ISRN Family Medicine The latest articles from Hindawi Publishing Corporation © 2014 , Hindawi Publishing Corporation . All rights reserved. Qualitative Exploration of the Suitability of Capability Based Instruments to Measure Quality of Life in Family Carers of People with Dementia Tue, 04 Mar 2014 12:19:35 +0000 Background. In an ageing population, many individuals find themselves becoming a carer for an elderly relative. This qualitative study explores aspects of quality of life affected by caring for a person with dementia, with the aim of identifying whether capability based questionnaires are suitable for measuring carer quality of life. Methods. Semistructured interviews lasting up to an hour were conducted, November 2010–July 2011, with eight family carers of people with dementia. Interviews typically took place at the participants’ homes and were recorded and transcribed verbatim. Framework analysis was used to code and analyse data. Domains from three capability based questionnaires (ICECAP-O, Carer Experience Scale, and ASCOT) were used as initial codes. Similar codes were grouped into categories, and broader themes were developed from these categories. Results. Four themes were identified: social network and relationships; interactions with agencies; recognition of role; and time for oneself. Conclusions. By identifying what affects carers’ quality of life, an appropriate choice can be made when selecting instruments for future carer research. The themes identified had a high degree of overlap with the capability instruments, suggesting that the capabilities approach would be suitable for future research involving carers of people with dementia. Carys Jones, Rhiannon Tudor Edwards, and Barry Hounsome Copyright © 2014 Carys Jones et al. All rights reserved. Patient Choice for Older People in English NHS Primary Care: Theory and Practice Tue, 04 Mar 2014 08:05:54 +0000 In the English National Health Service (NHS), patients are now expected to choose the time and place of treatment and even choose the actual treatment. However, the theory on which patient choice is based and the implementation of patient choice are controversial. There is evidence to indicate that attitudes and abilities to make choices are relatively sophisticated and not as straightforward as policy developments suggest. In addition, and surprisingly, there is little research on whether making individual choices about care is regarded as a priority by the largest NHS patient group and the single largest group for most GPs—older people. This conceptual paper examines the theory of patient choice concerning accessing and engaging with healthcare provision and reviews existing evidence on older people and patient choice in primary care. Andrew J. E. Harding, Frances Sanders, Antonieta Medina Lara, Edwin R. van Teijlingen, Cate Wood, Di Galpin, Sue Baron, Sam Crowe, and Sheetal Sharma Copyright © 2014 Andrew J. E. Harding et al. All rights reserved. Mothers’ Perception and Healthcare Seeking Behavior of Pneumonia Children in Rural Bangladesh Sun, 23 Feb 2014 00:00:00 +0000 We describe mothers’ perception about signs and symptoms, causes of the illness, and healthcare seeking behaviors related to pneumonia and express the major modifiable barriers to seeking timely treatment when their under-5 children had pneumonia in rural Bangladesh. Using focus group discussion, we understood mothers’ perception and healthcare seeking behavior of childhood pneumonia. Although mothers described pneumonia as a serious life threatening disease in young children but most of the mothers could not diagnose whether their child had pneumonia or not. Environmental factors such as dust particles, spread from coughing mother, and drinking cold water or playing with water were perceived as the causes for pneumonia. Three common barriers noted were as follows: illness was not perceived as serious enough or distance from healthcare facility or lack of money at household for seeking treatment outside. Most of the rural mothers did not have knowledge about severity of childhood pneumonia. Farzana Ferdous, Fahmida Dil Farzana, Shahnawaz Ahmed, Sumon Kumar Das, Mohammad Abdul Malek, Jui Das, Abu Syed Golam Faruque, and Mohammod Jobayer Chisti Copyright © 2014 Farzana Ferdous et al. All rights reserved. A Qualitative Study of Psychosocial Problems among Parents of Children with Cerebral Palsy Attending Two Tertiary Care Hospitals in Western India Thu, 20 Feb 2014 11:33:33 +0000 Objective. To explore the psychosocial problems faced by the parents of children with cerebral palsy (CP) in rural and urban settings. Design. Qualitative research design using focus group discussions (FGDs) was used for the study. Setting. Two FGDs comprising one at a rural tertiary level care hospital and the other at an urban tertiary level care hospital were conducted. Participants. A total of thirteen parents participated in the two FGDs. Main Outcome Measured. Psychosocial problems experienced by the parents of children suffering from CP were measured. Results. The problems experienced by the mothers were associated with common themes such as disturbed social relationships, health problems, financial problems, moments of happiness, worries about future of the child, need for more support services, and lack of adequate number of trained physiotherapists. All the parents had children with problems since birth and most had approached various health care providers for a cure for their child. Conclusions. A wide range of psychosocial problems are experienced by the parents of children with