical therapists modify their beliefs and attitudes to reduce this sense of conflict. Improving physical therapist communication skills may help decrease feelings of conflict, enhance working relationships, and encourage a more consistent approach toward patients with NSLBP. [ABSTRACT FROM AUTHOR]

BackgroundThe question of whether reduced sodium intake is effective as a health prophylaxis initiative is unsolved. The purpose was to estimate the effects of low-sodium vs. high-sodium intake on blood pressure (BP), renin, aldosterone, catecholamines, and lipids.MethodsStudies randomizing persons to low-sodium and high-sodium diets evaluating at least one of the above outcome parameters were included. Data were analyzed with Review Manager 5.1.ResultsA total of 167 studies were included. The effect of sodium reduction in: (i) Normotensives: Caucasians: systolic BP (SBP) −1.27 mm Hg (95% confidence interval (CI): −1.88, −0.66; P = 0.0001), diastolic BP (DBP) −0.05 mm Hg (95% CI: −0.51, 0.42; P = 0.85). Blacks: SBP −4.02 mm Hg (95% CI: −7.37, −0.68; P = 0.002), DBP −2.01 mm Hg (95% CI: −4.37, 0.35; P = 0.09). Asians: SBP −1.27 mm Hg (95% CI: −3.07, 0.54; P = 0.17), DBP −1.68 mm Hg (95% CI: −3.29, −0.06; P = 0.04). (ii) Hypertensives: Caucasians: SBP −5.48 mm Hg (95% CI: −6.53, −4.43; P < 0.00001), DBP −2.75 mm Hg (95% CI: −3.34, −2.17; P < 0.00001). Blacks: SBP −6.44 mm Hg (95% CI: −8.85, −4.03; P = 0.00001), DBP −2.40 mm Hg (95% CI: −4.68, −0.12; P = 0.04). Asians: SBP −10.21 mm Hg (95% CI: −16.98, −3.44; P = 0.003), DBP −2.60 mm Hg (95% CI: −4.03, −1.16; P = 0.0004). Sodium reduction resulted in significant increases in renin (P < 0.00001), aldosterone (P < 0.00001), noradrenaline (P < 0.00001), adrenaline (P < 0.0002), cholesterol (P < 0.001), and triglyceride (P < 0.0008).ConclusionsSodium reduction resulted in a significant decrease in BP of 1% (normotensives), 3.5% (hypertensives), and a significant increase in plasma renin, plasma aldosterone, plasma adrenaline, and plasma noradrenaline, a 2.5% increase in cholesterol, and a 7% increase in triglyceride.This article is based on a Cochrane Review published in the Cochrane Database of Systematic Reviews (CDSR) 2011, Issue 11, DOI: 10.1002/14651858.CD004022.pub3 (see www.thecochranelibrary.com for information). Cochrane Reviews are regularly updated as new evidence emerges and in response to feedback, and the CDSR should be consulted for the most recent version of the review.American Journal of Hypertension (2012). doi:10.1038/ajh.2011.210 [ABSTRACT FROM AUTHOR]

Background. There is little evidence for the measurement properties of instruments commonly used for women with pelvic girdle pain. Objective. The aim of this study was to examine the internal consistency, test-retest reliability, and construct validity of instruments used for women with pelvic girdle pain. Design. This was a cross-sectional methodology study, including test-retest reliability assessment. Methods. Women with pelvic girdle pain in pregnancy and after delivery participated in a postal survey that included the Pelvic Girdle Questionnaire (PGQ), Oswestry Disability Index (ODI), Disability Rating Index (DRI), Fear-Avoidance Beliefs Questionnaire (FABQ), Pain Catastrophizing Scale (PCS), and 8-item version of the Medical Outcomes Study 36-Item Short-Form Health Survey questionnaire (SF-36). Test-retest reliability was assessed with a random subsample 1 week later. Internal consistency was assessed with the Cronbach alpha, and test-retest reliability was assessed with the intraclass correlation coefficient (ICC) and minimal detectable change (MDC). Construct validity based on hypotheses was assessed by correlation analysis. Discriminant validity was assessed with the area under the receiver operating characteristic curve. Results. All participants responded to the main (N=87) and test-retest (n=42) surveys. Cronbach alpha values ranged from .88 to .94, and ICCs ranged from .78 to .94. The MDC at the individual level constituted about 7% to 14% of total scores for the 8-item version of the SF-36, ODI, and PGQ activity subscale; about 18% to 22% for the DRI, PGQ symptom subscale, and PCS; and about 25% for the FABQ. Hypotheses were mostly confirmed by correlations between the instruments. The PGQ was the only instrument that significantly discriminated participants who were pregnant from participants who were not pregnant as well as pain locations. Limitations. A comparison of responsiveness to change of the various instruments used in this study was not undertaken, but will be carried out in a future study. Conclusions. Self-report instruments for assessing health showed good internal consistency, test-retest reliability, and construct validity for women with pelvic girdle pain. The PGQ was the only instrument with satisfactory discriminant validity, thus, it is recommended for evaluating symptoms and disability in patients with pelvic girdle pain. [ABSTRACT FROM AUTHOR]

