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At least 433 records · Page 24Linked to original sources
PubMed2006

The factor structure of the General Health Questionnaire (GHQ): a scaled version for general practice in Spain.

BACKGROUND: The 28-item version of the General Health Questionnaire (GHQ-28) developed by Goldberg and Hillier in 1979 is constructed on the basis of a principal components analysis of the GHQ-60. When used on a Spanish population, a translation of the GHQ-28 developed for an English population may lead to worse predictive values. METHODS: We used our Spanish sample to replicate the entire process of construction of the GHQ-28 administered in a primary-care setting. RESULTS: Two shorter versions were proposed: one with six scales and 30 items, and the other with four scales and 28 items. CONCLUSIONS: The resulting GHQ-28 was a successful adaptation for use on the Spanish sample. When compared with the original version, only 21 items were the same. Moreover, contrary to the English version, which groups sleep problems and anxiety in the same scale, a scale with items related exclusively to 'Sleep disturbances' was found.

Adolescent↗
PubMedDate not supplied

Patients with a psychiatric disorder in general practice: determinants of general practitioners' psychological diagnosis.

BACKGROUND: Although psychiatric disorders are highly prevalent in the community, many patients with a psychiatric morbidity remain unidentified as such in primary care. OBJECTIVE: The aim of this study was to analyze which clinical and sociodemographic characteristics of patients with psychiatric morbidity are related to general practitioners' (GPs) diagnosis of mental illness. METHODS: A 1-year naturalistic survey of primary care contacts of patients with a Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) diagnosis of affective disorder, anxiety disorder or alcohol abuse was carried out. RESULTS: Of the patients with a DSM-IV diagnosis, 10% did not visit their GP at all during 1 year, 40% visited their GP but were only diagnosed as having somatic diagnoses and 50% were given a psychological or social diagnosis at least once during 1 year. Affective disorders are more frequently diagnosed than anxiety disorders or alcohol abuse. The chances of psychological GP diagnosis increase with the number of GP contacts. CONCLUSIONS: GPs appear to have few indications to help them distinguish patients with a psychiatric morbidity from others, as long as the patients themselves do not express more explicit clues to their condition. Public mental health education and a better public relations policy are badly needed.

Diagnostic and Statistical Manual of Mental Disord↗
PubMed2005

Evaluation of the relationship between periapical lesions/sclerotic bone and general bone density as a possible gauge of general health among 80-year-olds.

OBJECTIVES: To evaluate the incidence among 80-year-olds of periapical lesions as detected on panoramic radiographs and to determine the relationship between sclerotic bone around the periapical lesions to heel bone density, body height, and hand-grip strength. STUDY DESIGN: Six hundred fifty-nine panoramic radiographs (262 males, 397 females), obtained from 80-year-old residents of Fukuoka Prefecture, Japan, were used for evaluation of periapical lesions. These findings were correlated with physical examination results to determine the relationship to general health. RESULTS: Of 659 panoramic radiographs, 31 (5%) were noted to have periapical lesions. Average size of the 31 periapical lesions was 6.1 +/- 2.2 mm. Of the 31 periapical lesions, 21 (68%) were accompanied by linear or diffuse types of sclerotic bone. Of the 21 sclerotic bones, 10 (48%) were of a linear type of sclerotic bone and 11 (52%) of a diffuse type of sclerotic bone. Of the 11 diffuse types of sclerotic bone, 10 (91%) were in the mandible and 1 (9%) in the maxilla. Periapical lesions in the mandible were more frequently accompanied by a diffuse type of sclerotic bone than those in the maxilla (P < .01). The hand-grip strength of those having periapical lesions, accompanied by a diffuse type of sclerotic bone, was stronger than those having no periapical lesions (P < .01) and those accompanied by a linear type of sclerotic bone (P < .03). However, there was no relationship between presence of sclerotic bone and heel bone density or body height. CONCLUSIONS: Periapical lesions accompanied by a diffuse type of sclerotic bone were more frequently seen in the mandible of 80-year-olds. To evaluate the clinical significance of sclerotic bone around periapical lesions in 80-year-olds, further study to evaluate the significance of endodontic treatment needs to be done.

Aged↗
PubMedDate not supplied

Comparison of ketoprofen, piroxicam, and diclofenac gels in the treatment of acute soft-tissue injury in general practice. General Practice Study Group.

