Antibiotic resistance is a problem in nursing homes. Presumed urinary tract infections (UTI) are the most common infection. This study examines urine culture results from elderly patients to see if specific guidelines based on gender or whether the patient resides in a nursing home (NH) are warranted.
This is a cross sectional observation study comparing urine cultures from NH patients with urine cultures from patients in the same age group living in the community.
There were 232 positive urine cultures in the NH group and 3554 in the community group. Escherichia coli was isolated in 145 urines in the NH group (64%) and 2275 (64%) in the community group. There were no clinically significant differences in resistance. Combined, there were 3016 positive urine cultures from females and 770 from males. Escherichia coli was significantly more common in females 2120 (70%) than in males 303 (39%) (p?
Cites: Intern Med J. 2012 Jul;42(7):e157-6421241444
BACKGROUND: Back pain is a major health problem and the most important disorder associated with sickness absence. This report presents experiences from a back pain outpatient clinic. MATERIAL AND METHODS: We collected demographic data, diagnoses on the referrals (ICPC) and in the outpatient clinic (ICD-9) and recommendations given to 206 patients, referred 1 January to 30 April 1998. RESULTS: 41% were women (mean age 45), 59% men (mean age 44). Mean waiting time before appointment was 35 days compared to 49 days before the clinic was opened. 43% were prioritized for an appointment within two weeks; mean waiting time in this group was 16 days. 125 (63%) of 200 were referred with non-specific low back pain. Of these, 99 (79%) were given the same diagnosis in the clinic. 75 (37%) had a referral diagnosis of lumbar disk injury with radiation, of whom 46 (61%) were diagnosed with lumbar nuclear prolapse or lumbar spinal stenosis in the clinic. INTERPRETATION: An outpatient clinic may be a useful way to organise the specialist health service system for back pain patients.
STUDY DESIGN: A 2-year follow-up study of patients with back disorders certified as sick. OBJECTIVES: To identify predictors of return to work. SUMMARY OF BACKGROUND DATA: Back disorders are common health problems and the most important disorders associated with absence from work in the welfare states. Predictors of future absence may be of help in allocating rehabilitation efforts to such patients. Possible predictors include demographic and medical factors, the patients' functional status, and former absence. METHODS: For this study, 190 patients certified as sick who attended a back disorder outpatient clinic from September 1997 to December 1998 answered a questionnaire. Demographic data, medical factors, self-assessed function, and absence data were recorded. Return to work, defined as returning to work for at least 60 consecutive calendar days, was used in Cox regression analyses. RESULTS: According to multiple Cox regression analyses, age of 40 to 49 years (HR, 0.52; 95% confidence interval [95%CI], 0.29-0.94), high pain intensity (HR, 0.30; 95%CI, 0.17-0.55), low self-assessed work ability (HR, 0.43; 95%CI, 0.25-0.73), and a self-predicted absence status of not returning to work (HR, 0.31; 95%CI, 0.17-0.54) predicted longer time until return to work. Back disorders with radiation predicted shorter time until return to work (HR, 2.08; 95%CI, 1.37-3.16). The COOP/WONCA chart's physical fitness, daily activities, overall health, and change in health were associated with time until return to work in univariate analyses only, as was the duration of the sickness certification episodes from start to inclusion and the degree of sickness certification at inclusion. CONCLUSIONS: Information about the age of the patients, diagnoses, pain intensity, self-assessed work ability, and self-predicted absence status may be used as predictors of time until return to work in patients with back disorders certified as sick who attend a back disorder outpatient clinic.
Borreliosis is a bacterial infection transferred by tick-bites. Neuroborreliosis is the most frequent disseminated form of the disorder in Norway. Registers exist in Norway on all reported communicable diseases (The Norwegian Surveillance System for Communicable Diseases [MSIS]) and disability pension diagnoses (The Norwegian Directorate of Labour and Welfare).
Geographic distributions of borreliosis and changes over time are presented. Disability pensions (coded by International Classification of Diseases [ICD]) in the period 1998-2005, in which borreliosis was used as the primary or secondary diagnosis (ICD-10), were compared with MSIS-data for borreliosis on municipal and county levels.
