Scandinavian Journal of Primary Health Care最新文献

{"title":"Exercise capacity after long-term physical activity on prescription provided by physiotherapists.","authors":"Daniel Karsberg Zotterman, Åsa Cider, Stefan Lundqvist","doi":"10.1080/02813432.2025.2450376","DOIUrl":"10.1080/02813432.2025.2450376","url":null,"abstract":"<p><p><b>Background:</b> Research has shown that physical activity on prescription (PAP), used in Swedish healthcare, increases patients' physical activity, but data are lacking regarding the long-term effects of PAP on exercise capacity. Therefor exercise capacity was evaluated in patients with metabolic risk factors, after 4.5 years of PAP treatment provided by physiotherapists in primary healthcare.</p><p><p><b>Method:</b> This study included 98 patients (49% women; mean age, 56 years) with metabolic risk factors, who were still physically inactive after a previous 6-month PAP treatment. The patients received physiotherapist-provided PAP treatment for 4.5 years, including 11 follow-ups and 6 exercise capacity tests.</p><p><p><b>Results:</b> After 4.5 years, 41 patients completed the final exercise capacity test (58% drop-out rate). Compared to baseline, the whole cohort exhibited a significantly increased exercise capacity (9.1 W, <i>p</i> = 0.014) with a small effect size (<i>r</i> = 0.27), with no significant differences associated with age or gender.</p><p><p><b>Conclusion:</b> The increased exercise capacity may indicate positive effects on longevity, and consolidates previous findings that long-term behavior change is possible among physically inactive patients. It also demonstrates the feasibility of continuous exercise capacity testing with physiotherapist support in an ordinary primary care setting. The drop-out rate and lack of control group complicate the interpretation of the effects of PAP treatment on the increased exercise capacity. Further research should strive for an RCT study design.</p>","PeriodicalId":21521,"journal":{"name":"Scandinavian Journal of Primary Health Care","volume":" ","pages":"392-402"},"PeriodicalIF":1.9,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12090311/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143029308","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":"B-phosphatidylethanol testing to identify hazardous alcohol use in primary health care-a game changer and a challenge for general practitioners: a qualitative study.","authors":"Åsa Steensland, Anna Segernäs, Mårten Larsson, Andrea Johansson Capusan, Lisa Kastbom","doi":"10.1080/02813432.2025.2456949","DOIUrl":"10.1080/02813432.2025.2456949","url":null,"abstract":"<p><strong>Background and aims: </strong>Alcohol use disorder (AUD) and hazardous alcohol use are common but underdiagnosed in primary health care (PHC). This study aimed to explore general practitioners' (GPs') experiences and perceptions of using B-Phosphatidylethanol (PEth), a specific quantitative biomarker for alcohol use, in their clinical work with patient consultations and treatment follow-up in Swedish PHC.</p><p><strong>Design, participants, and setting: </strong>Individual interviews were conducted with GPs and resident GPs (n 20) in Swedish PHC and analysed using qualitative content analysis.</p><p><strong>Findings: </strong>The overarching theme <i>PEth testing in primary health care-a game changer and a challenge</i> illustrated that PEth testing has improved the prerequisites for the GP-patient interaction while making it more complex. Four categories underpinned this theme: <i>Comprehending the context</i>, describing the challenges in the GP-patient interaction when hazardous alcohol use or AUD was suspected; <i>Getting the pieces in place</i>, illustrating the struggle of integrating PEth testing into clinical practice and how it diminished the role of alcohol history taking; <i>The challenges and facilitators of the conversation</i>, comprising both the difficulties in informing about PEth testing and the positive impact on the interaction, and <i>Considerations based on the PEth test results</i>, emphasising the consequences of elevated PEth test results and their influence on physicians' motivation to using PEth.</p><p><strong>Conclusions: </strong>PEth is an important tool in the identification of hazardous alcohol use. Emerging ethical dilemmas regarding patient information on PEth testing and management of medical and medico-legal obligations when test results indicate high alcohol use need to be addressed in future guidelines for clinical management of PEth.</p>","PeriodicalId":21521,"journal":{"name":"Scandinavian Journal of Primary Health Care","volume":" ","pages":"463-475"},"PeriodicalIF":1.9,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12090308/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143067659","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":"Letter to the editor.","authors":"Håkan Hanberger, Anders Ternhag, Enrico Baraldi, Sofia Wagrell, Charlotta Edlund","doi":"10.1080/02813432.2025.2487094","DOIUrl":"10.1080/02813432.2025.2487094","url":null,"abstract":"","PeriodicalId":21521,"journal":{"name":"Scandinavian Journal of Primary Health Care","volume":" ","pages":"258-259"},"PeriodicalIF":1.9,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12090255/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143803993","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":"A systems perspective on gaps in the person-centered sick leave and rehabilitation process: a Swedish interview study.","authors":"Märit Löfgren, Karin Törnbom, Daniel Gyllenhammar, Lena Nordeman, Gun Rembeck, Cecilia Björkelund, Irene Svenningsson, Dominique Hange","doi":"10.1080/02813432.2024.2434123","DOIUrl":"10.1080/02813432.2024.2434123","url":null,"abstract":"<p><strong>Background: </strong>Consensus on priorities to optimize the sick leave and rehabilitation process (SRP) is lacking.