Scandinavian Journal of Primary Health Care最新文献

{"title":"A randomized controlled trial comparing sleep hygiene advice with a self-help book focusing on cognitive behavioral therapy for insomnia: a study among patients with prescribed hypnotics from the GP.","authors":"Bjørn Bjorvatn, Ragnhild Stokke Lundetræ, Øystein Vedaa, Ståle Pallesen, Linn Nyjordet Evanger","doi":"10.1080/02813432.2025.2525423","DOIUrl":"https://doi.org/10.1080/02813432.2025.2525423","url":null,"abstract":"<p><strong>Background: </strong>Chronic insomnia is commonly treated with hypnotics. However, the treatment of choice is cognitive behavioral therapy for insomnia (CBTi). We investigated whether a self-help book based on CBTi is effective in reducing hypnotic use and improving sleep.</p><p><strong>Methods: </strong>Patients who had received a prescription from their GP for z-hypnotics (zopiclone or zolpidem) in the last 6 months were recruited through PraksisNett, an infrastructure within General Practice, for a randomized controlled trial comparing written materials in form of a sheet of sleep hygiene advice and a self-help book. The participants completed an online questionnaire about hypnotic use, insomnia symptoms, sleep duration, anxiety and depression before the intervention and at 4-5 months follow-up.</p><p><strong>Results: </strong>In total, 125 patients (response rate 72.7%) completed the follow-up questionnaire. Interaction analyses indicated effects favoring the self-help book for hypnotic use and anxiety. The book reduced the proportion using hypnotics daily from 25.4% to 18.6%, while the proportion increased from 21.2% to 22.7% in the sleep hygiene group. The proportion reporting anxiety was reduced from 32.1% to 23.2% in the self-help book group, while it increased from 27.0% to 31.7% in the sleep hygiene group. Insomnia symptoms were lowered in both intervention groups, whereas depression remained unchanged.</p><p><strong>Conclusion: </strong>This study indicated that the self-help book was an effective low-threshold treatment option that seems to reduce hypnotic use and at the same time improve sleep and mental health. The patients who received sleep hygiene advice also reported some positive effects, but daily hypnotic use and anxiety increased.</p>","PeriodicalId":21521,"journal":{"name":"Scandinavian Journal of Primary Health Care","volume":" ","pages":"1-10"},"PeriodicalIF":1.9,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144512450","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Conflicts of interest and industry funding declared in systematic reviews of interventions for six common diagnoses.","authors":"Marek Czajkowski, Louise Olsson","doi":"10.1080/02813432.2025.2519660","DOIUrl":"https://doi.org/10.1080/02813432.2025.2519660","url":null,"abstract":"<p><strong>Background: </strong>There is a lack of data on the prevalence of conflicts of interest (COI) declared in systematic reviews over time.</p><p><strong>Methods: </strong>PubMed was searched for systematic reviews on interventions for chronic obstructive pulmonary disease, type 2 diabetes mellitus, hypertension, dementia, major depression, and osteoarthritis from 2010 and 2019. Selection was conducted by two independent authors, with disagreements resolved in consensus. COI and funding disclosures were extracted. COI were categorised using a specific framework.</p><p><strong>Results: </strong>746 systematic reviews were included. One third involved pharmacological interventions. Systematic reviews from China increased from 4% to 21% between 2010 and 2019; Cochrane reviews decreased from 19% to 4%.Systematic reviews presenting a COI statement increased from 79% to 94%. Those with at least one author declaring individual financial COI decreased from 22% to 17% but remained at 22-23% when excluding systematic reviews from China. Almost 1 in 3 systematic reviews on pharmacological interventions and invasive procedures declared individual financial COI for 2019. Individual intellectual COI were declared in 2.5% and other types of COI were very rare.Systematic reviews presenting a funding statement increased from 65% to 81%; industry funding decreased from 6% to 3.4%. Adding industry funding to the prevalence of systematic reviews declaring financial COI only made a marginal difference.</p><p><strong>Conclusions: </strong>The proportion of systematic reviews on interventions for common diagnoses declaring individual financial COI remained consistent at approximately one in five for both 2010 and 2019, underscoring the need for further research into the implications of this finding.