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Objective. To investigate the feasibility and impact on BMI and physical fitness of an intervention for obese and inactive children, based on physical activity and carried out in primary health care. Design. A prospective, longitudinal one-year follow-up study. Setting. The community of Kristiansand, Norway (80 000 inhabitants). Intervention. A 40-week structured intervention based on physical training with some lifestyle advice for the obese child and one parent. Subjects. A total of 62 physically inactive children aged 6-14 years with iso-BMI ≥ 30 kg/m2. Main outcome measures. Body mass index (BMI), maximum oxygen uptake, and physical fitness in tests of running, jumping, throwing, and climbing assessed at baseline and after six and 12 months as well as number of dropouts and predicting factors. Results. A total of 49 out of 62 children completed the first six months and 37 children completed 12 months. Dropout rate was higher when parents reported being physically inactive at baseline or avoided physical participation in the intervention. The children's maximum oxygen uptake increased significantly after 12 months from 27.0 to 32.0 ml/kg/min (means), as did physical fitness (endurance, speed, agility, coordination, balance, strength) and BMI was significantly reduced. Conclusion/implications. This one-year activity-based intervention for obese and inactive children performed in primary health care succeeded by increasing cardiovascular capacity and physical fitness combined with reduced BMI in those who completed. Dropout was substantial and depended on the attendance and compliance with physical activity by the parents. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To establish a clinically relevant list with explicit criteria for pharmacologically inappropriate prescriptions in general practice for elderly people > or =70 years. DESIGN: A three-round Delphi process for validating the clinical relevance of suggested criteria (n = 37) for inappropriate prescriptions to elderly patients. SETTING: A postal consensus process undertaken by a panel of specialists in general practice, clinical pharmacology, and geriatrics. Main outcome measures. The Norwegian General Practice (NORGEP) criteria, a relevance-validated list of drugs, drug dosages, and drug combinations to be avoided in the elderly (< or =70 years) patients. RESULTS: Of the 140 invited panellists, 57 accepted to participate and 47 completed all three rounds of the Delphi process. The panellists reached consensus that 36 of the 37 suggested criteria were clinically relevant for general practice. Relevance of three of the criteria was rated significantly higher in Round 3 than in Round 1. At the end of the Delphi process, a significant difference between the different specialist groups' scores was seen for only one of the 36 criteria. CONCLUSION: The NORGEP criteria may serve as rules of thumb for general practitioners (GPs) related to their prescribing practice for elderly patients, and as a tool for evaluating the quality of GPs' prescribing in settings where access to clinical information for individual patients is limited, e.g. in prescription databases and quality improvement interventions. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To investigate the spectrum of diagnoses made by general practitioners (GPs) seeing patients with acute abdominal pain, as well as GPs' handling of these patients. To investigate factors predictive of acute admission to hospital. DESIGN: Descriptive study. SETTING: General practices in southern Norway, autumn 2007 and spring 2008. Subjects. A total of 134 patients who were offered an acute appointment with a GP because of abdominal pain. MAIN OUTCOME MEASURES: Tentative diagnosis made and handling of the patient by the GP. Explanatory factors: pain duration, findings on clinical examination. RESULTS: The most frequent diagnosis was non-specific pain (20%), followed by gastroenteritis (13%), appendicitis (12%), ulcer disease (11%), gynaecological disease (9%), and urinary tract problems (7%). One-quarter of patients were sent home after clinical examination without any specific action taken. One-quarter were acutely admitted to hospital, and one-quarter were treated with medication. The rest was either referred for further investigations on a non-acute basis (14%) or given a follow-up appointment with the GP (10%). Suspected appendicitis was the strongest predictor for acute admission. Rebound tenderness on clinical examination as well as pain duration for 24 hours or less also independently predicted acute hospital admission. CONCLUSION: GPs face the challenge of meeting a wide and inhomogeneous spectre of complaints when dealing with patients with acute abdominal pain. Three-quarters of patients are taken care of in primary care. [ABSTRACT FROM AUTHOR]

