Increased knowledge makes a difference! – general practitioners’ experiences of pictorial information about subclinical atherosclerosis for primary prevention: an interview study from the VIPVIZA trial

ObjectivesTo explore how pictorial information on subclinical atherosclerosis affects GPs’ perception of patient cardiovascular disease (CVD) risk, their communication with patients, and GPs’ attitude to the treatment of CVD risk factors.Design, setting and subjectsFifteen individual interviews were conducted between March 2014 and December 2016, with GPs who had received pictorial information regarding their patients’ subclinical atherosclerosis. The pictorial information was also received by the patients together with written information regarding atherosclerosis and CVD risk prior to the appointment with their GP. The interviews were recorded, transcribed and analyzed using qualitative content analysis.ResultsThree categories were identified in the analysis. Increased knowledge makes a difference: When patients had more in-depth knowledge regarding atherosclerosis, the consultation became more patient-centered and moved towards shared decision making. This is real, not just a number: GPs described their risk assessment and the patient’s risk perception as more accurate with pictorial information about subclinical atherosclerosis. How to deal with the result – A passive to active approach: Some GPs acted promptly on the pictorial information while others took no action.Conclusion and implicationsPictorial information regarding patients’ subclinical atherosclerosis affected GPs’ assessment of CVD risk. The communication shifted towards shared decision-making although the GPs’ attitude to the result and treatment of CVD risk factors varied. Informing patients about examination results, both in writing and pictures, prior to a consultation can facilitate shared decision making and enhance preventive measures.Trial registrationhttps://clinicaltrials.gov/ct2/show/{"type":"clinical-trial","attrs":{"text":"NCT01849575","term_id":"NCT01849575"}}NCT01849575.

KEY POINTS

• Providing pictorial information about carotid ultrasound results and information regarding atherosclerosis to GPs and patients affects primary prevention:
• •Informing patients about examination results prior to a consultation can be useful in clinical practice to enhance preventive measures
• •GPs experienced that increased patient knowledge resulted in a more patient-centered consultation and improved shared decision-making
• •GPs described their risk assessment and patients’ risk perception as more accurate with pictorial information about subclinical atherosclerosis

     

Prevalence of urinary incontinence among women at a Swedish primary health care centre

Information on urinary incontinence was obtained by means of a questionnaire from women visiting a Swedish health centre. Among women aged 18 and above, 44% stated that they had urinary incontinence. About one-third of these women reported stress incontinence, one-third urge incontinence, and one-third both. Urinary incontinence was more prevalent with increasing age and was more common among women who had given birth to children, in overweight women, in women taking diuretics, and in women with some defined diseases. Of those with incontinence, 13% stated that it impaired their work and 28% that it impaired leisure activities. Many of them had not asked for medical help for the symptom. It is important to emphasize the high prevalence of the symptom, and even more important to increase our knowledge of how best to take care of these women.     

Release of interleukin-10 by reinfusion of salvaged blood after knee arthroplasty

OBJECTIVES: To determine whether the method of the autotransfusion in association with knee arthroplasty leads to differences in anti-inflammatory cytokines in the patient's circulation. DESIGN AND SETTING: Prospective study in a university hospital. PATIENTS: Twenty-one patients undergoing knee arthroplasty were randomized into two groups assigned to postoperative blood salvage. Seven patients received postoperatively filtered salvaged blood, and seven received centrifuged and washed salvaged blood. Patients with postoperative blood loss less than 400 ml (n=7) did not receive any transfusion. MEASUREMENTS AND RESULTS: Plasma levels of interleukin (IL) 1beta, IL-4, and IL-10 and of polymorphonuclear leukocyte elastase were measured by enzyme-linked immunosorbent assay. The plasma concentration of IL-10 was elevated after reinfusion of salvaged blood in all groups 1 day after surgery (p<0.05). Plasma IL-6, IL-10, and PMN elastase was higher (p<0.01) in all groups 1 day after surgery than preoperatively. There were significantly higher plasma levels 1 min after retransfusion of IL-6 (p<0.01) and IL-10 (p<0.05) in patients receiving filtered blood than in those receiving centrifuged and washed salvaged blood. CONCLUSION: Total knee arthroplasty results in the release of interleukin-10. Transfusion of filtered salvaged blood leads to higher levels of cytokines IL-6 and IL-10 than after transfusion of washed and centrifuged salvaged blood.     

Brain serotonin metabolism and behavior in rats with carbon tetrachloride-induced liver cirrhosis

Increased brain serotonin metabolism has been suggested as an etiologic factor in the development of portal-systemic encephalopathy (PSE) in connection with liver disease. We therefore investigated brain serotonin metabolism and open-field behavior (spontaneous activity and exploration) in rats with carbon tetrachloride (CCl4)-induced liver cirrhosis. Brain serotonin metabolism was evaluated in rats pretreated with an amino acid decarboxylase inhibitor. The 5-hydroxyindoles were analyzed by high-performance liquid chromatography (HPLC) with electrochemical detection. The results revealed an increased serotonin synthesis rate in all investigated brain regions in rats with histologically verified diffuse micronodular cirrhosis of the liver. Slightly impaired open-field behavior (i.e., decreased spontaneous activity) in the cirrhotic rats could not be excluded. However, the elevated brain serotonin synthesis rate could not be correlated to any abnormalities in open-field behavior.     