CP. Studies like this can provide valuable information for designing a family centered care programme for children with CP. Somashekhar Nimbalkar, Shyamsundar Raithatha, Rutvij Shah, and Dhara Antani Panchal Copyright © 2014 Somashekhar Nimbalkar et al. All rights reserved. The Potential Value of Sleep Hygiene for a Healthy Pregnancy: A Brief Review Mon, 17 Feb 2014 10:47:50 +0000 The quality of the intrauterine environment influences maternal-fetal health and also offspring predisposition to obesity and cardiometabolic disease later in life. Several determinants, including but not limited to pregravid obesity and excessive gestational weight gain, alter the developmental milieu, fetal growth, and child obesity risk. However, the role of sleep and its relationship to healthy pregnancy is not fully established. Given the host of psychosocial and physiological complications associated with childhood obesity, targeting the gestational period is purported to be an opportune time for preventive intervention. Many longitudinal studies suggest that short sleep duration is a risk factor for the development of impaired glycemia and obesity. However, there is a dearth of information concerning the role of sleep hygiene and its role in a healthy pregnancy. Reports note disrupted and poorer quality of sleep during gestation and highlight an association between reduced sleep and risk of gestational diabetes mellitus. Given the lack of well-designed human trials assessing the value of sleep and healthy pregnancy outcomes, this review summarizes current evidence which suggests that incorporating sleep recommendations and utilizing time management strategies that encourage a healthful night ’s sleep may improve the health of the mom and the baby. Zachary M. Ferraro, Jean-Philippe Chaput, Andrée Gruslin, and Kristi B. Adamo Copyright © 2014 Zachary M. Ferraro et al. All rights reserved. Self-Care Practices among Diabetic Patients in Anand District of Gujarat Tue, 11 Feb 2014 10:37:45 +0000 Background. Diabetes care requires a multipronged approach, wherein the patient has an important role to play. This study was undertaken to explore self-care practices of diabetic patients residing in Anand district of Gujarat. Methods. A cross-sectional study, involving 100 diabetic patients, was conducted in 2009-2010. Self-care practices in seven domains of physical activity, dietary practices, medication taking, monitoring of glucose, problem solving, foot care, and psychosocial adjustment were assessed using scores assigned to participants’ responses. Results. The mean age was 60.9 () years and 57% were males. Majority (92%) were Hindus and were consulting private medical practitioners (71%). “Medication taking” was the domain with the best performance score (88.1%) and “problem solving” the worst (11.0%). The “psychosocial adjustment” of the participants was satisfactory (82.5%). Overall mean performance percentage score was 54.41%. Males had better performance scores as compared to females in areas of “physical activity,” “dietary practices,” and “problem solving.” Housewives had poorer performance scores. Total mean performance score was similar for patients on treatment from specialists and general practitioners. Conclusion. A self-care education program designed for this region should address the lacunae identified in various domains with a special emphasis on females. Shyamsundar Jagdish Raithatha, Singh Uday Shankar, and Kumar Dinesh Copyright © 2014 Shyamsundar Jagdish Raithatha et al. All rights reserved. Patient Attitudes towards Physician Nonverbal Behaviors during Consultancy: Result from a Developing Country Tue, 04 Feb 2014 06:50:43 +0000 Background. Nonverbal behaviors have a significant impact on patients during consultations. This study was undertaken to find out the attitudes and preferences of the patients regarding nonverbal communication during consultations with physicians, in a tertiary care hospital. Methods. A questionnaire based cross-sectional study was carried out at the Aga Khan University Hospital, Karachi, Pakistan, during the months of January to March 2012. All patients (>18 years of age) coming for consultancy in the family medicine clinics were approached; out of 133, 120 agreed to participate. The subjects were asked questions regarding physician’s comforting touch and eye contact and their responses were noted. The data were analyzed using SPSS and chi-square test was used to identify corelations. Results. Overall, 120 patients were enrolled. About 58.3% were men and 41.7% were women with a mean age of years. 95.8% were Muslims and 57.6% had more than 12 years of education. Among females 74% wanted supportive touch from doctors, used to comfort the patient (45%) or to show respect (27.5%) or as healing (30%). 