</p><p><strong>Objective: </strong>To explore perspectives of stakeholders in the SRP on bridging the gap between desired process scope, and actual practice, from a multi-professional, multi-organizational, and interdisciplinary approach.</p><p><strong>Design and setting: </strong>Focus group interviews were conducted with various SRP frontline professionals in Region Västra Götaland, Sweden, using purposive sampling to capture a range of experiences. Participants discussed their perceptions of critical changes and priorities needed to meet patients' SRP needs in a primary care context. All interviews were analyzed using systematic text condensation, as described by Malterud.</p><p><strong>Subjects: </strong>General practitioners (<i>n</i> = 6), rehabilitation coordinators and licensed healthcare professionals from primary healthcare (<i>n</i> = 13), administrators from the Social Insurance Agency, the Employment Agency and Social Services (<i>n</i> = 12).</p><p><strong>Results: </strong>Through data analysis, the following themes emerged: 1) The need for rules and regulations to enable coherent process governance 2) Challenges and opportunities in person-centered SRP: Professional collaboration, organizational priorities, and the need for enhanced leadership, and 3) Balancing resources and patient needs in the SRP: How to improve care quality and accessibility. In summary, participants mainly discussed how to improve process efficiency and quality of care while balancing available resources and a heavy workload. A main goal was to prevent negative spirals of suboptimal decision-making in individual cases, which could lead to increased work, unfortunate outcomes, and patient suffering.</p><p><strong>Conclusions: </strong>This qualitative study indicated that gaps between a desired process scope and actual practice might be bridged by enabling coherent cross-organizational process governance, prioritizing person-centered ways of working, and balancing available resources and workload. The above changes were believed to improve process quality and overall efficiency.</p><p><strong>Trial registration: </strong>The study project plan was pre-registered on September 21st, 2020, in the database FOU i VGR (researchweb.org), project number 274941.</p>","PeriodicalId":21521,"journal":{"name":"Scandinavian Journal of Primary Health Care","volume":" ","pages":"324-337"},"PeriodicalIF":1.9,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12090277/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142771822","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":"Nurse-led atrial fibrillation clinics in primary health care: a review of the evidence.","authors":"Maria Dahlberg, Ulf Jakobsson","doi":"10.1080/02813432.2025.2466175","DOIUrl":"10.1080/02813432.2025.2466175","url":null,"abstract":"<p><strong>Background: </strong>Atrial fibrillation (AF) is the most common arrhythmia worldwide and the majority of AF patients are treated in primary care. In order to minimize hospitalizations and visits to emergency departments, nurse-led care was introduced in secondary care and primary health care (PHC). However, even though nurse-led care was initiated in PHC almost a decade ago, and ESC guidelines recommended patient-centered integrated care including PHC for patients, there seems to be a lack of scientific evidence regarding the effects.</p><p><strong>Aim: </strong>To review the scientific literature regarding the effects of nurse-led AF clinics in PHC.</p><p><strong>Methods: </strong>A systematic review of scientific literature in Medline/Cinahl. Two reviewers independently assessed the retrieved articles.</p><p><strong>Results: </strong>Only one study was found that investigated the effectiveness of nurse-led structured AF management in PHC. The results from the study indicated positive effects; 45% reduction in all-cause mortality compared to usual care and significantly lower number of all-cause hospitalizations with nurse-led care. Several studies were found analyzing the effects of nurse-led AF-care in secondary care facilities, but only one in PHC setting. The results mainly showed that nurse-led care in AF-clinics in secondary care reduces mortality, hospitalizations and visits in emergency departments.</p><p><strong>Conclusions: </strong>Even though only one study focused on PHC, the review indicated positive effects of nurse-led care for AF patients. However, the results are only based on studies performed in inpatient care. Hence, no firm conclusion can be drawn about nurse-led AF-clinics in PHC, and more research is clearly needed in this area.