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Background: Overweight and obesity are a global pandemic, contributing to death and disability-adjusted life-years. Obesity is a major factor in the onset of chronic inflammatory diseases (CIDs). Yet, several knowledge gaps remain: For several CIDs, inconsistent results have been reported, relating to their obesity-imposed risk, data on most rare CIDs remain unavailable, sex differences and racial disparities remain mostly unaddressed. Methods: A large-scale cohort study compared the risk of developing 46 CIDs in individuals with overweight/obesity (n=3,101,824) to an equal number of non-overweight/obese individuals. Propensity score matching optimized between-group comparability, and sensitivity analyses assessed study robustness. Results: The risk of developing any CID was 28.48% in overweight/obese individuals versus 17.55% in non-overweight/obese controls, with a hazard ratio (95%-confidence interval) of 1.52 (1.509-1.521, p<0.0001). This risk was consistent across all sensitivity, sex-, and race-stratified analyses. Overweight and obesity were associated with an increased risk for 24 of 46 CIDs in the primary analysis and all sensitivity analyses. For 12 diseases, increased risks were confirmed to one of the two sensitivity analyses, while for 10 diseases, results were discordant. No increased risk was observed for one disease. In sex-stratified analysis, overweight and obesity posed a more pronounced risk for four CIDs in female individuals. In race-stratified analysis, overweight and obesity were linked to a higher risk for seven CIDs in White individuals and to one CID in "Black or African American" individuals. Conclusion: Overweight and obesity increase the risk for the majority of CIDs in a sex- and race-specific manner. [ABSTRACT FROM AUTHOR]

Purpose: Diabetes Mellitus (DM) management is increasingly focusing on patient-centered care, making patient-reported experience measures (PREMs) critical for understanding the subjective aspects of diabetes treatment and self-management. These measures differ based on cultural contexts and individual perspectives, leading different countries to the development of country-specific tools to assess care quality from the patient's viewpoint. This review aimed to identify available instruments for assessing patient-reported experiences in individuals with diabetes and examine the different domains, items, and the validity and reliability of these instruments. Methods: Following PRISMA-ScR guidelines, databases including PubMed, Embase, CINAHL, Cochrane, and Scopus were searched for English-language articles without year limitations. This scoping review focused on PREMs that evaluate the quality of diabetes care among adolescent and adult patients with type 1 and type 2 DM. Studies that used patient expectation questionnaires, involved individuals not receiving care, or focused on patient-reported outcomes rather than experiences were excluded. Results: Eight articles from six countries representing different healthcare settings were included, mostly from developed countries. A variety of methodologies were used to develop these PREM instruments, with unique domains and items. Content analysis revealed five commonly measured domains: (1) care planning, (2) patient education, (3) professionalism, (4) quality of care, and (5) hospital care and transition, reflecting diverse patient experiences across healthcare services. Conclusions: This scoping review identifies a limited number of tools for evaluating PREMs in diabetes care, highlighting variability in their development and domain coverage. Five core domains are proposed across different settings, with an emphasis on culturally adapted measures to enhance the accuracy of patient experience capture in diverse populations. [ABSTRACT FROM AUTHOR]