The efficacy, tolerability, and acceptability of topical applications of ketoprofen gel (2.5% w/w), piroxicam gel (0.5% w/w), and diclofenac gel (1% w/w), when administered three times daily for 5 days, in the treatment of acute (within 48 hours) soft-tissue injury, were compared in an open-label, randomized, multicenter, general practice study. Of 1575 patients recruited, 1048 received ketoprofen gel (525 used the gel with a dose-measuring device), 263 received piroxicam gel, and 264 received diclofenac gel. Ketoprofen gel was significantly superior to piroxicam gel in terms of global assessment of treatment response (improvement in 74% vs 65% of patients) and the severity of the injury (38% vs 26% "greatly improved") and in improvements in stiffness (71% vs 64%), restriction of mobility (34% vs 22%), and pain on pressure (81% vs 78%) and movement (83% vs 77%). Ketoprofen gel also compared favorably with diclofenac gel, with a larger proportion of patients assessing a great improvement in the injury (38% vs 30%). Patient acceptability of ketoprofen gel was significantly better than piroxicam gel. More patients noted a significant cooling effect with ketoprofen gel (71%) than with either piroxicam gel (49%) or diclofenac gel (60%). Ketoprofen gel also showed excellent tolerability. In conclusion, ketoprofen gel may offer benefits over established therapies for the treatment of acute soft-tissue injury.

Acute Disease↗
PubMedDate not supplied

Ninety-seven-year-old people: general presentation, and some general and medical characteristics from a Swedish population study.

This study--the first in a series of reports--is a description of some general and medical characteristics of 97-year-olds from the representative longitudinal Gerontological and geriatric population studies in Göteborg, Sweden. The sample comprised 117 females and 15 males, a total of 132 97-year-olds. The probands were examined in their homes, with an interview based on a questionnaire. Blood hemoglobin, blood glucose and serum cobolamines were analyzed with standard methods, as well as a detailed hematological analysis which will be reported separately. An examination by a nurse and a physician was completed, comprising also dental status, visual ability and a simple hearing test. Anthropometric measurements and ECG were performed, and blood pressure was measured. Judged from cross-sectional data from our population studies, many symptoms and conditions seem to have a higher prevalence at age 97 than at age 70 and 85, respectively, especially regarding visual impairment, oral dryness, and hearing and ECG abnormalities. On the other hand the prevalence of edentulousness was surprisingly low. We find this investigation important for several reasons, namely its comprising a total community sample at this very high age in an urban area. Furthermore, the subjects are survivors of a cohort of elderly investigated several times by us since 1971/72 at age 70. In some aspects these survivors seem to be an elite of elderly people.

Aged↗
PubMed1997

Is a series of blood pressure measurements by the general practitioner or the patient a reliable alternative to ambulatory blood pressure measurement? A study in general practice with reference to short-term and long-term between-visit variability.

We studied the reproducibility of a series of blood pressure measurements by general practitioner (GP) and patient in comparison with that of ambulatory blood pressure measurement (ABPM), with reference to short-term and long-term between-visit variability using a prospective, comparative diagnostic study. The study group was 88 potentially hypertensive primary care patients (initial systolic blood pressure [SBP] between 160 and 200 mm Hg or with diastolic blood pressure [DBP] between 95 and 115 mm Hg). ABPMs were measured on 2 separate days (at a 6 month interval). Two series of measurements by the doctor (at 1 to 6 month intervals), and the patient (at a 1 week interval) were measured. Mean differences and standard deviations of mean differences (SDD) between two successive series of measurements, and between two ABPMs were computed. The Wilcoxon signed-ranks test was used to compare these standard deviations. Mean initial office-blood pressures were 161 (SBP) and 102 (DBP) mm Hg. Long-term between-visit variability (measurements by GP) was larger than short-term between-visit variability: SDDs were 16 v 11 mm Hg (SBP), and 10 v 8 mm Hg (DBP). The differences in average SBP and DBP between successive ABPMs and between successive series of office measurements by GP and home measurements by patient were not statistically significant. Mean differences between two series of measurements by GP and patient, and between two ABPMs, were 0 +/- 1 mm Hg. SDDs between successive ABPMs and series of measurements by GP and patient ranged from 8 to 11 mm Hg (SBP), and were 6 mm Hg (DBP). No statistically significant differences were found between the SDDs of the studied measurement procedures (SBP and DBP). In our study the reproducibility of ambulatory blood pressure measurement was not found to be better than that of a series of four duplicate measurements by GP or patient. Long-term (6 months interval) between-visit variability was larger than the short-term (1 week interval) between-visit variability.

Adult↗
PubMed1991

How general is general slowing? Evidence from the lexical domain.