</p>","PeriodicalId":21521,"journal":{"name":"Scandinavian Journal of Primary Health Care","volume":" ","pages":"510-514"},"PeriodicalIF":1.8,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12090316/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143441756","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":"Exploring colorectal cancer patients' diagnostic pathways and general practitioners' assessment of the diagnostic processes: a Danish survey study.","authors":"Dorte E Jarbøl, Sanne Rasmussen, Kirubakaran Balasubramaniam, Jesper Lykkegaard, Linda Juel Ahrenfeldt, Gitte B Lauridsen, Peter Haastrup","doi":"10.1080/02813432.2024.2432376","DOIUrl":"10.1080/02813432.2024.2432376","url":null,"abstract":"<p><strong>Introduction: </strong>Colorectal cancer (CRC) is among the most common cancers and the prognosis of CRC is highly dependent on stage at diagnosis. Although many cases are diagnosed swiftly, there is still room for improvement.</p><p><strong>Aim: </strong>We aimed to explore CRC diagnostic pathways, encompassing (1) place of initial contact; (2) associations with symptom presentations, sex, and age with events in the diagnostic process and initial referrals and (3) the general practitioner's (GP's) evaluation of the diagnostic processes.</p><p><strong>Methods: </strong>All GPs in North-, Central-, and Southern Denmark were invited to fill in questionnaires for their listed patients diagnosed with cancer during the past two years.</p><p><strong>Results: </strong>Among 1,032 recorded CRC patients, 65% had their initial contact in general practice, 5% within the out-of hours service, 10% in the hospital, and 20% were diagnosed based on screening. A total of 27% of CRC patients over 40 who initially presented in general practice were treated or referred on suspicion of another disease first, and 9% were reported to have had hesitated in seeking medical attention. Some 37% presented solely non-specific symptoms, increasing the odds of the GP advising watchful waiting (OR 2.48; 95% CI 1.06-5.81), treating or referring on the suspicion of another illness first (OR 2.57; 95% CI 1.76-3.75), wait due to normal findings (OR 2.11; 95% CI 1.16-3.85), or referring to diagnostic imaging (OR 3.07; 95% CI 1.63-5.79). The GPs assessed nearly one fifth of the diagnostic processes as poor.</p><p><strong>Conclusion: </strong>Most CRC patients are diagnosed with initial presentation in general practice. Having non-specific symptoms is common and challenges timely diagnosis.</p>","PeriodicalId":21521,"journal":{"name":"Scandinavian Journal of Primary Health Care","volume":" ","pages":"303-312"},"PeriodicalIF":1.9,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12090287/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142716623","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":"Primary health care in Ukraine is a cornerstone in both health reform and response to the full-scale invasion.","authors":"Jens Wilkens, Michael Harris, Pavlo Kolesnyk","doi":"10.1080/02813432.2025.2477787","DOIUrl":"10.1080/02813432.2025.2477787","url":null,"abstract":"","PeriodicalId":21521,"journal":{"name":"Scandinavian Journal of Primary Health Care","volume":" ","pages":"255-257"},"PeriodicalIF":1.9,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12090254/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143606288","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":"Worries and information seeking during pregnancy: a cross-sectional study among 1402 expectant Norwegian women active on social media platforms.","authors":"Mari Hegnes Hansen, Hanna Sandbakken Mørkved, Bjarne Austad, Gunnhild Åberge Vie, Linn Okkenhaug Getz, Bente Prytz Mjølstad","doi":"10.1080/02813432.2025.2461036","DOIUrl":"10.1080/02813432.2025.2461036","url":null,"abstract":"<p><strong>Background: </strong>Pregnant women often navigate extensive information from healthcare professionals, social networks and online sources, which can increase anxiety. Understanding their concerns and preferred information sources is crucial for effective antenatal care.</p><p><strong>Objective: </strong>To explore worries and information-seeking behaviour among pregnant women in Norway using social media.</p><p><strong>Methods: </strong>An anonymous, web-based survey was conducted among 1402 pregnant women in Norway from January to March 2022, distributed via Facebook and Instagram. The survey covered 11 pregnancy worries, eight postpartum worries, information sources and thoughts regarding childbirth.</p><p><strong>Results: </strong>Nearly, all participants had concerns, mainly about foetal anomalies (99%, <i>n</i> = 1381), miscarriage (95%, <i>n</i> = 1332) and childbirth (85%, <i>n</i> = 1195). Postpartum worries included physical changes (90%, <i>n</i> = 1266), breastfeeding (85%, <i>n</i> = 1187) and financial situation (74%, <i>n</i> = 1030). Major worries were more common among first-time mothers and women with financial insecurity. Most women sought information from quality-assured public health websites (74%, <i>n</i> = 1042) and healthcare personnel (56%, <i>n</i> = 775), with only 2% (<i>n</i> = 32) turning to influencers or bloggers.</p><p><strong>Conclusions: </strong>Pregnancy and postpartum worries are widespread among pregnant women using social media, especially among first-time mothers and those with financial insecurity. Most pregnant women prefer quality-assured websites and healthcare personnel for information. Antenatal care could benefit from offering more tailored information and follow-up, particularly for first-time mothers and financially insecure women.