Objective. To assess Norwegian general practitioners' (GPs') level of potentially harmful drug prescribing for elderly patients. Design. Prescription data for 12 months were retrospectively retrieved from the Norwegian Prescription Database (NorPD). Data were assessed in relation to 13 prescription quality indicators. Setting. General practice. Subjects. A total of 454 GPs attending continuous medical education (CME) groups in Southern Norway, 85 836 patients >=70 years who received any prescription from the GPs during the study period. Main outcome measures. Number of prescriptions assessed in relation to pharmacological inappropriateness based on a list of 13 explicit prescription quality indicators. Results. Some 18.4% of the patients (66% females with mean age 79.8 years, 34% males with mean age 78.7 years) received one or more inappropriate prescriptions from their GP. An NSAID in a potentially harmful combination with another drug (7%) and a long-acting benzodiazepine (4.6%) were the most frequent inappropriate prescriptions made. Doctor characteristics associated with more inappropriate prescribing practice were old age and working single-handed with many elderly patients. Conclusion. The study reveals areas where GPs' prescribing practice for elderly patients can be improved and which can be targeted in educational interventions. [ABSTRACT FROM AUTHOR]

Objective. To assess level of cardiovascular risk factors in a non-selected, middle-aged population. To estimate the proportion target for risk intervention according to present guidelines and according to different cut-off levels for two risk algorithms. Design. Population survey, modelling study. Setting. The Norwegian Hordaland Health Study (HUSK) 1997-99. Subjects. A total of 22 289 persons born in 1950-57. Main outcome measures. Own and relatives' cardiovascular morbidity, antihypertensive and lipid-lowering treatment, smoking, blood pressure, cholesterol. Framingham and Systematic Coronary Risk Evaluation (SCORE) algorithms. The European guidelines on CVD prevention in clinical practice were applied to estimate size of risk groups. Results. Some 9.7% of men and 7.6% of women had CVD, diabetes mellitus, a high level of one specific risk factor, or received lipid-lowering or antihypertensive treatment. Applying a SCORE (60 years) cut-off level at 5% to the rest of the population selected 52.4% of men and 0.8% of women into a primary prevention group, while a cut-off level at 8% included 22.0% and 0.06% respectively. A cut-off level for the Framingham score (60 years) of 20% selected 43.6% of men and 4.7% of women, while a cut-off level of 25% selected 25.6% of men and 1.8% of women. Conclusion. The findings illustrate how choices regarding risk estimation highly affect the size of the target population. Modelling studies are important when preparing guidelines, to address implications for resource allocation and risk of medicalization. The population share to be targeted for primary prevention ought to be estimated, including the impact of various cut-off points for risk algorithms on the size of the risk population. [ABSTRACT FROM AUTHOR]

Aims/hypothesis: Intima media thickness (IMT) of the common carotid artery (CCA) is a validated surrogate marker of early atherosclerosis. The aim of our study was to assess the association between IMT in CCA and long-term mean HbA1c in type 1 diabetes. We also elucidated the association between carotid IMT and preclinical coronary atherosclerosis. Methods: In 39 individuals with type 1 diabetes, HbA1c was measured prospectively over 18 years. The IMT examinations were performed with high-resolution ultrasound. The association between carotid IMT and preclinical coronary atherosclerosis (assessed by intravascular ultrasound [IVUS]) was tested in 29 of the patients. Results: Mean HbA1c over 18 years was 8.2% (range: 6.6- 11.3%). Mean age at follow-up after 18 years was 43 years and mean duration of diabetes was 30 years. IMT was significantly higher in diabetic patients than in an age- and sex- matched reference population. The IMT values were at the same level as for controls who were 20 years older. In women, HbA1c was significantly associated with mean average CCA IMT (r2=0.77,p<0.000 1 when adjusted for age), whereas there was no significant association for men. Among women, a significant association was also found between carotid IMT and the percentage of coronary vessel area stenosis (r=0 .65 ,p=O .03). Conclusions/interpretation: The present findings suggest an important role of long-term hyperglycaemia in the development of atherosclerosis, especially in women with type 1 diabetes.: Type 1 diabetes patients have earlier development of, and more advanced, atherosclerosis compared with an age- and sex-matched reference population. In women, carotid IMT reflects pre- clinical coronary atherosclerosis. [ABSTRACT FROM AUTHOR]