Three analyses are reported that are based on data from 19 studies using lexical tasks and a reduced version of the Hale, Myerson, and Wagstaff (1987) nonlexical data set. The results of Analysis 1 revealed that a linear function with a slope of approximately 1.5 described the relationship between the lexical decision latencies of older (65-75 years) and younger (19-29 years) adults. The results of Analysis 2, based on response latencies from 6 lexical tasks other than lexical decision, revealed a virtually identical linear relationship. In Analysis 3, it was found that performance on nonlexical tasks spanning the same range of task difficulty was described by a significantly steeper regression line with a slope of approximately 2.0. These findings suggest that although general cognitive slowing is observed in both domains, the degree of slowing is significantly greater in the nonlexical domain than in the lexical domain. In addition, these analyses demonstrate how the meta-analytic approach may be used to determine the limits to the external validity of experimental findings.

Adult↗
PubMed2006

General health promotion in general dental practice--the involvement of the dental team. Part 1: a review of the evidence of effectiveness of brief public health interventions.

OBJECTIVES: To review the evidence of the effectiveness of dentists, dental teams and other healthcare workers in seven different brief public health interventions that might contribute to Government targets in cancer and circulatory disease. The interventions were: smoking prevention, smoking cessation, advice on alcohol consumption, diet counselling, advice on physical exercise, advice on skin cancer prevention and blood pressure monitoring. METHOD: A series of literature reviews, using a generic systematic approach, were undertaken to investigate the effectiveness of dentists, dental teams and other healthcare workers in each intervention. RESULTS: Apart from smoking cessation and dietary advice, no studies were identified on the effectiveness of dentists or dental teams in the interventions investigated. There is some evidence that dentists and dental teams can be effective in smoking cessation. There is minimal evidence for effectiveness in dietary counselling, and that which exists shows only a transient effect. There is evidence that other healthcare workers can have some effect in all interventions, though the effect in preventing skin cancer is questionable. CONCLUSIONS: Due to the paucity of studies undertaken, there is minimal evidence of effectiveness of dentists and dental teams in any of the seven interventions. However other healthcare workers are effective in most of them. Dentists and dental teams' involvement in such brief general health promotion interventions might contribute to Government targets on cancer and circulatory disease.

Alcohol Drinking↗
PubMedDate not supplied

Acute generalized varicella zoster in the setting of preexisting generalized erythema.

We report a 5-year-old girl who initially had generalized erythema from scarlet fever. Four days later she developed sheets of monomorphous vesicles in the areas of erythema. A Tzanck smear of a vesicle base showed multinucleated giant cells, and viral culture grew varicella zoster virus, confirming a clinical diagnosis of varicella. This case illustrates that, with a background of preexisting erythema, varicella may present in an atypical manner.

Acute Disease↗
PubMed1998

Severe idiopathic generalized epilepsy of infancy with generalized tonic-clonic seizures.

PURPOSE: While the literature on infantile epilepsies with minor and major seizures is extensive, little consideration has been given to infantile epilepsy with generalized tonic-clonic seizures (GTCS) alone. The aim of the present study was to analyze the data of a large group of patients and their families to obtain further insight into the clinical picture and pathogenesis of this type of epilepsy. METHODS: The 101 children (58 boys, 43 girls) met the following inclusion criteria: onset of the epilepsy with febrile or afebrile GTCS in the first 5 years of life, absence of primary organic brain lesion or progressive brain disease, severe course with frequent febrile and/or afebrile GTCS, failure of conventional anticonvulsive therapy. RESULTS: The epilepsy predominantly afflicts normally developed infants, boys and girls being about equally affected. The epilepsy begins with frequent febrile or afebrile GTCS, characteristically of long duration and often with alternating lateralization. In half of the cases additional myoclonic or myoclonic astatic seizures and/or absences occur. The initial GTCS phase is the same in epilepsies with and without minor seizures. Erratic myoclonias are especially characteristic. With advancing age, the symptomatology becomes increasingly polymorphic due to the occurrence of additional simple and complex focal and tonic seizures. Severe impairment of mental development soon after onset is a leading symptom. The overall death rate was 9%. Only 11% of the patients had been seizure-free for at least two years at final examination. The EEG was initially normal and subsequently exhibited diffuse 4-7/s rhythms, and only later spikes and waves of irregular shape (87%). Focal sharp waves occurred transiently in 26%. The family history and EEG of probands and relatives showed the pathogenesis to be decisively determined by genetic factors. CONCLUSION: Early infantile GTCS epilepsy represents a genetically determined (idiopathic) epileptic encephalopathy. It overlaps with other forms of early childhood epilepsy such as severe myoclonic epilepsy, severe type of myoclonic astatic epilepsy, as well as early childhood absence epilepsy with GTCS.