</p>","PeriodicalId":21521,"journal":{"name":"Scandinavian Journal of Primary Health Care","volume":" ","pages":"1-9"},"PeriodicalIF":1.9,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144508054","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"From rural Norway to high-density systems: translating nurse-led emergency models.","authors":"Yalcin Golcuk","doi":"10.1080/02813432.2025.2524367","DOIUrl":"https://doi.org/10.1080/02813432.2025.2524367","url":null,"abstract":"","PeriodicalId":21521,"journal":{"name":"Scandinavian Journal of Primary Health Care","volume":" ","pages":"1-2"},"PeriodicalIF":1.9,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144476599","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnostic equipment and point-of-care tests in Norwegian emergency primary healthcare clinics: a cross-sectional study.","authors":"Bent Håkan Lindberg, Jesper Blinkenberg, Tone Morken, Merete Allertsen, Ingrid Keilegavlen Rebnord","doi":"10.1080/02813432.2025.2519658","DOIUrl":"10.1080/02813432.2025.2519658","url":null,"abstract":"<p><strong>Introduction: </strong>In recent years, the increasing availability of instruments and laboratory tests has significantly influenced the diagnostic work in primary healthcare. This study aimed to map the availability of diagnostic equipment and point-of-care tests (POCTs) in Norwegian emergency primary healthcare clinics and examine the demographic and organisational factors influencing their availability.</p><p><strong>Methods: </strong>This cross-sectional study utilised the National Out-of-Hours Services Registry (NOOHR) survey across all Norwegian emergency primary healthcare clinics in early 2024. Clinic managers provided data on diagnostic equipment and POCTs. Clinics were categorised by population size, hospital proximity, co-location with general practitioner (GP) offices, and total equipment available.</p><p><strong>Results: </strong>All 167 Norwegian emergency primary healthcare clinics responded. The median number of diagnostic equipment and POCTs was 17 (Interquartile range (IQR) 16-20). Clinics with the most equipment were often smaller, co-located with a GP office, and over 40 km from a hospital. Almost all clinics had a repertoire of CRP, urinary dipstick, haemoglobin, glucose, strep A test, SARS-CoV-2 rapid test, urinary HCG test, pulse oximeter, and ECG. Clinics far from hospitals more frequently had tests like D-dimer and troponin. Of the clinics with troponin tests, 69% had a low-sensitive POCT.</p><p><strong>Conclusion: </strong>Norwegian emergency primary healthcare clinics are well equipped, especially if co-located with a GP office or far from a hospital. Further research is needed to enlighten how availability influences use and the possible impact on patient trajectories. Clinic leaders should pave the way for sustainable practices and high-value care when deciding their diagnostic equipment and POCTs repertoire.</p>","PeriodicalId":21521,"journal":{"name":"Scandinavian Journal of Primary Health Care","volume":" ","pages":"1-10"},"PeriodicalIF":1.9,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144333824","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Challenges in pain management and opioid prescribing practices following traumatic injury: a focus group study with orthopedic surgeons and general practitioners.","authors":"Jeanette Finstad, Thomas Clausen, Olav Røise, Leiv Arne Rosseland, Ingrid Amalia Havnes","doi":"10.1080/02813432.2025.2517769","DOIUrl":"https://doi.org/10.1080/02813432.2025.2517769","url":null,"abstract":"<p><strong>Objective: </strong>To explore the experiences of orthopedic surgeons and general practitioners (GPs) in providing pain management, focusing on opioid prescribing practices and follow-up care for trauma patients following orthopedic injuries.</p><p><strong>Methods: </strong>Four semi-structured focus group interviews were conducted among 18 physicians, two among GPs and two among orthopedic trauma surgeons. Each group consisted of either specialist candidates or experienced specialists. The interviews explored experiences with follow-up care for orthopedic trauma patients, pain management, including opioid use and tapering, and were thematically analyzed.</p><p><strong>Results: </strong>Four main themes were identified: (1) Navigating post-discharge pain management, where GPs experienced problematic transfer of treatment responsibility and lack of opioid taper plans from the specialist health service. (2) A knowledge gap in pain management, with GPs reporting insufficient knowledge about opioid treatment, and orthopedic residents describing lacking systematic training in this area during specialization. (3) Changes in opioid prescribing practices over time, which had led to a self-perceived shift from liberal to restrictive prescription attitudes. (4) Unrealistic expectations of pain relief among patients were perceived by GPs and orthopedic surgeons throughout recovery.</p><p><strong>Conclusions and implications: </strong>Our findings reveal a knowledge gap in pain management, suggesting a need for enhanced education and training for GPs, both in specialization and specialist, and for orthopedic residents. This is crucial to meet the needs of trauma patients with severe orthopedic injuries and long-term pain. GPs need access to advisory support from the specialist healthcare system. These resources, including follow-up during challenging recovery phases, must be accessible to enhance patients care.