RESUMEN
OBJECTIVES: The aim of this study was to investigate the effectiveness of an ergonomic intervention on productivity loss at work caused by upper-extremity disorders (UED). METHODS: Workers with medically verified UED were invited to participate. The intervention consisted of a physician contacting the worker's supervisor and an occupational physiotherapist conducting an ergonomic assessment at the worksite. Before and after the intervention, the employees self-assessed UED-related productivity loss (ie, decreased quality and quantity of the daily work output). We tested for differences between groups at 8 and sub-sequently 12 weeks. We also applied generalized estimating equation (GEE) to analyze repeated measures data. RESULTS: Altogether 177 employees were randomized. The overall participation rate was 88%. At baseline, 54% of the intervention group and 58% of the control group reported productivity loss. The magnitude of productivity loss was 17% and 20%, respectively. At 8 weeks, both the proportion and magnitude of productivity loss were lower in the intervention than the control group, but the differences were statistically significant only at 12 weeks (proportion 25% versus 51%, magnitude 7% versus 18%, P=0.001 for both). Using GEE analyses, we also found the differences to be statistically significant (proportion 38% versus 52%, magnitude 12% versus 18%). The intervention only benefitted employees with 0-20% loss of productivity at baseline, not those with a higher initial productivity loss. CONCLUSIONS: Early ergonomic intervention, in addition to adequate medical care, is effective in preventing and restoring self-reported productivity loss associated with UED.
Asunto(s)
Traumatismos del Brazo/terapia , Trastornos de Traumas Acumulados/terapia , Ergonomía , Enfermedades Musculoesqueléticas/terapia , Enfermedades Profesionales/terapia , Adulto , Eficiencia , Femenino , Humanos , Masculino , Persona de Mediana Edad , Resultado del Tratamiento , Adulto JovenRESUMEN
OBJECTIVE: Upper extremity disorders (UED) are prevalent in working populations. This study investigates the prevalence, magnitude, and associated factors of on-the-job productivity loss among workers with UED. METHODS: Workers with incipient upper extremity symptoms were invited to participate in our study after the disorder was verified by a physician and no immediate sick leave was required. Of the 177 eligible patients, 168 (95%) were included in the study. They were asked to describe their symptoms, personal characteristics, and work-related factors. Self-assessed productivity measured the impact of UED on the achieved work output. RESULTS: Of the 168 participants, 56% reported a productivity loss; the average reduction thereof was 34%. Productivity loss was associated with pain intensity [odds ratio (OR) for the third tertile 2.8, 95% confidence interval (95% CI) 1.2-6.5], pain interference with work (OR for the third tertile 5.7, 95% CI 2.2-14.3) and fear-avoidance beliefs (OR 2.8, 95% CI 0.9-8.9). Pain interference with sleep was associated with productivity loss only among those aged 46 years or older, whereas high job strain showed an association with productivity loss only among workers aged 20-45 years. In the younger group, productivity loss was more associated with a combination of any two of the following three factors than the presence of only one: pain intensity, job strain, and physical loads at work. CONCLUSIONS: UED cause substantial loss of productivity at work. The most important associated factors are related to pain and its impact on work and sleep, but also to psychological aspects of pain and work. Our findings suggest that the factors associated with productivity loss differ in younger and older workers.