Borreliosis was the cause of disability pensions in 55 cases. The Vestfold and Agder counties had the highest number of cases. Larvik municipality had 9 cases, Arendal had four and Kristiansand had nine cases. The annual rates of new disability pensions caused by borreliosis were low but increasing in the period 1998-2005. The disability pension rates tended to reflect changes in the number of MSIS-reported cases, with pensions changing 1-2 years after MSIS-changes. Most MSIS-reported cases are in the Agder and Telemark counties.
Disability pension are rarely caused by borreliosis. The annual incidence of disability pensions seems to reflect the number of MSIS-reported cases of borreliosis. The Agder and Vestfold counties have the highest incidence.
BACKGROUND: Doctors' ability to predict the duration of their patients' certified sickness absence is important for follow-up efforts aimed at patients with increased probability of long-term absence. OBJECTIVES: The aim of this study was to examine the accuracy of doctors' predictions of their patients' sickness absence status 4 weeks ahead, and which factors were associated with it. METHODS: A questionnaire survey was carried out in primary health care concerning 796 patients certified sick within 140 days after the start of absence. The episodes of absence were labelled short-standing (up to 2 weeks) and long-standing (from 3 to 20 weeks), at the time of consultation. The doctors' prediction of the patients' absence status 4 weeks ahead, diagnoses, work ability, clinical information sources used and the presence of non-medical factors that could have influenced the doctors' work ability assessments were collected. The predictions were compared with the patients' absence status 4 weeks later by positive predictive values (PPVs) for the statements 'returned to work' and 'still certified sick'. Factors associated with the accuracy of the predictions were analysed by multiple logistic regression analyses. RESULTS: The doctors accurately predicted return to work in 84% [95% confidence interval (CI) 79-87] of the cases in short-standing episodes, and in 53% (43-62) in long-standing episodes. The corresponding PPVs for still certified sick were 72% (62-80) and 91% (85-94). In short-standing episodes, the doctors' probability of making accurate predictions was higher for respiratory disorders [odds ratio (OR) 2.84; 95% CI 1.36-5.90], than for the reference category 'all other disorders', and lower for mental disorders (0.46; 0.24-0.89). In long-standing episodes, the probability was lower for musculoskeletal disorders (0.33; 0.12-0.86) and injuries (0.12; 0.03-0.48). Neither the age nor gender of patients or doctors, nor the degree of work ability reduction, nor other factors were associated with the accuracy of the predictions. CONCLUSIONS: The doctors' predictions were highly accurate for return to work in short-standing episodes, and for still certified sick in long-standing episodes. Diagnoses were associated with the accuracy; other factors, including the doctors' work ability assessments, were not.
We wanted to examine how many of our patients with elevated serum ferritin had undetected haemochromatosis.
Searches in our patient files showed that 519 persons aged 20-70 had tested positively for elevated serum ferritin over the five-year period 1996-2000. 379 of these (73%) were found suitable for follow up and were offered examination for serum ferritin and transferrin saturation. 291 of these (77%) came in. Patients with elevated transferrin saturation had a gene test for haemochromatosis.
23 of the 291 persons with elevated serum ferritin also had elevated transferrin saturation (8%). 12 out of 23 (52%) were homozygote for the haemochromatosis mutation C282Y.
In our opinion, persons with elevated serum ferritin should be offered a control of serum ferritin and transferrin saturation. If both these tests show elevated levels, a gene test for haemochromatosis should be performed. Persons who are homozygote for the haemochromatosis mutation should have a follow up with testing of serum ferritin with some years' intervals in order to secure that venesection is started in due time.
