Search

Objective. Sexual problems are common in people with diabetes. It is unknown whether early detection of diabetes and subsequent intensive multifactorial treatment (IT) are associated with sexual health. We report the prevalence of low sexual desire and low sexual satisfaction among people with screen-detected diabetes and compare the impact of intensive multifactorial treatment with the impact of routine care (RC) on these measures. Design. A cross-sectional analysis of the ADDITION-Denmark trial cohort six years post-diagnosis. Setting. 190 general practices around Denmark. Subjects. A total of 968 patients with screen-detected type 2 diabetes. Main outcome measures. Low sexual desire and low sexual satisfaction. Results. Mean (standard deviation, SD) age was 64.9 (6.9) years. The prevalence of low sexual desire was 53% (RC) and 54% (IT) among women, and 24% (RC) and 25% (IT) among men. The prevalence of low sexual satisfaction was 23% (RC) and 18% (IT) among women, and 27% (RC) and 37% (IT) among men. Among men, the prevalence of low sexual satisfaction was significantly higher in the IT group than in the RC group, p = 0.01. Conclusion. Low sexual desire and low satisfaction are frequent among men and women with screen-detected diabetes, and IT may negatively impact men's sexual satisfaction. [ABSTRACT FROM AUTHOR]

Background. Diabetes is becoming more common in the Greenlandic population. Patients with diabetes are more prone to periodontal disease. Periodontal status may have an effect on metabolic control. Objective. The aim of this study was to estimate the prevalence of periodontitis amongst patients with diabetes in Nuuk, Greenland, and secondly, to observe if dental care was associated with improved periodontal status and metabolic control. Study design. Observational cross-sectional study and a pilot study of a dental care intervention. Methods. Sixty-two Greenlandic patients with diabetes were included in the study. Data were collected from the Electronic Medical Records (EMR), in addition to a telephone interview. Patients were offered 3 dental examinations with a 3-month interval. The dental examinations consisted of a full-mouth assessment of number of remaining teeth and assessment of periodontal status. Patients received scaling and root planing, together with information and instructions on oral hygiene. Information on glycated haemoglobin (HbA1C) values was collected from the EMR at each dental examination. Results. In this study, 21.0% (13/62) of patients with diabetes had periodontitis. About 42% had less than 20 teeth. The association between diabetes and periodontitis was known by 20 out of the 62 patients. Over half of the patients had been to a dental examination within the last year. The prevalence of periodontitis decreased significantly from 21.0 to 0% (p<0.001) after 3 dental examinations. No change in HbA1C levels was observed (p=0.440). Conclusion. Periodontitis was common among patients with diabetes in Nuuk. Dental health status based on Periodontal Screening Index (PSI) and bleeding on probing (BOP) seemed to improve after dental health care, indicating a need for increased awareness among patients and health care professionals. HbA1C levels were not improved among the patients. [ABSTRACT FROM AUTHOR]

Objective. To describe lipid-lowering treatment in a primary care setting and how well target levels are reached. Furthermore, the aim is to describe long-term adherence to treatment. Design. Population-based cross-sectional study with follow-up. Setting. A total of 139 general practices from three of five Danish regions, taking part in the ADDITION study from 2001 to 2006. Subjects. The study population comprises 1468 patients who started lipid-lowering drugs and were followed for a minimum of one year after starting treatment. Median time of follow-up after starting drug therapy was 936 days (range: 366-2068). Results. Of 1468 patients starting treatment, a total of 781 (53%) reached the treatment goal of total cholesterol <5.0 and low-density lipoprotein <3 mmol/l within one year after drug therapy start. The percentage increased throughout the study period from 27% of patients initiating treatment in 2001 to 66% of patients initiating treatment in 2005. Age over 50, repeated cholesterol measurements within three months after treatment start, larger initial dose, and calendar year of treatment start were associated with reaching the goal within the first year, and most recent total cholesterol measurement before start of treatment >7 mmol/L was associated with not reaching the goal in the first year. Among patients followed for a minimum of three years after drug therapy started ( n == 536), adherence was 77%, 72%, 75% in the first, second, and third year respectively. Conclusion. Initial doses and the percentage reaching their goal increased substantially throughout the study period. Adherence to lipid-lowering treatment is relatively high in a primary care setting. However, current practice shows room for improvement if treatment recommendations are to be met. [ABSTRACT FROM AUTHOR]