Age of Onset↗
PubMed2006

Chlamydia testing in general practice - a survey of Victorian general practitioners.

BACKGROUND: To assess the current chlamydia testing practices of Victorian general practitioners (GPs). METHODS: GPs were randomly selected from the Australasian Medical Publishing Company's national database of medical practitioners and mailed a letter of invitation asking them to complete a postal survey. Up to three postal reminders were sent to non-responders. RESULTS: Of 421 eligible GPs, 252 (60%) returned a completed survey; 22.9% (95% CI: 17.8%, 28.6%) reported testing at least some asymptomatic patients for chlamydia each week and 26.8% (95% CI: 21.4%, 32.7%) reported that they presumptively treated patients for chlamydia without testing them at least half the time. The majority knew the appropriate specimens for diagnosing chlamydia, but 6-8% thought blood and 6% indicated that the Pap smear could be used to reliably diagnose chlamydia infection. CONCLUSIONS: These findings have implications for the future chlamydia screening pilot program in Australia and indicate that a comprehensive education program will be necessary to inform GPs and equip them with the skills to appropriately test for chlamydia in their practice.

Adult↗
PubMed1992

Class II (B) general transcription factor (TFIIB) that binds to the template-committed preinitiation complex is different from general transcription factor BTF3.

A class II (B) general transcription factor of 34 kDa has been purified from HeLa cells to apparent homogeneity. This factor appears to be transcription factor IIB (TFIIB), since it binds in vitro to template-committed preinitiation complexes formed between a template containing the TATA box/cap-site elements of the adenovirus type 2 major late promoter (Ad2MLP) and recombinant human or yeast TFIID (previously called BTF1) expressed in Escherichia coli. DNase I footprint studies show an extended pattern of protection of Ad2MLP TATA box/cap-site sequences when TFIIB is bound to template-committed complexes, even though TFIIB does not bind on its own to the template in the absence of TFIID. We also show that TFIIB is different from BTF3 by a number of criteria.

Amino Acid Sequence↗
PubMed2000

List patient system: straitjacket or a tool for developing general practice? General practitioners' experiences from a pilot project in Norway.

OBJECTIVE: To investigate attitudes and experiences among general practitioners (GPs) taking part in an experiment with a list patient system in four municipalities in Norway. DESIGN: A questionnaire distributed to all 160 GPs in the four municipalities after 3 years' trial of the system. SETTING: Primary health care in Norway. MAIN OUTCOME MEASURES: The opinions of physicians on a list patient system after 3 years of trial. RESULTS: Most of the physicians held that the list patient system imposed more obligations than they were used to. However, the majority also held that the system enhanced preconditions for doing a good professional job; 68% wanted the system on a permanent basis, while 14% rejected it. CONCLUSION: Positive aspects outweigh negative aspects in the attitude of GPs to a list patient system.

Attitude of Health Personnel↗
PubMed2001

Audit in general practice: how much and how complete? Frequency of audit in general practice.

The aim of this study was to determine the frequency of audit and the proportion completed in a group of practices. Data obtained by interviewing a member of each practice and inspecting practice records were independently coded by researchers. Practices initiated an average of 3.5 (range 1-7) audits in 2 years, of which an average of 0.9 (range 0-3) were completed. Ten of 16 completed audits were externally funded or facilitated. Few audits are completed in general practice and practices require continuing support for audit.

Abstracting and Indexing↗
PubMed2000

Lung function measurement in general practice. General practice measurements compared with laboratory measurements during the DIMCA trial.

BACKGROUND: Lung function measurement in the general practice setting (GPS) is of growing importance. OBJECTIVE.:The aim of this study was to compare results from a lung function laboratory (LFL) with those in a GPS. METHODS: Comparisons were made for decline calculated from GPS and LFL measurements and intra-individual paired measurements. Test characteristics of the spirometer used in the GPS were also assessed. RESULTS: The mean decline in lung function was: -0.037 l/year [95% confidence interval (CI) -0.202 to 0.129] from LFL data and -0.027 l/year (95% CI -0.242 to 0.188) from GPS data. The mean intra-individual difference was -0.0025 l (95% CI -0.493 to 0.488 l). The test characteristics of the spirometer used in GPS did not meet all of the American Thoracic Society guidelines; in particular, the random error was too large. The difference in assessments between measurement in LFL and GPS were such that misclassification might occur if slopes were calculated. CONCLUSIONS. :Repeated measurement in this study showed that GPS measurements are not interchangeable with LFL measurements. Therefore, one has to be cautious when interchanging lung function data from an LFL and a GPS.