Background. The EUROPEP is a widely used international instrument to evaluate general practice care from the perspective of patients, but measurement properties including reliability at the GP level are not sufficiently documented.Objective. The objectives of this study were to assess the psychometric properties of the Norwegian version of the EUROPEP and estimate GP-level reliability for scales and items.Methods. Nine hundred patients consulting nine GPs at a medical centre in Norway were invited to complete the Norwegian EUROPEP at home following a recent consultation. We assessed item missing and ceiling effects and used factor analysis to assess the structure of the 23 items of the EUROPEP. Scales were tested for reliability and construct validity, while reliability at the GP level was tested for items and scales.Results. Five hundred and fifty-seven patients (61.9%) returned the questionnaire. Seven of 23 items had missing responses >10% and 20% had high ceiling effects. Factor analysis identified two groups of questions that formed scales with satisfactory internal consistency reliability and validity. The clinical behaviour scale (12 items) and the organization of care scale (4 items) met the criterion of 0.7 for Cronbach’s alpha. The GP-level reliability was >0.7 for both scales, but 9 of 23 items were below the criterion of 0.7.Conclusions. The study identified two scales in the Norwegian EUROPEP instrument with satisfactory psychometric properties. However, high proportions of item non-response large ceiling effects and low GP-level reliability for several items indicate the need for further instrument refinement. [ABSTRACT FROM AUTHOR]

Background. Exercise benefits patients with chronic nonspecific low back pain; however, the most effective type of exercise remains unknown. Objective. This study compared outcomes after motor control exercises, sling exercises, and general exercises for low back pain. Design. This was a randomized controlled trial with a 1-year follow-up. Setting. The study was conducted in a primary care setting in Norway. Patients. The participants were patients with chronic nonspecific low back pain (n=109). Interventions. The interventions in this study were low-load motor control exercises, high-load sling exercises, or general exercises, all delivered by experienced physical therapists, once a week for 8 weeks. Measurements. The primary outcome measure was pain reported on the Numeric Pain Rating Scale after treatment and at a 1-year follow-up. Secondary outcome measures were self-reported activity limitation (assessed with the Oswestry Disability Index), clinically examined function (assessed with the Fingertip-to-Floor Test), and fear-avoidance beliefs after intervention. Results. The postintervention assessment showed no significant differences among groups with respect to pain (overall group difference) or any of the outcome measures. Mean (95% confidence interval) group differences for pain reduction after treatment and after 1 year were 0.3 (-0.7 to 1.3) and 0.4 (-0.7 to 1.4) for motor control exercises versus sling exercises, 0.7 (-0.6 to 2.0) and 0.3 (-0.8 to 1.4) for sling exercises versus general exercises, and 1.0 ( -0.1 to 2.0) and 0.7 (-0.3 to 1.7) for motor control exercises versus general exercises. Limitations. The nature of the interventions made blinding impossible. Conclusions. This study gave no evidence that 8 treatments with individually instructed motor control exercises or sling exercises were superior to general exercises for chronic low back pain. INSET: The Bottom Line. [ABSTRACT FROM AUTHOR]

Objective: To describe a short questionnaire for measuring the quality of patient visits to family physician practices, and to assess the questionnaire's validity and reliability. [ABSTRACT FROM PUBLISHER]