Objective. ''Motivational interviewing'' (MI) has shown to be broadly applicable in the management of behavioural problems and diseases. Only a few studies have evaluated the effect of MI on type 2 diabetes treatment and none has explored the effect of MI on target-driven intensive treatment. Methods. Patients were cluster-randomized by GPs, who were randomized to training in MI or not. Both groups received training in target-driven intensive treatment of type 2 diabetes. The intervention consisted of a 1½½-day residential course in MI with half-day follow-up twice during the first year. Blood samples, case record forms, national registry files, and validated questionnaires from patients were obtained. Results. After one year significantly improved metabolic status measured by HbA1c (p < 0.01) was achieved in both groups. There was no difference between groups. Medication adherence was close to 100% within both treatment groups. GPs in the intervention group did not use more than an average of 1.7 out of three possible MI consultations. Conclusion. The study found no effect of MI on metabolic status or on adherence of medication in people with screen detected type 2 diabetes. However, there was a significantly improved metabolic status and excellent medication adherence after one year within both study groups. An explanation may be that GPs in the control group may have taken up core elements of MI, and that GPs trained in MI used less than two out of three planned MI consultations. The five-year follow-up of this study will reveal whether MI has an effect over a longer period. [ABSTRACT FROM AUTHOR]

Objective. To describe the management of dyslipidaemia in patients with high risk of cardiovascular disease (CVD) and patients with a history of CVD identified by screening for diabetes in general practice in Denmark, concentrating on prescription of lipid-lowering drugs. Moreover, to analyse predicting factors for starting lipid-lowering drugs related to patient and general practice characteristics. Design. Population-based cross-sectional study with follow-up. Setting. A total of 139 general practices from three of five Danish regions, totalling 216 GPs. Subjects. The study population comprised 4986 patients with a high risk of CVD and dyslipidaemia and 764 patients with a history of CVD and dyslipidaemia out of a population of 16 572 patients who completed screening for diabetes but were cleared for diabetes in the ADDITION study. Results. Of patients with a high risk of CVD and dyslipidaemia not receiving lipid-lowering drugs at the time of screening (n = 4823), 20% started lipid-lowering therapy within the follow-up period (median 2.1 years). This percentage was 45% (n = 536) for patients with CVD and dyslipidaemia (median follow-up period 1.6 years). Age over 50, high cholesterol, impaired fasting glucose and/or impaired glucose tolerance, minor polypharmacy, use of heart/circulation drugs, and cholesterol measurements after screening predicted the prescription of lipid-lowering drugs for patients at high risk of CVD. For patients with CVD, male gender, high cholesterol and use of heart/circulation drugs predicted the prescription of lipid-lowering drugs. No general practice characteristics were associated with different prescription habits. Conclusion. There is a gap between the recommended lipid-lowering drug therapy and current practice, with a substantial under-treatment and a considerable delay in the first prescription of lipid-lowering drugs. [ABSTRACT FROM AUTHOR]

Objective. In people with screen-detected type 2 diabetes in primary care, (1) to assess adherence to guidelines, recommending consultation with the GP every three months and treatment initiation with an ACE inhibitor or an angiotensin-II receptor antagonist when systolic BP was > 120 mmHg and/or diastolic BP was > 80 mmHg, and (2) to identify predictors for adherence. Design. Prospective follow-up of a fixed cohort of patients. Setting. Fifty-four Danish general practices. Subjects and main outcome measures. A total of 361 people with screen-detected type 2 diabetes were followed up for 410 days to assess planned consultations with their GP and recording of BP. Some 226 people, with BP recorded above guideline threshold(s) and where treatment was not already initiated, were followed for up to 410 days to monitor prescription redemption. Results. At 3, 6, 9 and 12 months 80%, 77%, 74%, and 73% of the cohort attended a consultation. A total of 89% of the cohort attended two of the four planned consultations. The probability of redeemed prescriptions for an ACE inhibitor or an angiotensin-II receptor antagonist according to the guideline during the first year following diagnosis was 51%. High initial BP was associated with prescription redemption. No other analysed individual or organisational characteristics were found to be associated with treatment initiation. Conclusion. The consultation attendance was reasonably high, and treatment initiation with an ACE inhibitor or an angiotensin-II receptor antagonist according to the guideline was found in half of the cases. High initial BP increased the probability of treatment initiation. [ABSTRACT FROM AUTHOR]