Clinical Trials as Topic↗
PubMed2005

Do clinical findings in lower respiratory tract infection help general practitioners prescribe antibiotics appropriately? An observational cohort study in general practice.

BACKGROUND: Antibiotics are over-prescribed for lower respiratory tract infection (LRTI). The influence of clinicians' history and examination findings on antibiotic prescribing for LRTI has not been directly assessed, and the extent to which these clinical findings predict appropriate antibiotic prescribing is unknown. A clearer understanding is crucial to achieving evidence-based prescribing. OBJECTIVES: To directly assess the influence of general practitioners' history and examination findings on antibiotic prescribing for LRTI, and to explore the extent to which these clinical findings predict appropriate antibiotic prescribing. METHODS: In this observational cohort study 25 GPs in The Netherlands were recruited during routine consultations and 247 adult patients with a clinical diagnosis of LRTI. The GPs recorded clinical information. Odds ratios (ORs) with 95% confidence intervals (CIs) for clinical variables predicting a prescription for an antibiotic were calculated. The relationship between antibiotic prescription and radiographic evidence of pneumonia was explored in order to gauge appropriateness of antibiotic prescribing. RESULTS: Auscultation abnormalities (OR 11.5; 95% CI 5.4-24.7), and diarrhoea (OR>11) were strongly associated with antibiotic prescribing. An antibiotic was prescribed for 195 (79%) patients. Assuming that an antibiotic definitely needs to be prescribed only for patients with pneumonia, antibiotics may have been inappropriately prescribed for 166/193 (86%) of the patients. Antibiotics were not prescribed for 5 of the 32 (16%) patients with a radiographic diagnosis of pneumonia. CONCLUSIONS: Abnormal findings on auscultation in patients with LRTI strongly predict antibiotic prescribing and this is probably inappropriate for most patients. These results should prompt GPs to consider the extent to which finding 'crackles/rhonchi on auscultation' influences their decisions to prescribe antibiotics for their patients with LRTI, and to consider the predictive value of individual clinical signs in reaching evidence-based prescribing decisions.

Adolescent↗
PubMed2001

Continuous quality improvement in small general medical practices: the attitudes of general practitioners and other practice staff.

OBJECTIVES: Continuous quality improvement (CQI) offers opportunities to improve care in small-scale office-based practice. Little is yet known about the implementation of CQI in small primary care practices. We studied the attitudes of physicians and staff in small family practices to a model of CQI tailored to office-based practice setting. PRACTICES AND DESIGN: An exploratory study in 20 family practices in The Netherlands. Practices were stimulated to adopt the model for continuous quality improvement. MAIN OUTCOME MEASURES: The use of the model at the end of the study period, the perception of the physicians and staff of their success with adopting the model, their view of its usefulness, their willingness to continue and personal and practical obstacles. Measurements were made using written questionnaires. RESULTS: The rate of implementation of the model varied between practices. Participants rated their success in performing improvement projects, holding regular quality meetings and setting targets and priorities. They were positive about the usefulness of the model and they were generally willing to continue to use it. Barriers included the size of workload and the tendency to postpone actions until external support by an outreach visitor was provided. Physician and staff attitudes were homogeneous at a practice level. CONCLUSION: Our findings stress the importance of starting CQI with small, easy-to-handle projects. Workload reduction might be an important issue to focus on. Personal obstacles should be addressed throughout the introduction. We found attitudes in small-scale practices to be homogeneous, so that it was important to pay explicit attention to commitment to CQI from the start of the introduction.

Attitude of Health Personnel↗
PubMedDate not supplied

Working alongside the general practitioner: a child psychiatric clinic in the general practice setting.

A monthly child psychiatric clinic was established in a primary health care centre in order to offer a more accessible service to patients, and to improve liaison with primary health care professionals. Compared with the base child guidance unit, at the health centre there was a better first attendance rate, a much higher proportion of referrals from health professionals especially general practitioners, and an increased proportion of younger children referred. If further follow-up was necessary at the child guidance unit the attendance rate was very good. The service provided, although not reducing the need for a main multidisciplinary base, offered an acceptable and accessible opportunity for children with psychological problems to be assessed and treated, and for the referring professionals to have easy communication with the child psychiatrist.

Adolescent↗