Background: Pregnancy-related posterior pelvic girdle pain (PPGP) is a common cause of back pain and disability in the postpartum period. The objective of this study was to investigate the efficacy of orthotic support on pain, disability, and motor control in women with pregnancy-related PPGP. Methods: Eighty-four women with a clinical diagnosis of pregnancy-related PPGP participated in this randomized controlled trial (RCT). Participants were randomly allocated into three groups (with a ratio of 1:1:1): the pelvic support group, the lumbar support group, and the control group (patient-education leaflet). Pain severity, disability, effort during active straight leg raising test (ASLR), maximum isometric muscle force (hip flexion and trunk rotation), and joint position reproduction (JPR) of hip abduction were assessed as study outcomes. These variables were measured at four time points —before the intervention, immediately after the intervention, at the 4-week follow-up (at this time, the intervention period was terminated), and at the 5-week follow-up (one week after discontinuing the interventions)— to evaluate the possible effects of wearing support. Repeated-measures multivariate analysis of variance (MANOVA) was applied to determine the statistical significance between groups. Bonferroni post-hoc correction was used to identify significant differences between groups at different study time points. Results: There was a significant interaction effect for group × time for the study outcomes, including pain severity, disability, effort during ASLR, and maximum isometric muscle force between groups (p < 0.001), except JPR of hip abduction (p = 0.13). There were statistically significant differences in post hoc comparisons for pain intensity and effort during ASLR in lumbar support versus control condition and for maximum isometric muscle force in orthotic interventions versus control conditions immediately after the intervention (P < 0.008). Post hoc tests demonstrated statistically significant differences in orthotic interventions versus control conditions after 4-week and 5-week follow-ups (P < 0.008). None of the interventions significantly changed the JPR of hip abduction compared to the control group (p > 0.008). The effect sizes for study outcomes were large, except for the JPR of hip abduction. Conclusions: For women with pregnancy-related PPGP, both lumbar and pelvic supports were beneficial for decreasing pain and disability symptoms. Lumbar support showed better results for managing PPGP than pelvic support. Clinical trial registration: Iranian Registry of Clinical Trials IRCT20150210021034N11. Date of registration: April 31, 2021. Available at: https://irct.behdasht.gov.ir/trial/70670 [ABSTRACT FROM AUTHOR]

Purpose: To compare sociodemographic, life style and clinical characteristics in patients operated for lumbar disc herniation in public and private clinics in Norway, and evaluate whether selection for surgery and surgical treatment were different across the two settings., Methods: A cross-sectional multicenter study of patients who underwent elective surgeries for lumbar disc herniation at 41 (31 public and 10 private) hospitals. Data were included in the Norwegian Registry for Spine Surgery., Results: Of the 5,308 elective surgical procedures, 3,628 were performed at public hospitals and 1,680 at private clinics. Patients in the private clinics were slightly younger, more likely to be man, have higher level of education, and more likely to be employed. Disability and retirement pensions were more than double in the public as compared to the private clinics. Mean duration of sick leave was 24 weeks (SD 36.4) in the public and 15 weeks (20.7) in the private clinics. There were minor differences in pain, disability and quality-of life, number of verified disc herniations and radiological findings. Number of days at hospital, total operation time and proportion of complications were significantly higher in the public than in the private clinics., Conclusion: Patients having elective surgery due to lumbar disc herniation in public and private clinics were different with respect to many sociodemographic and life style variables. There were minor differences with respect to clinical variables and selection of patients for surgery, but substantial differences related to aspects of the surgical treatment.

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]

Background: Mass media influence peoples' attitudes and conduct. We set out to investigate what Norwegian mass media write about back pain and whether this information is in accordance with national interdisciplinary guidelines for low back pain (published in 2002)., Material and Methods: Quantitative content analysis of 495 news stories from Norwegian newspapers and magazines published in 2001-03 and 2005-06., Results: Most publications were about a single case. Risk factors for low back pain, examinations, treatment and prevention were frequent topics. No publication was in direct disagreement with the clinical guidelines. Dependent on the media type, 44 to 62 % of the publications supported the guidelines' main messages of regaining daily normal activities, including work and exercises, as soon as possible., Interpretation: Norwegian mass media communicate evidence-based information about low back pain to a large extent. We regard these media as collaborators in the communication of important recommendations in guidelines about low back pain.

