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Background: Throat infections are common conditions in general practice. Pain and discomfort can be considerable in all kinds of throat infections and it would be of great clinical relevance to find out if either of the two types of colostrum tablets sold over the counter in Norway shortens the duration of symptoms in throat infections not caused by group A streptococci., Materials and Methods: The study was prospective, double-blinded, randomised and placebo-controlled. 148 adult patients with sore throat were recruited in five Norwegian military camps during the winters 1999-2001. The main outcome measures were the degree of sore throat and malaise as experienced by the patients, measured by visual analogue scale, and the number of days until recovery. The patients were divided in three groups who received either one of the two brands of tablets or placebo which they would use more or less continuously until recovery., Results: 148 patients completed the study. Patients in all three groups reported a reduction of pain on the visual analogue scale of approximately 50% after 6 days. There were no significant differences in pain reduction between the groups. As to malaise, the Curamed group had a somewhat lower, non-significant start value and also experienced less reduction in symptoms. The differences between the groups were not significant. There was no significant difference between the groups as to the duration of pain until recovery., Interpretation: In this study we found no symptomatic effect of neither of the colostrum tablets used by patients with sore throat.

Objective: The objectives of this study were to explore how frequently group A streptococci (GAS) were giving additional cases of clinical GAS tonsillitis within the households and to analyse predictors for such spread of GAS infection., Setting: Two Norwegian general practice populations in Stokke and Kongsberg communities., Patients: 110 households with at least one member with sore throat lasting less than 7 days, and GAS demonstrated in throat culture. Among the 110 index patients 51 (46%) were parents, 35 mothers and 16 fathers; 23 were children 6 years and younger, while 36 were children aged 7-15 years., Main Outcome Measures: Frequency of spread of clinical GAS infection to another household member within 4 weeks. Distribution of age and size of household in families with and without spread of GAS infection., Results: In 30 (27%) households one or more new cases of GAS tonsillitis was found, adding 40 new infections. No spread of GAS disease was found in households with only adult members. A significantly higher proportion of spread was found in households with 4 or more members compared with households with fewer members, and low age of the index person. Short duration of symptoms before seeing a doctor was also associated with spread of GAS. In a logistic regression analysis carried out in the households with children, short duration of symptoms before diagnosis and treatment and low age of index person were significantly associated with spread of the infection., Conclusions: Even with standard penicillin treatment, GAS infection is frequently spread within households, and most frequently in households with children and many members.

Objective: To compare an antigen detection test (GAS antigen test) with the results from combinations of two various bacteriological test media in general practice patients with sore throat. Furthermore to assess the diagnostic properties of the chosen GAS antigen test and to compare semi-quantitative results of this test with the bacterial load found in the throat culture., Setting: Two Norwegian general practices in Stokke and Kongsberg communities., Subjects: 306 patients with sore throat lasting less than 7 days; 244 were adults, 62 were children under 10 years old, mean age 23.9 years (SD 15.0), 40% were men., Main Outcome Measures: Results from GAS antigen test, and distribution of bacteriological findings in throat cultures, compared with the results of our GAS antigen test; semi-quantitative results of the GAS antigen test compared with the bacterial load by culture., Results: In the primary culture 110 patients harboured group A streptococci (GAS) infection, while the second culture identified another 17, giving a total of 127 patients. Some 33 patients harboured large-colony groups C and G. The GAS antigen test used had a sensitivity of 97% and specificity of 95% regarding GAS when compared with the two cultures. We found a significant correlation between the bacterial loads by culture and the semi-quantitative results of the GAS antigen test., Conclusions: By using a second, different set of bacteriological media, we identified an additional 17 patients with GAS infections. This raises the question of validity of frequently used reference standards in studies related to streptococcal infections. Compared with the combined results of the two throat cultures, the GAS antigen test used showed high sensitivity and specificity. Semi-quantitative evaluations of the rapid immunological test may also be of clinical value.