Objective. To examine whether training GPs in motivational interviewing (MI) can improve type 2 diabetic patients' (1) understanding of diabetes, (2) beliefs regarding prevention and treatment, and (3) motivation for behaviour change. Methods. A randomized controlled trial including 65 GPs and 265 type 2 diabetic patients. The GPs were randomized in two groups, one with and one without MI training. Both groups received training in target-driven intensive treatment of type 2 diabetic patients. The intervention was a 1½-day residential course in MI with ½-day follow-up twice during the first year. The patient data stemmed from previously validated questionnaires. Main outcome measures. The Health Care Climates Questionnaire assesses the patient-doctor relationship and type of counselling. The Treatment Self-Regulation Questionnaire assesses the degree to which behaviour tends to be self-determined. The Diabetes Illness Representation Questionnaire assesses beliefs and understanding of type 2 diabetes. The Summary of Diabetes Self Care Activities assesses the extent of various self-care activities related to type 2 diabetes. Results. The response rate to our questionnaires was 87%. Patients in the intervention group were significantly more autonomous and motivated in their inclination to change behaviour after one year compared with the patients from the control group. Patients in the intervention group were also significantly more conscious of the importance of controlling their diabetes, and had a significantly better understanding of the possibility of preventing complications. Conclusion. MI improved type 2 patients' understanding of diabetes, their beliefs regarding treatment aspects, their contemplation on and motivation for behaviour change. Whether our results can be sustained long term and are clinically relevant in terms of changes in risk profile advocates further research. [ABSTRACT FROM AUTHOR]

Objective. To explore how individuals whose health screening does not reveal a high cardiovascular risk score (CRS) interpret and respond to this result. Design. Qualitative semi-structured interviews. Purposeful sampling reflected variations in age, gender, and self-rated health within the sample. Analysis and interpretation were informed by the Health Belief Model concerning individuals' cues to act when told there is a health threat, and by Hollnagel and Malterud's theories about personal self-assessed health resources. Setting. Participants were recruited among participants without a high cardiovascular risk score in a Danish health-screening project. Subjects. Seven men and 15 women aged 36-50 years with a low or moderate cardiovascular risk score. Results. The screening confirmed the participants' feeling of being in good health and they put emphasis on this acquired peace of mind. Participants used the results to eliminate worries and confirm their lifestyle up to now but were aware that the results gave no guarantee that there was nothing the matter elsewhere. Some paid a price for the reassurance since they had to undergo further examinations, had unfulfilled expectations, or were irritated at not being left in peace with their reassurance. Conclusion. Screened individuals who were shown not to have a high risk score appear to be reassured and confirmed in their own feeling of being healthy, and to be aware of the limitations of the screening. Consideration should be given to the possible risk of creating either insecurity or over-complacency through population screening. [ABSTRACT FROM AUTHOR]

Objective. To describe patients' evaluation of the contents of preventive cardiovascular consultations and to analyse whether their evaluation is shaped by self-reported cognitive and emotional effects and lifestyle changes two to six weeks after the consultations. Design. Questionnaire developed by means of qualitative studies. Setting.Two counties in Denmark. Subjects. A total of 2450 subjects who had participated in a preventive cardiovascular consultation with their GP received a questionnaire; 1714 responded (70%); 1226 fulfilled the inclusion criteria, namely to be at increased risk of cardiovascular disease (CVD) but without having CVD. Main outcome measures. Cognitive and emotional effects and lifestyle changes. Odds ratios (ORs) were calculated between self-reported issues raised during the consultations and self-reported lifestyle changes, cognitive and emotional effects. Results. Some 58-79% reported cognitive effects (knowledge about risk and disease), 22-57% lifestyle changes (diet, exercise, and smoking), 80-97% emotional effects related to relief and satisfaction, and 23% worries. Those who reported that a dialogue had taken place (e.g. information concerning risk of disease, life habits, life circumstances/daily living, perception of risk, knowledge about disease, and own possibilities for prevention) had ORs between 1.7 and 4.3 for reporting three or more cognitive effects and one or more lifestyle changes (p < 0.05). These issues were also significantly related to emotional effects such as feeling relieved and satisfied. Conclusion. Patients report cognitive and emotional effects and healthy lifestyle changes following a cardiovascular preventive consultation and the magnitude of the effect is associated with the nature of the issues raised. [ABSTRACT FROM AUTHOR]