86.1% of the respondents believe that establishing eye contact with the patient shows that the doctor is attentive towards his/her patient. The eye contact should be brief but regular (54.1%) and prolonged staring (36.7%) makes them uncomfortable. Conclusion. Nonverbal communication helps to strengthen the doctor-patient relation as patients do appreciate positive touch and eye contact from their physicians. Fahad Hanif Khan, Raheela Hanif, Rumina Tabassum, Waris Qidwai, and Kashmira Nanji Copyright © 2014 Fahad Hanif Khan et al. All rights reserved. Home Care Learning Model for Medical Students in Chile: A Mixed Methods Study Thu, 16 Jan 2014 09:32:20 +0000 Introduction. The relevance of home care training is not questioned. However, there are no reported learning models to teach in this setting. Aims. To develop and evaluate a learning model to teach home care to medical students. Methods. Stage 1: Learning Model Design. Tutors teaching home care and a sample of medical students were invited to focus groups analyzed according to the grounded theory. Later, the researchers designed the learning model, which was approved by all participants. Stage 2: Learning Assessment. All students in their family medicine internship at Pontificia Universidad Catolica de Chile were invited to participate in a nonrandomized before-and-after pilot trial, assessing changes in their perception towards home care and satisfaction with the learning model. Results. Stage 1: Six tutors and eight students participated in the focus groups. The learning model includes activities before, during, and after the visits. Stage 2: 105 students (88.2%) participated. We observed improvement in all home care training domains () and a high satisfaction with the model. Students with previous home visit experiences and who participated with nurses and social workers reported more learning. Conclusions. We report an effective learning model to train medical students in home care. Limitations and recommendations for future studies are discussed. Diego Garcia-Huidobro, Solange Rivera, and Carolina Gonzalez Copyright © 2014 Diego Garcia-Huidobro et al. All rights reserved. Planning for Serious Illness by the General Public: A Population-Based Survey Mon, 30 Dec 2013 10:23:52 +0000 Background. While rates of advance care documentation amongst the general public remain low, there is increasing recognition of the value of informal planning to address patient preferences in serious illness. Objectives. To determine the associations between personal attributes and formal and informal planning for serious illness across age groups. Methods. This population-based, online survey was conducted in Saskatchewan, Canada, in April, 2012, using a nonclinical sample of 827 adults ranging from 18 to 88 years of age and representative of age, sex, and regional distribution of the province. Associations between key predictor variables and planning for serious illness were assessed using binary logistic regression. Results. While 16.6% of respondents had completed a written living will or advance care plan, half reported having conversations about their treatment wishes or states of health in which they would find it unacceptable to live. Lawyers were the most frequently cited source of assistance for those who had prepared advance care plans. Personal experiences with funeral planning significantly increased the likelihood of activities designed to plan for serious illness. Conclusions. Strategies designed to increase the rate of planning for future serious illness amongst the general public must account for personal readiness. Donna Goodridge, Elizabeth Quinlan, Rosemary Venne, Paulette Hunter, and Doug Surtees Copyright © 2013 Donna Goodridge et al. All rights reserved. Knee Pain as the Reason for Encounter in General Practice Thu, 26 Dec 2013 14:10:55 +0000 Objective. Currently, an overview of the management of knee pain in general practitioner’s offices is not available. The main concern of this study was to evaluate the consultation prevalence of knee pain, accompanying symptoms, the frequency of diagnostic and therapeutic procedures, and results of encounters of patients suffering from knee pain. Methods. For the SESAM 2 study cross-sectional data was collected from randomly selected patients during one year and compared with publicly available data from the Dutch Transition Project. Results. Overall, 127 out of 8,877 (1.4%) patients of the SESAM 2 study and 6,754 out of 149,238 (4.5%) patients of the Dutch Transition Project consulted for knee pain. Drug prescription, follow-up consultation, giving doctor’s advice, and referral to a specialist or physiotherapist were the most frequent procedures. Osteoarthritis of the knee and other musculoskeletal diseases were the most frequent results of encounter. Overweight, age, gender, and other musculoskeletal diseases were found to be significantly associated with knee pain. Conclusion. Knee pain in general practice settings is mainly associated with chronic problems. Dangerous outcomes (as suspected fracture or thrombosis) are rare. Further research is needed in order to reduce the influence knee pain has on daily living. Thomas Frese, Linda Peyton, Jarmila Mahlmeister, and Hagen Sandholzer Copyright © 2013 Thomas Frese et al. All rights reserved. Using NT-proBNP to Detect Chronic Heart Failure in Elderly Patients with Chronic Obstructive Pulmonary Disease Sun, 09 Jun 2013 13:44:14 +0000 Objective. To detect chronic heart failure in elderly patients with a registered diagnosis of chronic obstructive pulmonary disease (COPD) treated in Swedish primary health care using natriuretic peptide NT-proBNP. Design. A cross-sectional study. Setting. Two primary health care centres in southeastern Sweden each with about 9000 listed patients. Subjects. Patients aged 65 years and older with a registered diagnosis of COPD. Main Outcome Measures. Percentage of patients with elevated NT-proBNP, percentage of patients with abnormal left ventricular function assessed by echocardiography, and association between elevated NT-proBNP and symptoms, signs, and electrocardiography. Results. Using NT-proBNP threshold of 1200 pg/mL, we could detect and confirm chronic heart failure in 5.6% of the study population with concurrent COPD. An elevated level of NT-proBNP was only associated with nocturia and abnormal electrocardiography. Conclusions. We