The first stage of Lyme borreliosis (LB) is mainly the typical skin lesion, erythema migrans (EM), which is estimated to comprise 80-90% of all LB cases. However, the reporting of, and the actual incidence of LB varies throughout Europe. Studies from Sweden and Holland have found EM incidences varying from 53 to 464 EM/100,000 inhabitants/year. Under-reporting of LB is common and a coefficient of three to reach a realistic estimate is suggested. In Norway, it is mandatory to report only the second and third LB stages to the National Institute of Public Health. To find the Norwegian incidence of EM, we extracted data from the electronic medical records of regular general practitioners and out-of-hours services in the four counties with the highest rates of registered LB in the 5 years from 2005 to 2009. We found an EM incidence of 448 EM/100,000 inhabitants/year in these counties, which yields a national incidence of 148 EM/100,000 inhabitants/year. Our findings show that solitary EMs comprised almost 96% of the total LB incidence in Norway. Older females have the highest rates of EM. Phenoxymethylpenicillin is the most commonly used drug to treat EM in Norway, which complies with the national guidelines for antibiotic use. Antibody tests are performed in 15% of cases. Less than 1% of patients are referred to secondary care. The study also shows a high number of patients seeking care for tick bites without signs of infection and there is an overuse of antibiotics in these patients.
According to Norwegian guidelines for antibiotic use in primary care, ciprofloxacin is reserved for complicated urinary tract infections (UTI). Despite these recommendations, ciprofloxacin use has increased in Norway in recent years. We aimed to reduce inappropriate ciprofloxacin prescribing in the emergency department.
An intervention study was performed by removing ciprofloxacin from the local antibiotic formulary and including a suggestion list for antibiotic use with all point of care urine dipstick testing in an emergency department. An emergency department in the neighbouring county served as the control. Prescriptions for UTI were registered 1 y prior to and 1 y after the intervention.
In the targeted emergency department, there was a significant (p
There is controversy about chronic health consequences of tick-borne infections, especially Lyme borreliosis. This study aims to assess whether general function, physical fitness and subjective health complaints are associated with tick bites or antibodies to Borrelia burgdorferi sensu lato in blood donors.
Sera from 1,213 blood donors at four different blood banks in Sogn and Fjordane county in western Norway were obtained during January to June 2010, and analysed for specific IgG and IgM antibodies. A questionnaire including questions on tick bites, subjective health complaints, general function and physical fitness was completed.
Tick bites had been experienced by 65.7% of the study population. 78 (6.4%) were positive for IgG (9.7% in men, 2.4% in women), and 69 (5.7%) for IgM (6.1% in men, 5.1% in women), verified by immunoblot. No association between number of experienced tick bites or seropositivity for Borrelia antibodies and subjective health complaints, reduced general function or reduced physical fitness was found.
The results do not support any association between tick bites or Borrelia antibodies and subjective health complaints in blood donors in an endemic area for Lyme borreliosis.
Cites: Scand J Public Health. 2002;30(1):20-911928829
Promptly treated erythema migrans (EM) has good prognosis. However, some patients report persistent symptoms. Do patients with EM have more symptoms than the general population? We describe individual symptoms and general function in EM-patients at time of diagnosis and one year after treatment.
Prospective study with 1-year follow up after treatment. Questionnaires included a modified version of the Subjective Health Complaints Inventory, comprising three additional Lyme borreliosis (LB) related symptoms. General function was assessed using a five-point scale modified from the COOP/WONCA charts.
Norwegian general practice.
A total of 188 patients were included in a randomized controlled trial comparing three antibiotic regimens for EM, of whom 139 had complete data for this study.
Individual symptoms, symptom load and general function.
Mild symptoms were common, reported by 84.9% at baseline and by 85.6% at follow-up. At baseline, patients reported a mean of 5.4 symptoms, compared with 6.2 after one year. Severely bothersome symptoms and severely impaired general function were rare. Tiredness was the most reported symptom both at baseline and at follow-up. Palsy (other than facial) was the least reported symptom, but the only one with a significant increase. However, this was not associated to the EM.
The symptom load was comparable to that reported in the general population. We found an increase in symptom load at follow-up that did not significantly affect general function.
Monitoring patients' symptom loads prior to treatment reduce the probability of attributing follow-up symptoms to LB. Key points Erythema migrans has a good prognosis.Patients treated for erythema migrans have a slight increase in symptom load one year after treatment. This increase does not affect general function. The levels of subjective health complaints in patients treated for erythema migrans are comparable to the background population.
Cites: N Engl J Med. 2007 Oct 4;357(14):1422-3017914043