Background: We wanted to analyse the frequency of list patient consultations in the off-hour emergency service in Skien., Material and Methods: Over one year, all emergency service consultations between 4 PM and 11 PM on workdays were registered according to the general practitioner (GP) patients used and divided by the number of patients on each list. We performed a multiple linear regression analysis with number of consultations adjusted for the total patient number on the list as the dependent variable., Results: We found great variation in the consultation rate among patients listed by various GPs. The consultation rate was significantly associated with the practice in which the GP worked. Quarterly feedback of the results to doctors did not change the consultation pattern., Interpretation: The use of the off-hour emergency service is associated with certain practice characteristics. We assume that the variation results from differences in accessibility by telephone, in the capacity for taking in patients needing urgent attention, and in varying degree of attention to service in the practices.

Background: Ambulatory blood pressure monitoring was introduced more than 40 years ago and is accepted as a clinically useful method to evaluate the white coat effect in patients with suspected and established hypertension., Aim: To study the differences between blood pressure readings taken in the physician's office in the primary healthcare setting, and ambulatory readings, and to find possible predictors., Design of Study: Prospective study., Setting: Two primary healthcare centres in Norway., Method: The study included 221 patients, 107 of whom were on antihypertensive treatment, and 114 of whom were under investigation for possible hypertension. Differences between blood pressure readings taken in the physician's office and ambulatory readings were calculated. Independent predictors for the white coat effect were calculated using linear regression analysis., Results: The difference between blood pressure readings taken in the office and ambulatory readings was 27 mmHg systolic and 11 mmHg diastolic. For the systolic readings, the following factors were independent predictors of the amount of the white coat effect: mean blood pressure, age, history of smoking, family history of cardiovascular disease, and antihypertensive treatment. For the diastolic readings, they were: mean blood pressure, history of smoking, and sex of the patient (with this being most significant for women)., Conclusion: Ambulatory blood pressure measurement is of significant value in identifying patients with white coat hypertension. It can be an important supplement for use in the diagnosis and follow-up of patients with hypertension in general practice.

Background: The prevalence of drug use among young people in Norway is probably changing. Cannabis use in towns is gradually spreading out into the countryside, and newer drugs like ecstasy are introduced. We explored the situation among high school pupils in a small Norwegian town in May 1999., Material and Methods: A questionnaire was administered in the classroom to 62 classes with a total of 1,002 pupils, 79% of all high school pupils in the town. Anonymity was guaranteed by an elaborate and unique system., Results: 1,001 pupils answered all questions regarding drug use. 40% were tobacco users, 26% drank alcohol weekly, 26% had tried cannabis and 5% used it monthly, 4% had tried amphetamine, 2% had tried ecstasy, 1% had tried heroin/cocaine. A logistic regression analysis demonstrated that "tried cannabis" was strongly associated with one of five best friends using cannabis, smoking, school, weekly use of alcohol, sexual debut and sex with same gender. More girls tended to smoke tobacco, boys used more alcohol and cannabis., Interpretation: Compared to data from 1991, the use of cannabis had increased from 8% tried in 1991 to 25% in 1999; monthly use had increased from 2% to 5%.

Acute sinusitis is a common illness in primary care. Studies have demonstrated the difficulty of making the differential diagnosis of acute purulent sinusitis based on clinical evaluations alone. This leads to a significant overuse of antibiotics, which in turn may contribute to increased bacterial resistance. In most cases, GPs have to base their differential diagnosis of sinusitis on clinical signs and symptoms and examination of the patient. The aim of this review is to assess which clinical signs and symptoms can predict an acute purulent sinusitis, compared with accepted reference standards. A review of the literature was performed by looking at articles related to the diagnoses of acute sinusitis in general practice. The following search criteria were used: unselected general practice population; objective reference standard; and logistic regression to evaluate symptoms and signs independently associated with the diagnosis. Four studies were identified for further analysis. The following symptoms and signs were associated with acute purulent sinusitis: purulent secretion as a symptom experienced by the patient or as a sign demonstrated in the nasal cavity by the doctor; pain in the teeth; pain at bending forward, and two phases in the illness history. An elevated erythrocyte sedimentation rate and increased C-reactive protein also contributed to the diagnosis. By use of the specified signs and symptoms the GP can increase the probability of correctly diagnosing an acute purulent sinusitis and reserve antibiotic prescription for these patients.