Background: Low back pain is a challenge in daily clinical activity. The prognosis for single episodes of acute pain is good, but many patients have persistent/recurrent illness, often characterized by a complex pattern of somatic, psychological and social factors. The aim of this article is to present the evidence-based recommendations in the Norwegian clinical guidelines and to discuss new knowledge., Material and Methods: The Norwegian guidelines for diagnosis and treatment of low back pain of 2007, are based on literature searches that were completed in 2005. This article presents the main content of those national guidelines and assessment of new knowledge based on more recent Cochrane reviews and relevant articles., Results: Low back pain can be categorized according to development over time, etiology or a diagnostic triad with so-called red, green or yellow flags. Diagnostic imaging is recommended after four to six weeks duration without improval. A main treatment goal is to provide early and sufficient pain reduction. It is also important to regain normal daily activities as soon as possible., Interpretation: Low back pain often resolves without treatment within a few weeks. Adequate diagnostic categorization and good pain alleviation is possible with simple means in most patients. Simple diagnostic measures can help to identify individuals with serious pathology.

Background: Musculoskeletal disorders are an extensive burden to society, yet few studies have explored and replicated modifiable prognostic factors associated with high societal costs. This study aimed to replicate previously identified associations between nine modifiable prognostic factors and high societal costs among people on sick leave due to musculoskeletal disorders. Methods: Pooled data from a three-arm randomised controlled trial with 6 months of follow-up were used, including 509 participants on sick leave due to musculoskeletal disorders in Norway. Consistent with the identification study, the primary outcome was societal costs dichotomised as high (top 25th percentile) or low. Societal costs included healthcare utilization (primary, secondary, and tertiary care) and productivity loss (absenteeism, work assessment allowance and disability benefits) collected from public records. Binary unadjusted and adjusted logistic regression analyses were used to replicate previously identified associations between each modifiable prognostic factor and having high costs. Results: Adjusted for selected covariates, a lower degree of return-to-work expectancy was associated with high societal costs in both the identification and replication sample. Depressive symptoms and health literacy showed no prognostic value in both the identification and replication sample. There were inconsistent results with regards to statistical significance across the identification and replication sample for pain severity, self-perceived health, sleep quality, work satisfaction, disability, and long-lasting disorder expectation. Similar results were found when high costs were related to separately healthcare utilization and productivity loss. Conclusion: This study successfully replicated the association between return-to-work expectancy and high societal costs among people on sick leave due to musculoskeletal disorders. Other factors showed no prognostic value or inconsistent results. Trial registration: ClinicalTrials.gov NCT03871712, 12th of March 2019. [ABSTRACT FROM AUTHOR]

Background: The European guideline for the diagnosis and treatment of insomnia recommends, for all age groups, only restrictive, short-term, and periodic use of potentially addictive hypnotics. As in other European countries, in Norway, actual practice involving older patients differs substantially from this recommendation, as shown by the persistent high frequency of regular prescriptions of addictive hypnotics. Aim: To explore experienced Norwegian GPs' views of the regular prescription of addictive hypnotics to patients aged >70 years living at home. Design & setting: In-depth individual interviews of a purposive sample of experienced specialists in family medicine at GP offices in Southern Norway. Method: The interviews used a semi-structured interview guide and were performed between June 2022 and January 2023. Reflexive thematic cross-case analysis was used to analyse the data. Results: Most of the 11 GPs interviewed had more than 10 older patients who were prescribed hypnotics for daily use and the same number for intermittent prescription. Almost all prescriptions were of z-hypnotics. The GPs knew this was contrary to the guideline. Many were at ease with this fact. They emphasised the need to avoid creating new dependencies. The GPs considered these patients a selected minority within this age group with serious sleep problems, for whom few realistic alternatives were available and whose tolerance over time was better than expected. This logic of pragmatic practice reflected a patient-centred approach and respect for the patient's view in a shared decision-making process, combined with challenges of limited alternatives and resources. Conclusion: A 'zero vision' on the prescription of addictive hypnotics to older people may neither be prudent nor realistic in the context of general practice. [ABSTRACT FROM AUTHOR]