Asunto(s)
Eficiencia , Enfermedades Musculoesqueléticas/complicaciones , Salud Laboral , Autorrevelación , Extremidad Superior/patología , Adolescente , Adulto , Intervalos de Confianza , Estudios Transversales , Ergonomía , Femenino , Finlandia/epidemiología , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Enfermedades Musculoesqueléticas/epidemiología , Oportunidad Relativa , Postura , Prevalencia , Encuestas y Cuestionarios , Adulto JovenRESUMEN
OBJECTIVES: To identify potential barriers and facilitators to implementing computerized decision support systems (CDSSs) in health care as perceived by clinicians. METHODS: We carried out a qualitative focus group study with primary and secondary health care settings in six areas of Finland. A total of 39 interviewed physicians, of whom 22 practised in primary care and 17 in secondary care. The main outcome measures physicians' expectations, preconceived barriers and facilitators were explicitly identified by the participants during the interviews. RESULTS: Identified barriers were earlier experience of dysfunctional computer systems in health care, potential harm to doctor-patient relationship, obscured responsibilities, threats to clinician's autonomy and potential extra workload due to excessive reminders. Identified facilitators were self-control of frequency and contents of CDSS and noticeable help of CDSS in clinical practice. It was easy for the physicians to think of applications and clinical topics for CDSS that could help them to avoid mistakes and improve work processes. CONCLUSIONS: Physicians had relatively positive attitudes towards the idea of CDSS. They expected flexibility, individuality and reliability of the CDSS. The rather high level of computerized practices and wide use of electronic guidelines probably have paved the way for the CDSS in Finland.
Asunto(s)
Actitud hacia los Computadores , Sistemas de Apoyo a Decisiones Clínicas , Difusión de Innovaciones , Médicos , Adulto , Femenino , Finlandia , Grupos Focales , Humanos , Entrevistas como Asunto , Masculino , Persona de Mediana EdadRESUMEN
BACKGROUND: Expert opinions vary on the appropriate role of antibiotics for sinusitis, one of the most commonly diagnosed conditions among adults in ambulatory care. OBJECTIVES: We examined whether antibiotics are effective in treating acute sinusitis, and if so, which antibiotic classes are the most effective. SEARCH STRATEGY: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, 2007, Issue 3); MEDLINE (1950 to May 2007) and EMBASE (1974 to June 2007). SELECTION CRITERIA: Randomized controlled trials (RCTs) comparing antibiotics with placebo or antibiotics from different classes for acute maxillary sinusitis in adults. We included trials with clinically diagnosed acute sinusitis, whether or not confirmed by radiography or bacterial culture. DATA COLLECTION AND ANALYSIS: At least two review authors independently screened search results, extracted data and quality assessed trials. Risk ratios (RR) were calculated for differences in the intervention and control groups to see whether or not the treatment was a failure. In meta-analysing the placebo-controlled studies, the data across antibiotic classes were combined. Primary outcomes were the clinical failure rates at 7 to 15 days and 16 to 60 days follow up. MAIN RESULTS: Fifty-seven studies were included in the review; six placebo-controlled studies and 51 studies comparing different classes of antibiotics. Five studies involving 631 participants provided data for comparison of antibiotics to placebo, when clinical failure was defined as a lack of cure or improvement at 7 to 15 days follow up. These studies found a slight statistical difference in favor of antibiotics, compared to placebo, with a pooled RR of 0.66 (95% confidence interval (CI) 0.44 to 0.98). However, the clinical significance of the result is equivocal, also considering that cure or improvement rate was high in both the placebo group (80%) and the antibiotic group (90%). Based on six studies, when clinical failure was defined as a lack of total cure, there was significant difference in favor of antibiotics compared to placebo with a pooled RR of 0.74 (95% CI 0.65 to 0.84) at 7 to 15 days follow up. None of the antibiotic preparations was superior to each other. AUTHORS' CONCLUSIONS: Antibiotics have a small treatment effect in patients with uncomplicated acute sinusitis in a primary care setting with symptoms for more than seven days. However, 80% of participants treated without antibiotics improve within two weeks. Clinicians need to weigh the small benefits of antibiotic treatment against the potential for adverse effects at both the individual and general population level.