The aim of this study was to investigate possible differences in measures on disease process, joint damage, health status and self-efficacy between patients with rheumatoid arthritis (RA) living in an affluent and in a less affluent area in the same city. We analyzed data collected on patients enrolled in a community-based register of patients with RA in Oslo, Norway. 246 patients were examined by questionnaire in 1994 and 133 patients were examined clinically in 1997. Measures on disease process, joint damage, health status and self-efficacy were compared between patients from two residential areas. There was no significant difference regarding joint counts, patients' or investigator's evaluation of disease severity, blood test results and number of joint replacements. Significant differences were observed for disability and for various dimensions of health measured by the arthritis impact measurement scales and the short form-36: patients in the less affluent area reported poorer health status. Patients in this area also showed significantly lower scores on the arthritis self-efficacy scale. Patients with RA in two socioeconomically different areas in Oslo thus were found to be equal regarding disease process and joint damage measures. However, in the measures reflecting physical and psychosocial health status, patients in the less affluent area seemed to be more seriously ill. They also showed less confidence in their ability to influence the disease. Even in a welfare society with universal access to health care the impact of a well-defined chronic disease seems to be closely linked to the patient's socioeconomic situation. [ABSTRACT FROM AUTHOR]

Sixty-six physicians were randomized to three groups to conduct a 1-month campaign to help their patients stop smoking. The workshop group received free patient education materials and a 6-hour training workshop. The materials group received free patient education materials, and the no-assistance group received nothing. A telephone interview was completed with 89% of the 6767 eligible adult patients seen during the month of the campaign. The brief training program and patient education materials marginally increased the smoking intervention activities of volunteer physicians in private practice. Both workshop and materials physicians asked 54% of their smoking patients to stop; no-assistance physicians asked 40%. One year later, 36% of patients who had not even been asked by their doctors if they smoked reported that they had tried to stop smoking. If the physician had asked the patient if he or she smoked, the probability of a quit attempt was 47%. Patients who had been asked if they smoked were more likely to claim to have stopped (13%) than patients who had not been asked (9%). However, the proportion of patients claiming continued abstinence (range, 12% to 14%) was not related to the group of the physician. [ABSTRACT FROM AUTHOR]

If the physician is to help a patient adopt and maintain "preventive behaviors," the processes that influence and shape both patient and physician behaviors must be understood, the physician's role in the behavioral change process must be acceptable to both the patient and the physician, and an environment that both permits the physician to act and reinforces the physician for acting appropriately must be designed for the physician. A physician's role that is acceptable to both the patient and the physician can be seen as six obligations. The physician must 1) evaluate the medical literature on prevention to determine which services are indicated for which types of patients, 2) when seeing an individual patient, identify the services and behaviors needed by that patient, and 3) advise the patient of the need for action. As the patient responds positively to the physician's advice, the physician must 4) enable and assist the patient to have the indicated tests or procedures and accomplish the suggested behavioral changes, and 5) reinforce the patient's new and ongoing preventive behaviors. The sixth obligation of the physician is to establish, support, and maintain a system to facilitate tasks 2 through 5. [ABSTRACT FROM AUTHOR]

Aim The present study was undertaken to assess the effect of balloon inflation during percutaneous transluminal coronary angioplasty on markers of myocardial damage.Methods and results Seventy-five patients undergoing elective percutaneous transluminal coronary angioplasty were evaluated with serum creatine kinase MB and cardio-specific troponin T before and 1 and 4 days after the procedure. On day 1, 28% of the patients had increased cardiospecific troponin T values and 18% had increased creatine kinase MB values. On day 4, 24% had increased cardiospecific troponin T values, whereas all creatine kinase MB values were normal. A high degree of correlation between creatine kinase MB and cardiospecific troponin T on day 1, as well as between both markers on day 1 and cardiospecific troponin T on day 4 were found. The increased levels of cardiospecific troponin T on day 4 was significantly correlated with the total balloon inflation time (P<0·001).Conclusion We conclude that irreversible myocardial damage, as evidenced by increased cardiospecific troponin T values on day 4, occurs in an appreciable number of patients during percutaneous transluminal coronary angio-plasty, and that this damage is strongly correlated with the total balloon inflation time. [ABSTRACT FROM PUBLISHER]