Background: Chronic lower back pain (CLBP) is a global health issue leading to significant disability and socioeconomic burden. Traditional treatments, including exercise and cognitive behavioral therapy (CBT), are often limited by physical and temporal constraints. This study aimed to evaluate the efficacy of multidisciplinary digital therapeutics (MORA Cure LBP) compared to conventional treatments. Methods: This multicenter, randomized, controlled pilot study enrolled 46 participants. Participants were randomly assigned in a 1:1 ratio to either a MORA Cure LBP group or control group, which received conventional treatment. Results: At eight weeks, both groups demonstrated improvements compared to baseline. No statistically significant differences were observed between the MORA Cure LBP and control groups in reductions in usual pain intensity (MORA Cure LBP: 3.1 ± 1.9 vs. control: 3.0 ± 1.5, p = 0.809), worst pain intensity (MORA Cure LBP: 5.00 ± 2.18 vs. control: 4.27 ± 1.83, p = 0.247), and functional disability (ODI, MORA Cure LBP: 15.6 ± 9.6 vs. control: 15.6 ± 10.0, p > 0.999). Compliance was significantly higher in the MORA Cure LBP group during the first 4 weeks (MORA Cure LBP: 74.7% ± 27.4 vs. control: 53.1% ± 28.6, p < 0.001). Conclusions: Both multidisciplinary digital therapeutics (MORA Cure LBP) and conventional treatments were effective in reducing pain and functional disability in patients with CLBP, with no significant differences between the two groups. Digital therapeutics, particularly those that integrate CBT and exercise, offer promising alternatives to conventional therapies by improving accessibility and potentially enhancing patient engagement. [ABSTRACT FROM AUTHOR]

This study examined the erector spinae contractile properties, trunk isokinetic strength, and differences in acute muscle fatigue response after exercise in young females with and without non-specific chronic low back pain (NSCLBP). This study evaluated participants using tensiomyography and isokinetic trunk strength tests. An independent t-test compared the control group and the NSCLBP group, while a two-way mixed ANOVA analyzed differences in the erector spinae's acute muscle fatigue response before and after exercise within and between groups. The results of the tensiomyography indicated that the NSCLBP group exhibited significantly lower Dm and Vc (p < 0.05) compared to the control group, while Tc showed no significant difference between groups. Significant differences in all variables were observed between the groups in the isokinetic trunk strength test (p < 0.05). Furthermore, the two-way mixed ANOVA revealed significant group main effects in Dm and Vc of the erector spinae (p < 0.05). This study found that non-specific chronic low back pain is linked to a decrease in Dm, Vc, and trunk isokinetic strength in both extensor and flexor muscles. It suggests that future research should further investigate the acute muscle fatigue response in individuals with and without NSCLBP. [ABSTRACT FROM AUTHOR]

Background: As compared to men, older women´s higher rates of depression diagnosis and antidepressant use are widely reported. We aimed to: a) explore whether there is a potential gender bias in the clinical diagnosis of depression and antidepressant prescription in an older population from Stockholm; and 2) analyze if such gender bias differs by patients’ age and socioeconomic status. Methods: We used data from the Swedish National Study on Aging and Care in Kungsholmen, SNAC-K (N = 2,941). We compared gender differences in: (a) clinical diagnosis of depression according to the Swedish National Patient Register (ICD-10 codes F32-F34; F412) (“register-based diagnosis”); (b) SNAC-K-based diagnosis of depression, partially gender-blind, using the Comprehensive Psychopathological Rating Scale (CPRS) and the DSM-IV-TR (“SNAC-K based diagnosis); and (c) antidepressant use (ATC code N06A). To analyze the magnitude of the gender bias in the register-based diagnosis of depression and in antidepressant use, and the role of potential moderating factors, prevalence ratios (PR) were calculated using Poisson regression models. Models were run separately by age and social class. Results: Women had a 63% higher probability of having a register-based diagnosis of depression (PR = 1.63[1.23–2.15]) and a 79% higher probability of using antidepressants (PR = 1.79[1.34–2.40]). No gender differences were observed in the SNAC-K-based diagnosis of depression. The gender differences in the register-based diagnosis were narrowed, although remained significant, after considering age, depressive symptoms, and health services use (PR = 1.44[1.10–1.88]), as well as the register-based diagnosis in the case of antidepressant use (PR = 1.31[1.04–1.64]). This gender bias was larger among the younger-old and the most advantaged social class. Conclusion: A gender-bias was identified in the diagnosis and treatment of depression in older adults within the Swedish healthcare setting, which could imply that health services may be contributing to the medicalization of women’s mental health. Gender-sensitive clinical and public health interventions are essential to reduce gender disparities in mental healthcare, also in old age. [ABSTRACT FROM AUTHOR]