Lifestyle changes after a health dialogue. Results from the Live for Life health promotion programme

OBJECTIVE: To evaluate the effect of a health dialogue on lifestyle habits, and to relate the lifestyle changes to changes of biological risk markers for ischaemic heart disease. DESIGN: Cross-sectional study, intervention and follow-up. SETTING: The community of Habo, population 9500, located in Skaraborg, Sweden. PATIENTS: All 35-year-old inhabitants in Habo were invited to a health examination during a study period between 1989 and 1992. A community intervention programme was combined with a health examination consisting of a health dialogue with a specially trained nurse and use of a "health curve" as an educational tool. The effect of the health examination was examined by comparing baseline characteristics of participants in 1989-1992 with their follow-up data in 1993. RESULTS: Participants in the health dialogue who were re-examined reported lifestyle improvements including less smoking, decreased dietary fat intake and increased physical activity. Those who reported improved dietary intake and increased physical activity improved their biological risk markers correspondingly (body mass index, waist to hip ratio, serum cholesterol concentration). CONCLUSIONS: The combination of a community and an individually based health programme can be effective with respect to lifestyle variables and, in those improving their lifestyle, in biological risk markers.     

Antibodies to Rift Valley fever virus in Swedish U.N. soldiers in Egypt and the Sinai

Swedish United Nations Emergency Forces soldiers serving in Egypt and the Sinai peninsula were serologically tested for hemagglutination-inhibiting antibodies to Rift Valley fever (RVF) virus. Eight of 170 were positive. RVF has not been reported outside Africa, and a survey of 500 Swedish soldiers who had not served in the Middle East or Africa revealed no RVF virus antibodies. There were extensive RVF epidemics in Egypt in 1977 and 1978, and it is considered that these serologically positive soldiers contracted RVF disease while on duty in the Middle East.     

Patient contributions during primary care consultations for hypertension after self-reporting via a mobile phone self-management support system

Objective: This paper reports on how the clinical consultation in primary care is performed under the new premises of patients’ daily self-reporting and self-generation of data. The aim was to explore and describe the structure, topic initiation and patients’ contributions in follow-up consultations after eight weeks of self-reporting through a mobile phone-based hypertension self-management support system.

Design: A qualitative, explorative study design was used, examining 20 audio- (n?=?10) and video-recorded (n?=?10) follow-up consultations in primary care hypertension management, through interaction analysis. Clinical trials registry: ClinicalTrials.gov NCT01510301.

Setting: Four primary health care centers in Sweden.

Subjects: Patients with hypertension (n?=?20) and their health care professional (n?=?7).

Results: The consultations comprised three phases: opening, examination and closing. The most common topic was blood pressure (BP) put in relation to self-reported variables, for example, physical activity and stress. Topic initiation was distributed symmetrically between parties and BP talk was lifestyle-centered. The patients’ contributed to the interpretation of BP values by connecting them to specific occasions, providing insights to the link between BP measurements and everyday life activities.

Conclusion: Patients’ contribution through interpretations of BP values to specific situations in their own lives brought on consultations where the patient as a person in context became salient. Further, the patients’ and health care professionals’ equal contribution during the consultations showed actively involved patients. The mobile phone-based self-management support system can thus be used to support patient involvement in consultations with a person-centered approach in primary care hypertension management

• Key points

• The clinical consultation is important to provide opportunities for patients to gain understanding of factors affecting high blood pressure, and for health care professionals to motivate and promote changes in life-style.

  • This study shows that self-reporting as base for follow-up consultations in primary care hypertension management can support patients and professionals to equal participation in clinical consultations.

  • Self-reporting combined with increased patient–health care professional interaction during follow-up consultations can support patients in understanding the blood pressure value in relation to their daily life.

  • These findings implicate that the interactive mobile phone self-management support system has potential to support current transformations of patients as recipients of primary care, to being actively involved in their own health.

     

Fasting serum insulin concentration and early insulin response as risk determinants for developing diabetes

Among a cohort of 348 women aged 50 on entering a 12-year prospective study, the incidence of diabetes was increased (17.1%) during follow-up in those who initially had fasting glucose concentration above the upper quintile, a fasting serum insulin concentration above the upper quintile (14.9%), a disappearance rate of glucose below the lowest quintile in an IV glucose tolerance test (12.7%), or early insulin response below the lowest quintile (17.1%). The incidence in all women was 4.9%. By multivariate analysis, the highest risk was for high fasting serum insulin concentration. Obesity and treatment with antihypertensive drugs further increased the risk. An initial low early insulin response was not however a prerequisite for the development of manifest diabetes. Determination of fasting insulin concentration, especially in overweight hypertensive subjects, is of value in order to find out which subjects are at high risk of developing diabetes.