found considerably fewer cases of heart failure in patients with COPD than could be expected from the results of previous studies. Our study shows the need for developing improved strategies to enhance the validity of a suspected heart failure diagnosis in patients with COPD. Elzbieta Kaszuba, Bartlomiej Wagner, Håkan Odeberg, and Anders Halling Copyright © 2013 Elzbieta Kaszuba et al. All rights reserved. Concurrent and Convergent Validity of the Simple Lifestyle Indicator Questionnaire Sat, 01 Jun 2013 18:13:06 +0000 Lifestyle issues including physical activity, diet, smoking, alcohol consumption, and self-reported stress have all been shown to predispose people to higher risk of cardiovascular disease. This study provides further psychometrics on the Simple Lifestyle Indicator Questionnaire (SLIQ), a short, easy-to-use instrument which measures all these lifestyle characteristics as a single construct. One hundred and ninety-three individuals from St. John’s, Newfoundland, and Labrador, Canada completed the SLIQ and reference standards for diet, exercise, stress, and alcohol consumption. The reference standards were a detailed Diet History Questionnaire (DHQ), the Social Readjustment Rating Scale (SRRS), the SF36 Health Status Questionnaire, and a survey of eight questions from a cardiovascular risk questionnaire. Physical activity score was compared with number of steps on a pedometer. Correlations between scores on the SLIQ and the reference standards were the SLIQ versus DHQ (, ), SLIQ versus pedometer (, ), SLIQ versus alcohol consumption (, ), SLIQ versus SRRS (, ), SLIQ versus eight-question risk score (, ), and SLIQ versus Question 1 on SF36 (, ). The SLIQ is sufficiently valid when compared to reference standards to be useful as a brief assessment of an individual’s cardiovascular lifestyle in research and clinical settings. Marshall Godwin, Andrea Pike, Cheri Bethune, Allison Kirby, and Adam Pike Copyright © 2013 Marshall Godwin et al. All rights reserved. A Parent-Focused Pilot Intervention to Increase Parent Health Literacy and Healthy Lifestyle Choices for Young Children and Families Sun, 12 May 2013 17:38:50 +0000 Health literacy affects caregivers’ ability to engage in preventive health care behaviors for themselves and their children. Studies suggest that health literacy among low-income families needs improvement, and this possibly contributes to disparities in preventive health care rates. Additionally, parents and caregivers may not be able to provide or seek preventive health care for their children because of lack of knowledge and skills to do so effectively. This study designed and piloted an intervention that delivered to parents of young children (1) health literacy information in an experiential manner and (2) practical skills to engage their families in healthy lifestyle choices. Specifically, the intervention focused on diet/nutrition, physical activity, sleep hygiene, parenting, and mental wellness. Postintervention improvements were noted for factual knowledge for diet/nutrition, physical activity, and sleep, beliefs about diet/nutrition, and the relationship between mental health and stress. Additionally, postintervention improvements were noted for general knowledge and beliefs about sleep, knowledge about the relationship between sleep and health, knowledge about common childhood sleep problems, and parents’ bedtime interactions with children. The efficacy of the intervention should be evaluated on a larger, more diverse sample in the future with considerations for multiple health behavior change in the evaluation. Sasha Fleary, Robert W. Heffer, E. Lisako McKyer, and Aaron Taylor Copyright © 2013 Sasha Fleary et al. All rights reserved. The Effect of Training in Primary Health Care Centers on Medical Students’ Clinical Skills Thu, 18 Apr 2013 08:49:21 +0000 Medical students’ effective clinical skills training are an important goal of any medical school. When adequate, graduate doctors will have sufficient skills to consult a patient by taking proper history and conducting appropriate physical examination. The question under scrutiny is the optimal place for providing such training. Since the aim is to graduate general physicians, many literatures highlighted the importance of implementing such training in the primary health care centers. A special clinical skills training program was developed for the Year 4 pre-clerkship medical students of the Arabian Gulf University during the academic year 2011-2012. It was important for these students to acquire certain skills before transferring to the clerkship phase where they deal directly with patients. For the 130 students involved in this study, a self-assessment and clinical exam were conducted at the beginning and end of the program. The study showed that students benefited greatly from this training program with significant differences between their preexisting known skills and clinical skills acquired by the end of the program. Primary care centers are ideal places for optimal training because of small group training setting that is one tutor to two students and of the advantage that students face real patient environment. Faisal Abdullatif Alnasir and Ahmed Abdel-Karim Jaradat Copyright © 2013 Faisal Abdullatif Alnasir and Ahmed Abdel-Karim Jaradat. All rights reserved. Constructing Taxonomies to Identify Distinctive Forms of Primary Healthcare Organizations Mon, 15 Apr 2013 09:33:14 +0000 Background. Primary healthcare (PHC) renewal gives rise to important challenges for policy makers, managers, and researchers in most