BackgroundDespite its clinical relevance, sodium intake is seldom monitored by physicians, largely because of shortcomings of the 24-h urine collection for sodium excretion. In a prior study, sodium excretion was shown to be accurately estimated from a late afternoon/early evening spot urine sodium/creatinine ratio, adjusted for 24-h creatinine excretion. In this study, we assessed a more convenient and inexpensive method, using chloride and creatinine dipsticks.MethodsSubjects submitted 24-h urine collections along with an “AM sample,” collected at the beginning, a “PM sample” collected in the late afternoon/early evening before dinner, at roughly the midpoint, and a “random sample,” collected after completion, of the 24-h collection. Predicted 24-h sodium excretion was then determined from the spot urine dipstick chloride/creatinine ratio, measured by two independent observers, and from the spot urine laboratory sodium/creatinine ratio. Both ratios were adjusted for 24-h creatinine excretion.ResultsFor PM samples, predicted sodium excretion correlated strongly with actual 24-h sodium excretion, both for the dipstick method (r = 0.71; observer 1 and r = 0.65; observer 2; both P < 0.001), and the laboratory method (r = 0.86, P < 0.001). PM samples also differentiated subjects with sodium excretion <100 mEq/day vs. ≥100 mEq/day (sensitivity and specificity: dipstick method: 83 and 82%, respectively for observer 1, 89 and 77%, respectively, for observer 2; laboratory method: 100 and 82%, respectively). AM samples and random samples correlated less strongly.ConclusionThe dipstick method appears promising as a convenient and inexpensive means to serially assess sodium excretion.American Journal of Hypertension 2010; doi:10.1038/ajh.2010.57 [ABSTRACT FROM AUTHOR]

Background. Continuity between doctors and patients likely affects patient satisfaction. Objective. To assess the current evidence on the relationship between continuity and patient satisfaction. Methods. Systematic review of studies of adults in general, family, or internal medicine practices with ongoing, direct, face-to-face contact with their physician. Measures of the relationship between continuity and patient satisfaction were examined. Results. A MEDLINE search covering 1984-2007 and a Cumulative Index to Nursing and Allied Health Literature search covering 1981-2007 identified 263 relevant studies and 12 studies met inclusion criteria. There were 12 different continuity measures and 9 different satisfaction measures. Conclusions. Continuity has a variable effect on patient satisfaction. [ABSTRACT FROM AUTHOR]

The article reports on a systematic review of motor control exercise for patients with persistent, nonspecific low back pain. 14 randomized controlled trials which evaluated the efficiency of motor control exercises used to treat patients with persistent low back pain were systematically reviewed through the use of electronic database searches until June 2008. The study found that motor control exercises produced improved results when compared to minimal intervention and as an addition to another therapy for the treatment of pain.

Using a prospective design, this study examines the mediating effect of perceived control in explaining the predictive role of socioeconomic status (SES) in long-term changes in functional status as a consequence of the occurrence of coronary heart disease (CHD). We followed 221 older CHD patients by using a community-based survey. We collected data on patients' functional status before the onset of disease and 1 year after the diagnosis. Multiple linear regressions show that SES predicts functional changes only in relation to physical functioning. Furthermore, self-efficacy, but not mastery, mediates the predictive role of SES in changes in physical functioning in CHD patients. Self-efficacy is the only aspect of control that mediates the relation between SES and changes in physical functioning. Our findings provide a basis for future interventions in disadvantaged groups of older persons and new theoretical models of recovery processes. [ABSTRACT FROM AUTHOR]

The diagnostic approach to ureteric colic has changed due to the introduction of new radiological imaging such as non- contrast CT. The role of intravenous urography, which is regarded as the gold standard for the diagnosis of ureteric colic, is being challenged by CT, which has become the first-line investigation in a number of centres. The management of ureteric colic has also changed. The role of medical treatment has expanded beyond symptomatic control to attempt to target some of the factors in stone retention and thereby improve the likelihood of spontaneous stone expulsion. [ABSTRACT FROM AUTHOR]