</p>","PeriodicalId":21521,"journal":{"name":"Scandinavian Journal of Primary Health Care","volume":" ","pages":"488-499"},"PeriodicalIF":1.9,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12090261/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143425750","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":"Clinical presentation of scabies from 1996 to 2022: a retrospective cohort study from Finland.","authors":"Anna Mikola, Ella Jokela, Jari Jokelainen, Eetu Kiviniemi, Suvi-Päivikki Sinikumpu, Laura Huilaja","doi":"10.1080/02813432.2025.2511071","DOIUrl":"https://doi.org/10.1080/02813432.2025.2511071","url":null,"abstract":"<p><strong>Background: </strong>Increasing numbers of scabies cases have been reported in Europe and around the world in recent years. Scabies is more common in children and adolescents than in adults.</p><p><strong>Objectives: </strong>To characterise patient profiles and treatment strategies of scabies over time at the dermatology clinic of Oulu University Hospital (OUH), Finland.</p><p><strong>Methods: </strong>The OUH database was searched using diagnostic codes, and all patients diagnosed with scabies in the OUH dermatology unit between 1996 and 2022 were included in the study. The retrieved patient records were reviewed for demographic and clinical data.</p><p><strong>Results: </strong>The study included the records of 662 patients. 'Suspected scabies' was given as reason for referral to a specialist care in only 21.5% of cases. Time between a symptom onset and the referral to the dermatology unit was significantly longer in adults and adolescents than in small children (<i>p</i> < 0.001), and was longer than six months in one-fifth of adults. Symptomatic sites varied between age groups: compared with small children, adults more commonly (<i>p</i> < 0.001) presented with symptoms in the genital-gluteal area, whereas symptoms were located on the head and 'foot and ankles' more often in young children than other age groups (<i>p</i> < 0001 for all comparisons).</p><p><strong>Conclusions: </strong>Diagnosis was markedly delayed in many patients, especially adults. Unspecified, pruritic skin symptoms should lead to a suspicion of scabies, and when a diagnosis is unclear, the patient should be referred to a dermatologist as quickly as possible. This would both help patients and prevent further spread of the infestation.</p>","PeriodicalId":21521,"journal":{"name":"Scandinavian Journal of Primary Health Care","volume":" ","pages":"1-5"},"PeriodicalIF":1.9,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144199883","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":"General practitioners' clinical decision-making in patients that could have cancer: a vignette study comparing the Baltic states with four Nordic countries.","authors":"Alexander Rosendahl, Anet Vanaveski, Liina Pilv-Toom, Jānis Blumfelds, Vija Siliņa, Mette Brekke, Tuomas Koskela, Aurimas Rapalavičius, Hans Thulesius, Peter Vedsted, Michael Harris","doi":"10.1080/02813432.2025.2451653","DOIUrl":"10.1080/02813432.2025.2451653","url":null,"abstract":"<p><strong>Objective: </strong>Relative one-year cancer survival rates in the Baltic states are lower than the European mean; in the Nordic countries they are higher than the mean. This study investigated the likelihood of General Practitioners (GPs) investigating or referring patients with a low but significant risk of cancer in these two regions, and how this was affected by GP demographics.</p><p><strong>Design: </strong>A survey of GPs using clinical vignettes.</p><p><strong>Setting: </strong>General Practice in Denmark, Estonia, Finland, Latvia, Lithuania, Norway, and Sweden.</p><p><strong>Subjects: </strong>General Practitioners.</p><p><strong>Outcome measures: </strong>A regional comparison of GPs' stated immediate diagnostic actions (whether or not they would perform a key diagnostic test and/or refer to a specialist) for patients with a low but significant risk of cancer (between 1.2 and 3.6%).</p><p><strong>Results: </strong>Of the 427 GPs that completed the questionnaire, those in the Baltic states, and GPs that were more experienced, were more likely to arrange a key diagnostic test and/or refer their patient to a specialist than those in Nordic Countries or who were less experienced (<i>p</i> < 0.001 for both measures). Neither GP sex nor practice location within a country showed a significant association with these measures.</p><p><strong>Conclusion: </strong>While relative one-year cancer survival rates are lower in the Baltic states than in four Nordic countries, we found no evidence that this is due to their GPs' reluctance to take immediate diagnostic action, as GPs in the Baltic states were more likely to investigate and/or refer at the first consultation. Research on patient and secondary care factors is needed to explain the survival differences.</p>","PeriodicalId":21521,"journal":{"name":"Scandinavian Journal of Primary Health Care","volume":" ","pages":"403-410"},"PeriodicalIF":1.9,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12090267/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143010971","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}