Objective. Within the frame of a randomized clinical trial to examine whether training of general practitioners (the intervention group) in intensive lifestyle modification and pharmacological treatment of patients with type 2 diabetes has a spillover effect on individuals with impaired fasting glycaemia (IFG) or impaired glucose tolerance (IGT). Design. A high-risk screening study for type 2 diabetes with an intervention programme, where general practices were randomized to provide standard treatment versus intensive lifestyle modification and pharmacological treatment to newly diagnosed diabetic patients. Setting. General practices in Denmark. Subjects. Of 1821 individuals identified with IFG or IGT, results from oral glucose tolerance tests after one and three years were available in 1510 individuals. Main outcome measures. Progression rates from IFG and IGT to diabetes and effect of intervention were estimated in a regression model using interval censoring. Results. A total of 442 persons developed diabetes. There was no significant overall effect of intervention on progression rates. For risk factors, no difference in rate of change was found between randomization groups, but a difference was found between general practices within the same randomization groups. Conclusion. General practitioners identify a high number of incident diabetes cases in individuals with IFG or IGT found by high-risk screening. Intervention at the general practitioner's level in intensive treatment type 2 diabetes does not have a significant spillover effect reducing the risk of diabetes from pre-diabetic conditions. This could indicate that intervention strategies should be specifically targeted at individuals with IFG or IGT, either by training general practitioners or directly at the individual level. [ABSTRACT FROM AUTHOR]

Objective . This study aims to describe the routine monitoring of lipids and the use of lipid-lowering medicine in people with type 2 diabetes in the period 2000–2002. Material and methods . Data from the National Health Service Registry, the Regional laboratory database and the Danish National Hospital Registry have been used for identification and description of known diabetes in a background population of 649,177 citizens in the County of Aarhus, corresponding to 12% of the total Danish population. All data were collected for the period 1 January 2000 to 31 December 2002. Results . A total of 14,644 people with type 2 diabetes were identified, 52% of whom were men. The mean age was 64 years and the mean duration of diabetes was 7 years. A total of 61% had a minimum of one measurement of total cholesterol in 2000 compared with 64% in 2002. Some 71% of the patients in 2000 compared with 66% in 2002 had a total cholesterol concentration above 5.0 mmol/l. The proportion of people with type 2 diabetes treated with a lipid-lowering drug increased from 15% in 2000 to 24% in 2002. For those who were treated with lipid-lowering medication 33% in 2000 and 42% in 2002 reached currently recommended targets of total cholesterol concentrations. Conclusions . The results of this study provide a realistic picture of the monitoring of cholesterol as part of diabetes care and found a tendency to increased adherence to guidelines. Even so, it seems as if more patients with diabetes could benefit from treatment with lipid-lowering medication. [ABSTRACT FROM AUTHOR]

Objective. To explore how persons with an elevated cardiovascular risk score (CRS) balanced health-related advice against the life they wanted to live or were able to live. Setting. 2000 Danes aged 30–50 were invited to participate in a health-screening project in general practice. Screenings were conducted at baseline and after one and five years, and included among other screening procedures a calculation of CRS (see Figure 1). Design. Participants with an elevated CRS were asked to participate in a qualitative semi-structured interview. They were selected by stratified purposeful sampling reflecting variations in age, sex. and perceived health. Subjects. Nine men and five women aged 33–50 years. Theoretical frames of reference. Bandura's theory of self-efficacy and the Health Belief Model's consideration of individuals’ cues to act against a health threat supported analysis. Results. Being informed about an elevated CRS had a considerable impact on the informants. They initiated significant lifestyle changes though only to a limited degree when such changes would affect their quality of life adversely. In cases where other results of the multiphasic screening were normal, interpreted as such, or if there were stressful circumstances in the informant's life, the elevated CRS receded into the background. Interpretation. Doctors, who inform individuals about the impact of risk factors, need to know that the consequences and health advice are not always interpreted by laypeople as supposed by the medical culture. [ABSTRACT FROM AUTHOR]