Background: Despite primary care being largely free at the point of delivery, many Canadians experience challenges in accessing the services they need. A systematic review was conducted to summarize the evidence on the level of unmet need for primary care in Canada and its social determinants. Methods: MEDLINE, Embase, Cochrane, and Web of Science databases were screened from inception to December 2023 using relevant search terms for primary care and unmet healthcare needs. Quantitative observational studies in the English language that included Canadian adults aged 18 years and older and focused on unmet needs for primary care were included. The risk of bias in the studies was assessed using either the Joanna Briggs Institute (JBI) critical appraisal checklist or the Newcastle–Ottawa Scale. The included studies were synthesized narratively. Results: Forty-six studies met the inclusion criteria for this review. Of the included studies, 96% were cross-sectional in design and 91% had low risk of bias. The prevalence of unmet need, mostly self-reported, varied between 6.6% and 25.2% in national studies. Social determinants of unmet needs were heterogeneous across studies. Findings suggest that unmet need for primary care is related to having low income, mental health diagnoses, and chronic conditions, and negatively associated with older age, having better-perceived health, and having a family physician. Conclusions: Universal access to primary care is the founding principle of the Canadian healthcare system. However, we found evidence suggesting that the extent to which primary care needs are met is influenced by social determinants of health. Further research is needed to improve our understanding of the mechanisms of unmet primary care needs in Canada. Systematic review registration: PROSPERO CRD42021285074. [ABSTRACT FROM AUTHOR]

The healthcare sector constantly investigates ways to improve patient outcomes and provide more patient-centered care. Delivering quality medical care involves ensuring that patients have a positive experience. Most healthcare organizations use patient survey feedback to measure patients' experiences. However, the power of social media can be harnessed using artificial intelligence and machine learning techniques to provide researchers with valuable insights into understanding patient experience and care. Our primary research objective is to develop a social media analytics model to evaluate the maternal patient experience during the COVID-19 pandemic. We used the "COVID-19 Tweets" Dataset, which has over 28 million tweets, and extracted tweets from the US with words relevant to maternal patients. The maternal patient cohort was selected because the United States has the highest percentage of maternal mortality and morbidity rate among the developed countries in the world. We evaluated patient experience using natural language processing (NLP) techniques such as word clouds, word clustering, frequency analysis, and network analysis of words that relate to "pains" and "gains" regarding the maternal patient experience, which are expressed through social media. The pandemic showcased the worries of mothers and providers on the risks of COVID-19. However, many people also shared how they survived the pandemic. Both providers and maternal patients had concerns regarding the pregnancy risks due to COVID-19. This model will help process improvement experts without domain expertise to understand the various domain challenges efficiently. Such insights can help decision-makers improve the patient care system. [ABSTRACT FROM AUTHOR]

Chronic low back pain (LBP) represents a major health problem, especially in Western Europe and North America. The aim of this study is to give an account of why a multidisciplinary treatment program in an outpatient spine clinic is the best treatment for many sub-acute and chronic LBP patients on long-term sick leave. We present an overview of documented treatment effects from multidisciplinary treatment programmes, an outline of the treatment in an outpatient spine clinic, and an account of why multidisciplinary programs are beneficial. The treatment of this patient group is also shown to be cost-effective when one differentiates between light and extensive multidisciplinary programmes. A future challenge rests in the fact that even after optimal treatment, approximately 20 % of patients still do not return to work.