</p>","PeriodicalId":21521,"journal":{"name":"Scandinavian Journal of Primary Health Care","volume":" ","pages":"1-16"},"PeriodicalIF":1.9,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144286466","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Facilitating access to mental healthcare for patients with long-term conditions in general practice: a qualitative collective case study.","authors":"Amanda Nikolajew Rasmussen, Viola Burau, Helle Terkildsen Maindal","doi":"10.1080/02813432.2025.2516497","DOIUrl":"https://doi.org/10.1080/02813432.2025.2516497","url":null,"abstract":"<p><strong>Objective: </strong>Mental health problems among patients with type 2 diabetes (T2D) and ischemic heart disease (IHD) are common, but often undertreated. General practice is a relevant setting for addressing this complex health condition. However, research suggests that this group of patients often experience problems accessing care. This study aimed to explore how access to mental healthcare in general practice for patients with T2D and/or IHD is facilitated by processes of organizing care.</p><p><strong>Design, setting and participants: </strong>The study was designed as a qualitative collective case study in four general practices in Central Denmark Region participating in The Healthy Mind Study. Data were collected through ethnographic observations of, and qualitative interviews with patients and healthcare professionals.</p><p><strong>Results: </strong>We found that when healthcare professionals adapted services to specific patient needs, the patients felt welcome and accepted. Furthermore, finding a balance between letting the patient take responsibility while still providing sufficient support led to patients feeling empowered while still feeling cared for. Organizational prioritization of patients in u situations created circumstances that enabled healthcare professionals to provide better access to care and better treatment outcomes.</p><p><strong>Conclusion: </strong>Healthcare professionals in general practice must think about their role in facilitating access to mental healthcare. An important part of this is that general practices prioritize patients in vulnerable situations, for example through specialized services, outreach work, structured staff supervision, and extra time. Recruitment of participants for mental healthcare interventions in general practice may benefit from using informal strategies relying on the patient-provider relationship.</p>","PeriodicalId":21521,"journal":{"name":"Scandinavian Journal of Primary Health Care","volume":" ","pages":"1-13"},"PeriodicalIF":1.9,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144275869","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Response to letter to the editor regarding 'does point-of care ultrasound examination by the general practitioner lead to inappropriate care? A follow up study' by Andersen et al.","authors":"Camilla Aakjær Andersen, John Brandt Brodersen, Martin Bach Jensen","doi":"10.1080/02813432.2025.2516383","DOIUrl":"https://doi.org/10.1080/02813432.2025.2516383","url":null,"abstract":"","PeriodicalId":21521,"journal":{"name":"Scandinavian Journal of Primary Health Care","volume":" ","pages":"1-2"},"PeriodicalIF":1.9,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144249446","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cognitive dysfunction in diabetes - the 'forgotten' diabetes complication: a narrative review.","authors":"Åke Sjöholm, Louise Bennet, Peter M Nilsson","doi":"10.1080/02813432.2025.2455136","DOIUrl":"10.1080/02813432.2025.2455136","url":null,"abstract":"<p><strong>Background: </strong>In addition to peripheral neuropathy of various kinds, diabetes can also cause central neuropathy, which among other things can manifest itself as premature cognitive dysfunction, often linked to vascular dysfunction. Although the link between diabetes and cognitive dysfunction was discovered more than 100 years ago and has important clinical implications, this diabetes complication remains relatively unknown. Recent years have seen research that has clarified cerebral insulin resistance and defective insulin signaling as examples of pathogenic factors behind this cognitive impairment in diabetes.</p><p><strong>Method: </strong>We provide a narrative review of select and contemporary publications with relevance for the interface between diabetes/prediabetes and cognitive function.</p><p><strong>Results: </strong>Recently published studies show that physical activity can reverse insulin resistance in the brain as well as cognitive impairment and pathological appetite regulation. Pharmacological interventions with, for example, nasal insulin, GLP-1 receptor agonists, SGLT-2 inhibitors, or PPAR-γ agonists have also shown promising results.</p><p><strong>Conclusion: </strong>Optimization of lifestyle factors (e.g. physical activity), as well as several pharmaceutical agents already in clinical use against diabetes, have shown promising results in improving cognitive function in diabetic patients. An important task for primary health care, where most patients with type 2 diabetes are diagnosed, treated, and followed, is to increase awareness and early detection of cognitive dysfunction in these patients for optimizing risk factor control.