Discordance between doctors' and patients' evaluations of the latter's health status may be a source for miscommunication and lead to less efficient consultations. In about a third of cases studied, GPs' and patients' evaluations of the patients' health status were discordant. Patients could be classified as respectively "Good-health realists", "Poor-health realists", "Health pessimists" and "Health optimists". Proportion size of present risk factor in each patient category was associated with self-evaluated health. Objective - To describe the occurrence of "health realists", "health pessimists" and "health optimists" in a non-patient population by identifying cases of concordance and discordance between doctor-evaluated health and self-evaluated health and to describe the distribution of selected life-style-related physiological risk factors among these health-groups. Design - Comparative study. Setting - Primary health care. Subjects - 456 middle-aged persons registered with a general practitioner (GP) were after a general health screening invited to a health discussion. Prior to the health screening the participants had assigned their health status to one of five categories ranging from "very poor" to "excellent". After the health discussion the GP rated the participants' general health status on a visual analogue scale. On basis of this information patients were classified as "health realists", "health optimists" and "health pessimists". Results - 54% of the participants could be classified as "good-health realists", 14% as "poor-health realists", 22% as "health optimists", and 10% as "health pessimists". "Poor-health realists" had the greatest accumulation of risk factors, followed by "health optimists", "health pessimists" and "good-health realists". Among the "health pessimists" there was a significantly higher risk score of future cardiovascular disease and poor physical endurance compared with the "good-health realists". Conclusion - Discordance between doctor-evaluated health and self-evaluated health was found in 32% of the cases studied. "Health pessimists" had more risk factors than "good-health realists" even though the GPs had rated their general health status as good in both cases. [ABSTRACT FROM AUTHOR]

Objective: Mortality and incidence of cardiovascular disease have declined during the past 35-40 years. The dual aim of this study is to investigate whether the prevalence of electrocardiographic findings is low compared with older studies and to describe the prevalence of electrocardiographic findings in the Danish population, which has not been reported since 1981.Design: Cross-sectional study based on electrocardiograms obtained from a random sample of the population in the district of Ebeltoft, Denmark, December 1991-June 1992.Results: The age and sex stratified prevalence of abnormal electrocardiograms ranged from 6.8% (95% CI: 4.01-10.7%) in women to 15.0% (95% CI: 10.6-20.4%) in men aged 41-51 years. Men had significantly more electrocardiographic changes than women (p = 0.004). Frequent findings were signs of earlier myocardial infarction (3.1%; 95% CI: 2.1-4.5%), axis deviation (3.1%; 95% CI: 2.1-4.5%) and incomplete right bundle branch block (1.2%; 95% CI: 0.6-2.2%).Conclusion: Prevalence of ischemic electrocardiographic findings is low when compared with studies from the past 50 years. [ABSTRACT FROM AUTHOR]

Objectives - To evaluate changes in plasma cholesterol following health screening and health discussions in general practice. Design - Randomised prospective population-based study conducted over a period of 5 years. Setting - Primary care, all general practitioners (GPs) in a welldefined area. Subjects - A random sample of inhabitants aged 30-49 years in January 1991, registered with a local GP was invited to participate. The participants (1507 persons, or 75.4% of the 2000 invited) were randomly allocated to two intervention groups and a control group. Main outcome measures - Plasma cholesterol, percentage of subjects with plasma cholesterol higher than 7 mmol/l. Results - After 5 years of intervention, plasma cholesterol in the whole population was significantly lower in the intervention groups compared to the control group. The decrease was most pronounced (0.5 mmol/l) in subjects at high cardiovascular risk. The percentage of high-risk individuals with a cholesterol level higher than 7 mmol/l was significantly lower in the intervention groups compared to the control group (9.8% vs 6.2%, p =0.04), corresponding to a 37% reduction. Conclusions - The study shows that the health checks had a measurable impact on plasma cholesterol levels, the most pronounced effect is seen among individuals at high cardiovascular risk. [ABSTRACT FROM AUTHOR]

Objective - To describe the use and level of HbA1c in a large unselected Type 2 diabetic population in Denmark. In addition, to describe the characteristics of the patients and the general practitioners in relation to the monitoring of HbA1c. Design - Data were collected from public data files for the period January 1993 to December 1997. Setting - The County of Vejle with a background population of 342597 citizens, 303 250 of whom were listed with participating general practitioners. Patients - The Type 2 diabetic population alive and resident in the county on 1 January 1997. Results - In a population of 4438 Type 2 diabetics, 73% had a minimum of one annual HbA1c measurement in 1997. No HbA1c measurement was associated with a long history of diabetes, diet treatment or old age. Poor glycaemic regulation was found in 65% of the Type 2 diabetics in 1997. Poor glycaemic regulation was associated with tablet or insulin treatment, age under 70 years and long history of diabetes. The interpractice variation was huge. Conclusion - The quality of HbA1c monitoring of Type 2 diabetics needs to be improved. Possibilities for improvement seem to be present. [ABSTRACT FROM AUTHOR]