countries. Evaluating new emerging forms of organizations is therefore of prime importance in assessing the impact of these policies. This paper presents a set of methods related to the configurational approach and an organizational taxonomy derived from our analysis. Methods. In 2005, we carried out a study on PHC in two health and social services regions of Quebec that included urban, suburban, and rural areas. An organizational survey was conducted in 473 PHC practices. We used multidimensional nonparametric statistical methods, namely, multiple correspondence and principal component analyses, and an ascending hierarchical classification method to construct a taxonomy of organizations. Results. PHC organizations were classified into five distinct models: four professional and one community. Study findings indicate that the professional integrated coordination and the community model have great potential for organizational development since they are closest to the ideal type promoted by current reforms. Conclusion. Results showed that the configurational approach is useful to assess complex phenomena such as the organization of PHC. The analysis highlights the most promising organizational models. Our study enhances our understanding of organizational change in health services organizations. Roxane Borgès Da Silva, Raynald Pineault, Marjolaine Hamel, Jean-Frédéric Levesque, Danièle Roberge, and Paul Lamarche Copyright © 2013 Roxane Borgès Da Silva et al. All rights reserved. Tramadol/Paracetamol Fixed-Dose Combination for Chronic Pain Management in Family Practice: A Clinical Review Thu, 11 Apr 2013 09:57:54 +0000 The family practitioner plays an important role in the prevention, diagnosis, and early management of chronic pain. He/she is generally the first to be consulted, the one most familiar with the patients and their medical history, and is likely the first to be alerted in case of inadequate pain control or safety and tolerability issues. The family practitioner should therefore be at the center of the multidisciplinary team involved in a patient’s pain management. The most frequent indications associated with chronic pain in family practice are of musculoskeletal origin, and the pain is often multimechanistic. Fixed-dose combination analgesics combine compounds with different mechanisms of action; their broader analgesic spectrum and potentially synergistic analgesic efficacy and improved benefit/risk ratio might thus be useful. A pain specialist meeting held in November 2010 agreed that the fixed-dose combination tramadol/paracetamol might be a useful pharmacological option for chronic pain management in family practice. The combination is effective in a variety of pain conditions with generally good tolerability. Particularly in elderly patients, it might be considered as an alternative to conventional analgesics such as NSAIDs, which should be used rarely with caution in this population. Ignacio Morón Merchante, Joseph V. Pergolizzi Jr., Mart van de Laar, Hans-Ulrich Mellinghoff, Srinivas Nalamachu, Joanne O'Brien, Serge Perrot, and Robert B. Raffa Copyright © 2013 Ignacio Morón Merchante et al. All rights reserved. Is There a Need for Men's Health Training for Family Physicians in Canada? Wed, 20 Mar 2013 09:03:30 +0000 Objective. The goal of this study was to explore which topics were rendered important to incorporate into a men's health curriculum for family medicine resident training. Design. A mixed-methodology was used. A case study method with a sequential transformative strategy was utilized. A quantitative survey was sent to the 17 program directors of Canadian family medicine training programs. This was followed by a qualitative phase with interviews of selected program directors and two focus groups with practicing family physicians from a rural and an urban clinic. Main Findings. Certain issues were identified for incorporation into a men's health curriculum for family medicine resident training. These issues were grouped in three groups: male sexual and reproductive health, general topics, and procedures specific to men's health. Conclusion. It appears that there is no formal curriculum to address any of these issues in any of the current family medicine training programs in Canada. Based on the information gathered from participants in this study, there is a great need for such a curriculum to exist. Andries Muller, Vivian R. Ramsden, and Gill White Copyright © 2013 Andries Muller et al. All rights reserved. Computer Assisted Chronic Disease Management: Does It Work? A Pilot Study Using Mixed Methods Thu, 07 Mar 2013 13:54:59 +0000 Background. Key factors for the effective chronic disease management (CDM) include the availability of practical and effective computer tools and continuing professional development/education. This study tested the effectiveness of a computer assisted chronic disease management tool, a broadband-based service known as cdmNet in increasing the development of care plans for patients with chronic disease in general practice. Methodology. Mixed methods are the breakthrough series methodology (workshops and plan-do-study-act cycles) and semistructured interviews. Results. Throughout the intervention period a pattern emerged suggesting GPs use of cdmNet initially increased, then plateaued practice nurses’ and practice managers’ roles expanded as they became more involved in using cdmNet. Seven main messages emerged from the GP interviews. Discussion. The overall use of cdmNet by participating GPs varied from “no change” to “significant change and developing many