Aims: Individuals in treatment for alcohol use disorders are more likely to die from cigarette use than from alcohol consumption. Advanced statistical methodologies that increase study power and clinical relevance have been advocated to examine the timevarying nature of substance use relapse and abstinence, including drinking and smoking. The purpose of this investigation was to examine timevarying factors that are associated with smoking cessation among smokers in the general population, including alcohol use, self-efficacy, and depression, to determine if they were also related to smoking cessation during and after treatment for alcohol use disorders. Methods: Data were garnered from Project MATCH, a longitudinal prospective study of the efficacy of three behavioural treatments for alcohol use disorders. Timevarying covanate analyses were conducted to examine future smoking cessation. Results: Results showed that greater self-efficacy regarding resisting temptations to drink and lower levels of depression were independently associated with increased likelihood of stopping smoking. In contrast, drinks per drinking day and confidence regarding not drinking did not demonstrate such associations. Conclusions: Clinical implications of these findings suggest that interventions to help alcoholics in recovery avoid temptations to drink, as well as decrease depression, may be warranted. By using advanced statistical techniques, these results can help clinicians and organizations working with smokers in treatment for alcohol use disorders to make informed decisions regarding how best to use limited resources. [ABSTRACT FROM AUTHOR]

Objective. Misconceptions and exaggerated fear of fever may divert parents' attention from more predictive symptoms of childhood illness, such as appetite and level of activity. This study aims at exploring how specific predefined characteristics of febrile preschool children affected parents' assessment of the severity of the condition and the perceived need for treatment with paracetamol. [ABSTRACT FROM PUBLISHER]

Background. A deep and comprehensive understanding of what patients value about having a personal doctor in primary care is lacking.Objectives. To acquire a comprehensive understanding of the core values of having a personal doctor in a continuing doctor–patient relationship in primary care among long-term, chronically ill patients.Method. In this qualitative study, 14 chronically ill patients at three primary health care centres were strategically selected. The centres were selected to include patients with experiences from both long-term and short-term doctors. The patients were asked about their views on having a personal doctor in a continuing doctor–patient relationship in primary care compared with having different short-term doctors. Sixteen health care professionals were interviewed about what chronically ill patients convey to them about having a personal doctor in contrast to seeing different short-term locum doctors. The in-depth interviews were transcribed verbatim and analysed by qualitative content analysis.Results. The core category, i.e. a universal concept that many patients used to describe the impact of having access to a personal doctor, was a sense of security. This was based on four main categories or core foundations which were: feelings of coherence, confidence in care, a trusting relationship and accessibility. In turn, the four main categories emerged from two to four of subcategories.Conclusion. The foundations that underpin the value of personal care from the patients' perspective could be based on categories found in this study. [ABSTRACT FROM AUTHOR]

Background. Little is known about doctors' decision-making processes in prescribing antidepressants and how this is handled.Objective. To describe and understand doctors' strategies in prescribing mood-modifying drugs, especially when confronted with challenging patients or situations.Methods. Face-to-face interviews were conducted with GPs in Göttingen and Hannover, two areas in the north of Germany. GPs were enrolled until a sufficient variation (‘saturation’) had been reached (n = 19). Interviews were audiotaped and then transcribed verbatim. To analyse the GPs' concepts and strategies in prescribing antidepressants, the interviews were structured according to themes and recurrent items extracted by theoretical coding.Results. We identified four main strategies used by GPs in the pharmacological management of depressive patients: marketing additional beneficial drug effects, addressing the patients as experts, somatic attribution of the disease and referral to a specialist.Conclusions. To support their prescription, GPs use a variety of strategies to motivate both patients to take a certain drug and themselves to deal with difficult patients or situations in their management of depression. [ABSTRACT FROM AUTHOR]

Complementary and alternative medicines (CAM) are widely used by those with pain and/or musculoskeletal problems, and previous research has shown that high proportions of individuals with rheumatoid arthritis have used these therapies. One of the largest CAM modalities is that of naturopathy, which combines nutritional, herbal, and other complementary practices to treat such conditions. In this review, evidence is examined in relation to those factors which naturopaths believe are significant contributors to rheumatoid arthritis, and are hence the main focus of therapeutic management. These factors include food allergy, increased gut permeability, increased circulating immune complexes, excessive inflammatory processes, and increased oxidative stress. Naturopathic treatment attempts to alleviate symptoms by altering these factors through dietary modification, manipulation of dietary fats, and use of antioxidants and proteolytic enzymes. An understanding of the rationale for these treatments and evaluation of the evidence from their use in clinical settings will assist with the integration of complementary and conventional practices in the treatment of rheumatoid arthritis. [ABSTRACT FROM AUTHOR]