Objective: To determine the factors associated with high-volume prescribing of benzodiazepines and minor opiates--background characteristics, personal prescribing habits and general attitudes to prescribing., Design: A questionnaire survey. Descriptive statistics, bivariate analysis and multiple logistic regression., Setting: General practitioners in Norway., Subjects: Every third general practitioner from the list of members of the Norwegian Medical Association., Main Outcome Measures: Odds ratios for being a high prescriber., Results: The main predictors of high-volume prescribing were: patients allowed to influence prescribing decisions, benzodiazepines and minor opiates prescribed without consultation, prescribing perceived as difficult and the doctor being male., Conclusion: Emotional and relational aspects play an important part in decisions on prescribing benzodiazepine and minor opiates. Our findings indicate that there is potential for improvement in prescribing practice; for instance, by investigating how and to what extent prescribing decisions are influenced by patients and how the difficulties experienced influence the decision process. Better practice routines could be considered such as not prescribing these drugs without consultation.

Background: A great number of patients in general practice suffer from low back pain, and the total cost of this patient population is NOK 15 billion. The aim of this study was to find out how family doctors treat their low back pain patients., Material and Methods: During a two week period in 2001, all family doctors in Aust-Agder county were invited to register all patients suffering from low back pain. They also answered a questionnaire about themselves and their practice., Results: Of the total 80 doctors invited, 53 (66%) recorded their patients, and 48 (60%) also answered the questionnaire. 220 patients were included; i.e. 3.4% of the total number of patients seen in these practices during this period. 81% of the patients underwent clinical examination, 40% were referred to X-ray or CT, 31% to an appropriate specialist, 32% to physiotherapist and 11% to chiropractor. Most of the patients were referred after 12 weeks of pain. 79% of patients received a prescription. Only 24% continued working activity., Interpretation: Most patients in this study receive a medical treatment and a sick leave. More patients are referred to X-ray than what is recommended in the Norwegian guidelines.

Objective: To compare the effectiveness of two different stop smoking interventions., Design: A randomised, controlled trial. Results based on intention to treat., Setting: Three towns in the south-eastern part of Norway., Interventions: Visits to GP for "practice as usual" (GP group) or participation in the behavioural programme SmokEnders (SE group) with follow-up 2 weeks, 2 months and 1 year after an agreed stopping date., Subjects: 139 smokers recruited through open invitation., Main Outcome Measure: Self-reported smoking stop rate 2 weeks, 2 months and 1 year after an agreed stopping date, completed with biochemical indicators by the 1-year registration., Results: Two weeks after the agreed cessation date, 10/70 (14%) of the GP group and 46/69 (67%) of the SE group had stopped smoking. After 2 months, 9/70 (13%) in the GP group and 37/69 (54%) in the SE group were non-smokers. One year after cessation 5/70 (7%) in the GP group and 21/69 (30%) in the SE group were non-smokers., Conclusions: Both interventions were effective as measured by the smoking cessation rate. However, the intervention in the SE group was considerably more effective than in the GP group, which suffered from a sizeable number of drop-outs.

Increased knowledge of how patients express their experiences may help physicians to capture their patients' perceptions and agenda. The aim of the present study was to examine words and language used by patients when describing specific primary care consultation experiences. Six focus group sessions with a total of 31 patients were conducted shortly after a general practice consultation. All group sessions were audiotaped and analysed by qualitative ethnographic methodology. Seven distinct grammatical and verbal characteristics were found: The consultations were recited in the first person with little recollection of the doctors' talk or actions. Subjectivity was constantly underlined by the verbs "feel" or "think". When expressing negative emotions, the personal pronoun constantly was changed from the personal singular to the impersonal or plural form. Language tended to be evasive in connection with possible criticism. Negative emotions were diminished by the use of limiting expressions and modest wording. Non-committal expressions, with a wide range of possible meanings, were frequent, and were possible to decipher only by close attention to non-verbal cues. We conclude that doctors may capture more of their patients' hidden emotional messages in the consultation by increased awareness of specific verbal characteristics and non-verbal cues.