the GPMPs (general practice management plans) using cdmNet.” The variation may be due to several factors, not the least, allowing GPs adequate time to familiarise themselves with the software and recognising the benefit of the team approach. Conclusion. The breakthrough series methodology facilitated upskilling GPs’ management of patients diagnosed with a chronic disease and learning how to use the broadband-based service cdmNet. Kay M. Jones, Ruby Biezen, and Leon Piterman Copyright © 2013 Kay M. Jones et al. All rights reserved. Factors Associated with Antibiotic Prescribing in Children with Otitis Media Tue, 26 Feb 2013 09:36:30 +0000 Background. Acute otitis media (AOM) is often treated with antibiotics. However, initial observation is recommended. Denmark has a low use of antibiotics compared with other countries, but the total use of antibiotics has increased by 32% during the last decade, and it is important to know whether general practitioners (GPs) prescribe antibiotics according to guidelines. Objective. The aim of the study was to analyse associations between GPs' antibiotic prescribing for AOM and symptoms, diagnoses, and characteristics of children. Methods. A cohort study where GPs consecutively included 954 children between 0 and 7 years old with a new ear symptom was carried out. The GPs registered symptoms, results of otoscopy and tympanometry, together with diagnosis and treatment. Results. Fever with and without earache was statistically associated with prescribing antibiotics, and it applies to both children up to two years of age (OR: 5.89 (confidence interval (CI): 2.62–13.21) and OR: 8.13 (CI: 4.61–14.32)) and children older than two years of age (OR: 4.59 (CI: 2.55–8.25) and OR: 19.45 (CI: 6.38–59.24)). A red tympanic membrane was statistically associated with the prescribing antibiotics in both age groups (0–2 years: OR: 4.73 (CI: 2.52–8.86) and >2–7 years: OR: 3.76 (CI: 2.13–6.64)). A flat tympanometry curve was only statistically associated with prescribing antibiotics in the oldest children (OR: 2.42 (CI: 1.17–5.00)). Conclusion. This study indicates that GPs to a large degree prescribe antibiotics appropriately according to guidelines. Christina T. Ryborg, Jens Søndergaard, Jørgen Lous, Anders Munck, Pia V. Larsen, Malene Plejdrup Hansen, and Janus Laust Thomsen Copyright © 2013 Christina T. Ryborg et al. All rights reserved. Symptomatic Pectus Excavatum in Seniors: An Exploratory Study on Clinical Presentation and Incidence in Daily Practice Mon, 25 Feb 2013 18:42:10 +0000 Objectives. Doctors all over the world consider a pectus excavatum usually as an incidental finding. There is some evidence suggesting that a pectus excavatum may cause symptoms in the elderly. It is not known how often a pectus excavatum occurs and how strong the relation is with symptoms. Methods. In hospitals and general practice data, we searched for evidence of a connection between cardiac symptoms and the presence of a pectus excavatum in a retrospective survey among patients in whom a pectus excavatum was found in a chest X-ray. In radiology reports, we searched for “pectus excavat*” in almost 160000 chest X-rays. The identified X-rays were reviewed by 2 radiologists. Reported symptoms were combined to a severity sum score and the relation with pectus excavatum was assessed through logistic regression. Results. Pectus excavatum was found in 1 to 2 per 1000 chest X-rays. In 32% of patients (), we found symptoms that might reflect the presence of symptomatic pectus excavatum. We found a significant relation between the SPES sum score and the radiological level of pectus excavatum. Conclusions. A pectus excavatum found when examining the patient should not be neglected and should be considered as a possible explanation for symptoms like dyspnoea, fatigue, or palpitations. Ron A. G. Winkens, Frank I. Guldemond, Paul F. H. M. Hoppener, Hans A. Kragten, and J. Andre Knottnerus Copyright © 2013 Ron A. G. Winkens et al. All rights reserved. Underage Binge Drinking Adolescents: Sociodemographic Profile and Utilization of Family Doctors Thu, 07 Feb 2013 13:30:14 +0000 Context. Binge drinking (more than five drinks on one occasion) is a major public health problem among teenagers in the US, Canada, and Europe. Negative outcomes to binge drinking include alcohol related injuries and accidental death. Family physicians are the main point of contact between binging adolescents and the health care system. Design and Setting. This study was based on a secondary analysis of 6,607 respondents aged 15–17 from the regionally representative data acquired through the Canadian Community Health Survey 1.1. Results. According to our findings, one in every eight teens aged 15–17 binge drank monthly. The odds of binge drinking were higher among males, Whites, those living away from parents, teens who reported a decline in health status, and those experiencing back problems and depression. Smoking status was strongly associated with the binge drinking behavior. Three-quarters of binge drinking adolescents had seen their family doctor in the past year but only one in ten had spoken with any health professional about a mental health issue. Conclusions. Family physicians need to screen their adolescent patients for binge drinking in order to provide timely and effective interventions. Awareness of the profile of binge drinkers could improve the accuracy of targeting and outreaching strategies. Esme Fuller-Thomson, Matthew P. Sheridan, Cathy Sorichetti, and Rukshan Mehta Copyright © 2013 Esme Fuller-Thomson et al. All rights