Objective: Impaired fetal growth has been linked with cardiovascular disease and different cardiovascular risk factors. Few studies have examined the association between fetal growth and urinary albumin excretion, an important predictor of vascular disease in both diabetic and non-diabetic subjects. Material and methods: We examined the association between markers of fetal growth, ie. birth weight, birth length and Ponderal Index, from birth records and urinary albumin excretion in 545 middle-aged men and women who had taken part in a population-based follow-up study in the municipality of Ebeltoft, Denmark. The outcome was the urinary albumin-creatinine ratio. Results: Three men (1.1%) and 10 women (3.6%) had a albumin-creatinine ratio above 2.5/3.5 mg/mmol, which is considered abnormal and diagnostic of microalbuminuria. The strength of the associations between birth weight, birth length, Ponderal Index and albumin-creatinine ratio were fitted in separate multivariate models, but no associations were found in any model. Conclusions: Our study did not support the hypothesis of an association between fetal growth and adult albumin-creatinine ratio. Studies with larger numbers of microalbuminuric subjects are required in order to further clarify the relationship between fetal growth and later renal function. [ABSTRACT FROM AUTHOR]

Objectives: To investigate whether impaired fetal growth, measured by low birth weight and short birth length, is linked with raised levels of serum lipids and increased risk and mortality of coronary heart disease.Design: The association between birth length, birth weight, Ponderal Index and total serum cholesterol was examined in 545 Danish men and women aged 31 to 51 years who participated in the Ebeltoft Health Promotion Project in Denmark.Results: No associations were found in women. For men, a negative association was found between birth weight and serum total cholesterol, with a fall in mean serum total cholesterol from 6.03 mmol/l at birth weight below 3300 g to 5.64 mmol/l at birth weight above 4000. A similar association was found between birth length and serum cholesterol, with a mean value of 6.23 mmol/l at birth length below 51 cm and a mean value of 5.56 mmol/l at birth length above 54 cm. No associations were found for Ponderal Index. Between 3% and 8% of the variance in serum total cholesterol could be explained by the statistical models used in this study.Conclusion: Our findings support the hypothesis of a negative association between birth weight, birth length and elevated serum cholesterol in adult life, but only in men. [ABSTRACT FROM AUTHOR]

During the past decade, studies have shown an inverse association between birth weight and blood pressure and risk of coronary heart disease in adult life. From old public archives we were able to trace the birth records of 545 out of 905 persons (60.2%) aged 31-51 years who participated in the Ebeltoft Health Promotion Project in Denmark. We examined the associations between birth weight, length at birth, Ponderal Index and systolic and diastolic blood pressure. No associations were found for women. For men, the mean systolic blood pressure fell from 131.1 mmHg with a birth weight of less than 3300 g to 129.6 mmHg with a birth weight of more than 4000 g, and for diastolic blood pressure 81.6 mmHg to 80.3 mmHg, respectively. For men, the mean systolic blood pressure fell from 135.7 mm Hg with a birth length of 30-51 cm to 131.6 with a birth length of 55-62 cm, and for diastolic blood pressure 83.0 mmHg to 78.8 mmHg, respectively. The associations may reflect organ programming in fetal life. [ABSTRACT FROM AUTHOR]

This paper focuses on problems attached to using scientific results in everyday clinical practice. Based on examples we raise the question: Are research results obtained under ideal scientific conditions, presented to health professionals and the public in a way that creates unrealistic expectations of the health services? We suggest that the clinical researcher, when reporting scientific results, should be obliged to consider technological aspects, i.e. the human and monetary cost, effectiveness, compliance, the expected consequence for the patient, professionals and society, and resources needed to accomplish it. Presented with these considerations, actors of the health care scene in terms of professionals, administrators, politicians and patients should be better suited to decide if implementation of a new treatment should take place. Such procedures will give the population and the politicians more realistic expectations of the contributions of medical science and the health services in general. [ABSTRACT FROM AUTHOR]

The aim of this study was to validate the results of diagnostic pure-tone audiometry performed in a typical practice setting by comparing with test results obtained in a standardized audiological setting in accordance with the ISO standards. In a single-blinded crossover design, 119 persons were tested (0.25-8 kHz) in both settings. The mean deviations as a function of frequency were in the order of less than 2 dB (0.5-4 kHz) and otherwise up to 4 dB; the practice setting representing the poorer thresholds. The validity of the practice audiometry at three criteria of hearing impairment (0.5-4 kHz) was characterized by sensitivity (82-100%), specificity (95-99%); positive predictive values (75-90%) and negative predictive values (98-100%) focusing on the better ear. It is concluded that pure-tone audiometry of appropriate validity can be performed in general practice and that it is useful in selecting patients with no need of further audiological examination. Guidelines are needed. [ABSTRACT FROM AUTHOR]