Efficient medical communication depends on an understanding of the patient perspective. The purpose of this study was to characterise the most important consultation elements as perceived by primary care patients. The experience of 31 patients regarding their most recent medical encounter were recorded in six focus groups. All groups were audiotaped and analysed by qualitative methodology. Five consultation themes emerged spontaneously in all groups: Interaction between doctor and patient (e.g. communication, emotional experiences, and personal relationship with the doctor) and consultation outcome were the most important elements. Information, continuity of care, and time with the doctor were considered reasonably important. Six other themes received limited attention in a few groups only (e.g. availability, doctor's gender, time in the waiting room, auxiliary personnel, the clinical examination, and technical skills). Patients value the personal, attentive, and listening doctor. The feeling of not having to hurry during the consultation is more important than the actual number of minutes. Patients' level of emotional involvement and their specific expectations are often undisclosed. There are large individual differences with regard to the meaning of and need for information.

Objectives: 1. To compare a patient-centred, self-directive intervention with conventional care; 2. To evaluate longitudinal within-group changes of coronary heart disease risk., Methods: Risk factor changes were evaluated in 110 men with high coronary heart disease risk attending a one year intervention study in general practice. The 22 participating general practice centres were randomly allocated to follow either a patient-centred, self-directive intervention or a conventional approach., Results: No significant between-group differences were found in any single risk factor or in the combined risk of coronary heart disease. The improvement of total risk from screening time to conclusion of the study corresponded with changes of relative risks of CHD to 0.64 (95% CI: 0.54-0.77) and 0.65 (0.54-0.77) in the patient-centred, self-directive and the conventional care group respectively (p < 0.0001 in both groups)., Conclusion: Everyday general practice clinical work seems as efficacious as a specific intervention method based on currently advocated behaviour change principles.

Objective: To compare the morning and evening dose of 200 mg ketoprofen controlled release formulation with regard to both efficacy and GI tolerability., Design: Double-blind, randomized multicentre prospective trial with cross-over design combined with a parallel design., Participants: One hundred and eight female and 55 male patients with osteoarthrosis in hip(s) or knee(s) necessitating treatment with nonsteroidal antiinflammatory drugs., Main Outcome Measure: The degrees of pain and stiffness and joint movement ability in joints with osteoarthrosis., Results: Both the morning and the evening dose demonstrated a significant effect (p < 0.01) on all efficacy variables. The reduction in degree of pain in the afternoon and in the evening was significantly higher (p < 0.01) for the morning dose. The total frequency and degree of gastrointestinal discomfort increased significantly (p < 0.01) during both treatment periods. The increases were mainly caused by increased gastric pain and constipation. No significant differences were found between the two regimes regarding tolerability., Conclusion: Ketoprofen controlled release given once daily in the morning compared to the evening to patients with osteoarthrosis may increase the efficacy without reducing the tolerability of the drug.

An analysis was made of 2416 consecutive patients who underwent a double-contrast barium enema at the Central Roentgen Institute in Oslo. Age, sex, and radiological findings were registered. The age and sex distribution among patients consulting in general practice and in our study was surprisingly similar. This suggests that age as a risk factor for colorectal neoplasms did not play a prominent role among the referring doctors. Colorectal cancer was more frequent in males (4%) than females (2%) (p = 0.03). Odds ratio adjusted for age was 2.1 (1.3-3.8). This may be due to few examinations performed in old age, and different patient behaviour when experiencing colorectal symptoms. The overall polyp frequency was 11%. The frequency increased significantly from the age group 40-49.