reserved. Peer-Supported Diabetes Prevention Program for Turkish- and Arabic-Speaking Communities in Australia Wed, 06 Feb 2013 10:42:24 +0000 In Australia, type 2 diabetes and prediabetes are more prevalent in culturally and linguistically diverse (CALD) communities than mainstream Australians. Purpose. To develop, implement, and evaluate culturally sensitive peer-supported diabetes education program for the prevention of type 2 diabetes in high-risk middle-aged Turkish- and Arabic-speaking people. Methods. A two-day training program was developed. Ten bilingual peer leaders were recruited from existing health and social networks in Melbourne and were trained by diabetes educators. Each leader recruited 10 high-risk people for developing diabetes. Questionnaires were administered, and height, weight, and waist circumference were measured at baseline and three months after the intervention. The intervention comprised two 2-hour group sessions and 30 minutes reinforcement and support telephone calls. Results. 94 individuals (73% women) completed the program. Three months after the program, the participants’ mean body weight (before = 78.1 kg, after = 77.3; score = −3.415, ) and waist circumference ( = −2.569, ) were reduced, their diabetes knowledge was enhanced, and lifestyle behaviours were significantly improved. Conclusions. A short diabetes prevention program delivered by bilingual peers was associated with improved diabetes awareness, changed lifestyle behaviour, and reduction in body weight 3 months after intervention. The findings are encouraging and should stimulate a larger control-designed study. Nabil Sulaiman, Elaine Hadj, Amal Hussein, and Doris Young Copyright © 2013 Nabil Sulaiman et al. All rights reserved. Suicidal Ideation in a Population-Based Sample of Adolescents: Implications for Family Medicine Practice Wed, 30 Jan 2013 15:26:20 +0000 Introduction. This study investigated the relationship between suicidal ideation and demographic characteristics, health conditions, depression, and health care utilization patterns among adolescents. Methods. Secondary analysis of the regionally representative Canadian Community Health Survey conducted in 2000/2001 (response rate 85%). Adolescents aged 15 to 19 who reported suicidal ideation in the previous year () were compared with their peers who did not (). The association between suicidal ideation and socio-demographic and health characteristics were investigated. Findings. Almost three-quarters (73%) of suicidal adolescents had not spoken with any health professional about mental health issues in the preceding year. Despite the fact that 80% of suicidal adolescents had regular contact with their family doctor, only 5% had consulted with them about mental health issues. In addition to the well-known risk factors of depression and stress, suicidal ideation was highly elevated in adolescents with two or more chronic health conditions, self-reported poor health, migraines, and back pain and those whose activities were prevented by pain (). Other characteristics significantly correlated with suicidal ideation included smoking, living in single parent families, and having lower levels of social support. Conclusions. Family physicians should regularly screen for suicidal thoughts in their adolescent patients with these characteristics. Esme Fuller-Thomson, Gail P. Hamelin, and Stephen J. R. Granger Copyright © 2013 Esme Fuller-Thomson et al. All rights reserved. Impact of Growing Up with a Chronically Ill Sibling on Well Siblings' Late Adolescent Functioning Mon, 28 Jan 2013 10:34:01 +0000 The purpose of this study was to explore the continuing impact of growing up with an ill sibling on well siblings' late adolescent functioning. Forty late adolescents (, ), who identified themselves as growing up with an ill sibling, completed a semistructured interview, demographic questionnaire, Personality Assessment Screener, and My Feelings and Concerns Sibling Questionnaire. Participants reported clinically significant problems on some PAS scales, and gender differences were found for acting out and alienation. Significant relationships were reported for communication and social withdrawal and alienation. Both positive and negative themes about the experience were elicited from the responses in the semistructured interview. This study provides evidence for some lingering negative effects of growing up with an ill sibling on well siblings' late adolescent functioning. Additionally, evidence for siblings' development of positive characteristics that may act as protective variables as they face the stressors of late adolescence was also highlighted. Sasha A. Fleary and Robert W. Heffer Copyright © 2013 Sasha A. Fleary and Robert W. Heffer. All rights reserved. Long-Term Parental Unemployment in Childhood and Subsequent Chronic Fatigue Syndrome Sun, 27 Jan 2013 09:57:06 +0000 Objective. The association between long-term parental unemployment in childhood and chronic fatigue syndrome was examined in a population-based sample of women. Methods. A secondary analysis of data from a regionally representative sample of women () from the Canadian Community Health Survey (2005) was conducted using logistic regression. Age and race as well as the following clusters of factors were controlled for: (1) other childhood adversities, (2) adult health behaviors and hypertension, (3) adult stressors and socioeconomic status, and (4) adult mental health. Results. When adjusting for age and race only, the odds ratio of chronic fatigue syndrome among those reporting parental unemployment was 4.12 (95% CI: 2.60, 6.52) compared to those not reporting parental unemployment. When controlling for age and race plus all four clusters of factors the odds ratio for chronic fatigue syndrome dropped slightly to 3.05 (95% CI: 1.81, 5.14), but remained statistically significant. Conclusions. This study provides evidence for a significant association between long-term parental unemployment in childhood and chronic fatigue syndrome even after controlling for a wide range of potential risk factors. Esme Fuller-Thomson, Rukshan Mehta, and Joanne Sulman Copyright © 2013 Esme Fuller-Thomson et al. All rights reserved. Evaluation of Rubella Immunity in a Community Prenatal Clinic Tue, 15 Jan 2013 10:33:09 +0000 Since the introduction of the Rubella vaccine in 1969, prevalence of congenital Rubella syndrome (CRS) has greatly declined in the United States. However, reports of sporadic adult cases of the disease and frequent identification of non-Rubella immune (NRI) women in prenatal units may result in outbreak of CRS in susceptible communities. Identifying populations with high rates of NRI will assist in evidence-based public health intervention that may prevent epidemic of CRS in the United States. Method. This is a retrospective, cross-sectional study involving chart audit of Rubella screening results of 642 women who attended a high-risk prenatal care at a northwestern Iowa clinic between January 1 and December 31, 2007. Results. NRI was found in 6.9% of the study population. The highest prevalence rate of 10.2% was found among adolescents. NRI was highest among Native American women at 17.3%, compared to Whites 7.3%, African Americans 5.9%, and Hispanics 4.6%. Multivariate analysis demonstrated that Native Americans were 2.5 times more likely to be NRI compared to Whites (OR 2.7; 95% CI: 1.1, 6.6). Conclusion. This study demonstrated higher rate of non-Rubella immunity among adolescent pregnant women and supports Rubella booster immunization for all non-pregnant teenage women. The observed high rate of NRI among Native Americans may require further studies and evaluation of Rubella vaccination programs in tribal communities. Edward C. Nwanegbo, Thor Swanson, Oluseyi Vanderpuye, and Carlos F. Rios-Bedoya Copyright © 2013 Edward C. Nwanegbo et al. All rights reserved. Beta-Cell Age Calculator, a Translational Yardstick to Communicate Diabetes Risk with Patients: Tehran Lipid and Glucose Study Sun, 02 Dec 2012 15:02:03 +0000 Aims. To provide a yardstick for physicians/patients to efficiently communicate/measure incident diabetes risk. Methods. We included data on 5,960 (3,438 women) diabetes-free adults, aged ≥20 years at baseline who either developed diabetes during two consecutive examinations or completed the followup. Age, systolic blood pressure, family history of diabetes, waist-to-height ratio (WHtR), triglyceride-to-high-density lipoprotein cholesterol ratio (TG/HDLD-C), and fasting plasma glucose (FPG) were introduced into an accelerated failure time regression model. Results. Annual diabetes incidence rate was 0.85/1000-person (95% CIs 0.77–0.94). Point-score-system incorporated age (1 point for >65 years), family history of diabetes (4 points), systolic blood pressure (−1 to 3 points), WHtR (−4 to 6 points), TG/HDL-C (1 point for ≥1.5), and FPG (0 to 27 points). Harrell’s C statistic = 0.830 (95% CIs 0.808–0.852) and Hosmer-Lemeshow (P for lack of fitness = 0.462) indicated good discrimination and calibration. We defined beta-cell age as chronological age of a person with the same predicted risk but all risk factors at the normal levels (i.e., WHtR 0.50, no family history of diabetes, Ln (TG/HDL-C) = 0.531, and FPG = 4.9 (mmol·L−1)). Conclusion. Hereby, we have made it also possible to estimate wide ranges of “beta-cell age” for most chronological ages to assist clinician with risk communication. Mohammadreza Bozorgmanesh, Farzad Hadaegh, and Fereidoun Azizi Copyright © 2013 Mohammadreza Bozorgmanesh et al. All rights reserved. The General Practitioner’s Consultation Approaches to Medically Unexplained Symptoms: A Qualitative Study Sun, 16 Sep 2012 15:19:27 +0000 Background. The prevalence of medically unexplained symptoms (MUSs) in primary care is about 10–15%. The definition of MUS is descriptive and there are no specific diagnostic criteria for MUS in primary care. Furthermore, a general practitioner’s (GP’s) categorisation of patients with MUS shows large variation. The aim of the present study is to investigate how GPs employ the definition of MUS and how they manage patients with MUS in daily practice. Methods. With a grounded theory approach five focus group interviews with GPs were performed. The interviews addressed how GPs managed MUS and their reflections on the course and prognosis for MUS patients. Results. Consultations about MUS develop around the individual patient and usually include several appointments. We identified three different types of consultations: (1) “searching for a disease,” (2) “going by the routine,” and (3) “following various paths.” These types of consultations spanned from a biomedical approach to an approach where multiple explanations were offered to explain the patient’s problem. The choice of consultation types was influenced by the GP, the patient and contextual factors which, in turn, affected the diagnostic process. Conclusions. A diagnosis of MUS is contextually embedded and the diagnostic process is shaped by the consultation. Henriette Schou Hansen, Marianne Rosendal, Per Fink, and Mette Bech Risør Copyright © 2013 Henriette Schou Hansen et al. All rights reserved.