</p>","PeriodicalId":21521,"journal":{"name":"Scandinavian Journal of Primary Health Care","volume":" ","pages":"448-454"},"PeriodicalIF":1.9,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12090258/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143060529","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Differences in use of telemedicine integrated into traditional primary health care - a comparative observational study.","authors":"Pär Eriksson, Maria Randjelovic, Hans Thulesius, Tora Hammar, Stefan Lagrosen, Evalill Nilsson","doi":"10.1080/02813432.2025.2457542","DOIUrl":"10.1080/02813432.2025.2457542","url":null,"abstract":"<p><p>Telemedicine in primary health care is expected to address many of the issues currently challenging service delivery. However, the impact and effect will depend on who will use the new technology.</p><p><strong>Objective: </strong>The objective of the study was to investigate differences between users and non-users of telemedicine integrated into traditional office-based primary health care.</p><p><strong>Methods: </strong>Quantitative registry-based population study in two regions in the southeast part of Sweden (<i>n</i> = 73,486), comparing users with non-users of telemedicine across the variables sex, age, socioeconomic status (SES), morbidity and health care seeking behaviour (HSB). Two study periods of six months were used (September 2019-February 2020 for Region Östergötland, and September 2021-February 2022 for Region Kalmar County) to collect user data. A reference period of 36 months (September 2016-August 2019) was used, to collect data on HSB.</p><p><strong>Results: </strong>Users were more often women under the age of 60 and had higher morbidity (measured as resource utilisation) than non-users (<i>p</i> < .001). In contrast, no statistically significant differences were seen between the two groups regarding SES, measured as Care Need Index (CNI). Regarding HSB, a proxy measure (health record entries) showed more entries for users than non-users.</p><p><strong>Conclusions: </strong>Our findings suggest that users are more likely to be women and below the age of 60. Likewise, users also tend to have a greater need for health care services compared to non-users, and they seek health care more often compared to non-users. No differences regarding SES were found.</p>","PeriodicalId":21521,"journal":{"name":"Scandinavian Journal of Primary Health Care","volume":" ","pages":"476-487"},"PeriodicalIF":1.9,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12090274/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143365849","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Systematic Coronary Risk Evaluation 2 (SCORE2), arterial stiffness, and subclinical coronary atherosclerosis in a population-based study.","authors":"Susanna Strömberg, Andreas Stomby, Jan Engvall, Carl Johan Östgren","doi":"10.1080/02813432.2025.2456948","DOIUrl":"10.1080/02813432.2025.2456948","url":null,"abstract":"<p><strong>Aim: </strong>To investigate the association between Systematic Coronary Risk Evaluation 2 (SCORE2) and subclinical damage in two vascular beds: atherosclerosis in the coronary arteries and aortic arterial stiffness, in a large population-based cohort without cardiovascular disease or diabetes.</p><p><strong>Methods: </strong><i>Design:</i> A cross-sectional study based on Swedish CArdio Pulmonary bioImaging Study (SCAPIS) data. <i>Study population:</i> A population-based cohort of 3087 participants aged 50-64.</p><p><strong>Outcome: </strong>Pulse Wave Velocity (PWV) was measured, and aortic arterial stiffness was defined as PWV≥ 10 m/s. Coronary artery calcium score (CACS) was determined by coronary computed tomography and clinically significant coronary calcification was defined as CACS > 100.</p><p><strong>Results: </strong>The prevalence of arterial stiffness was 6.6% in the low-moderate SCORE2 risk group, 31.0% in the high-risk group, and 53.3% in the very high-risk group. The prevalence of coronary calcification was 4.5%, 18.5% 23.0%, respectively. There was a modest overlap between arterial stiffness and coronary calcification in all SCORE2 risk groups. When comparing the high SCORE2 risk group with the low-moderate risk group, the Odds ratio (OR) was 6.4, 95% confidence interval (CI 5.1-8.0) for arterial stiffness and 4.8 (CI 3.7-6.3) for coronary calcification. When comparing the very high SCORE2 risk group to the low-moderate group, the OR was 16.2 (CI 11.3-23.1) for arterial stiffness and 6.4 (CI 4.2-9.7) for coronary calcification.</p><p><strong>Conclusion: </strong>Our study shows that high cardiovascular risk according to SCORE2 is associated with increased arterial stiffness and significant coronary calcification in a population without prevalent cardiovascular disease or diabetes. This knowledge can be useful in primary care, where SCORE2 is frequently used as a risk prediction tool. The modest overlap between arterial stiffness and coronary calcification suggests that CACS and PWV describe different types of vascular damage.</p>","PeriodicalId":21521,"journal":{"name":"Scandinavian Journal of Primary Health Care","volume":" ","pages":"455-462"},"PeriodicalIF":1.9,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12090275/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143034162","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}