Asunto(s)
Antibacterianos/uso terapéutico , Sinusitis Maxilar/tratamiento farmacológico , Enfermedad Aguda , Adulto , Ensayos Clínicos como Asunto , Humanos , Ensayos Clínicos Controlados Aleatorios como AsuntoRESUMEN
BACKGROUND: Primary-care physicians continue to overprescribe antibiotics for acute rhinosinusitis because distinction between viral and bacterial sinus infection is difficult. We undertook a meta-analysis of randomised trials based on individual patients' data to assess whether common signs and symptoms can be used to identify a subgroup of patients who benefit from antibiotics. METHODS: We identified suitable trials--in which adult patients with rhinosinusitis-like complaints were randomly assigned to treatment with an antibiotic or a placebo--by searching the Cochrane Central Register of Controlled Trials, Medline, and Embase, and reference lists of reports describing such trials. Individual patients' data from 2547 adults in nine trials were checked and re-analysed. We assessed the overall effect of antibiotic treatment and the prognostic value of common signs and symptoms by the number needed to treat (NNT) with antibiotics to cure one additional patient. FINDINGS: 15 patients with rhinosinusitis-like complaints would have to be given antibiotics before an additional patient was cured (95% CI NNT[benefit] 7 to NNT[harm] 190). Patients with purulent discharge in the pharynx took longer to cure than those without this sign; the NNT was 8 patients with this sign before one additional patient was cured (95% CI NNT[benefit] 4 to NNT[harm] 47). Patients who were older, reported symptoms for longer, or reported more severe symptoms also took longer to cure but were no more likely to benefit from antibiotics than other patients. INTERPRETATION: Common clinical signs and symptoms cannot identify patients with rhinosinusitis for whom treatment is clearly justified. Antibiotics are not justified even if a patient reports symptoms for longer than 7-10 days.
Asunto(s)
Antibacterianos/uso terapéutico , Sinusitis/tratamiento farmacológico , Enfermedad Aguda , Adulto , Antibacterianos/administración & dosificación , Esquema de Medicación , Humanos , Ensayos Clínicos Controlados Aleatorios como Asunto , Sinusitis/diagnóstico , Sinusitis/fisiopatología , Resultado del TratamientoRESUMEN
BACKGROUND: Shoulder pain is prevalent and a common cause of disability at work and daily activities. Some studies suggest an association between risk factors of atherosclerosis and shoulder pain and disorders. AIM: To assess associations between risk factors of atherosclerosis and shoulder pain or disorders and to discuss possible pathophysiological pathways for found associations. METHODS: A systematic review was conducted searching Medline until June 2006. Two authors extracted data and assessed quality independently using the Cochrane criteria for the assessment of quality in non-experimental studies with slight modifications. Due to heterogeneity of studies, meta-analysis was not possible. Results were summarized and discussed paying attention to study design and quality. RESULTS: Fifteen papers from 14 studies were included in the review. Diabetes was consistently associated with clinically defined shoulder disorders in population studies. Overweight or obesity was associated with the incidence of shoulder symptoms in three studies and with clinically defined shoulder disorders in one case control study. A few studies showed a preventive effect of physical exercise. Associations between smoking and shoulder disorders were seen only in studies on occupational populations. CONCLUSIONS: A consistent association between diabetes and shoulder disorders, some associations for weight-related factors as well as a possible preventive effect from physical exercise and sports suggest a metabolic pathophysiological process in shoulder disorders. More prospective studies using appropriate analytical methods are needed.
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Aterosclerosis/epidemiología , Dolor de Hombro/epidemiología , Diabetes Mellitus/epidemiología , Humanos , Factores de Riesgo , Manguito de los RotadoresRESUMEN
AIM: To describe return-to-work services for employees on sick leave offered by Finnish occupational health services (OHS). METHODS: Finnish OHS are surveyed every 3 years. Respondents are asked if they offer services to facilitate return to work (RTW), and if so, to describe them. The description was qualitatively analysed using the Atlas-ti programme to find the themes that best describe the services. We also studied characteristics of OHS predicting a return-to-work policy. RESULTS: Of the total sample of 969 occupational health units, 95% responded to the survey. Forty-one per cent reported offering services for facilitating RTW after sick leave. The service usually consisted of occupational physician examination of employees on sick leave for approximately 6 weeks. This was followed by a joint discussion between employee, physician and supervisor, which could result in work accommodation or a work trial period. There was a substantial variation, with only 10% mentioning a joint meeting and 13% mentioning a work trial period or work accommodation. Return-to-work policies were more frequently found in the OHS that served only a few employers, provided more group activities and collaborated more with employers and research institutes. CONCLUSION: Less than half of Finnish OHS offer return-to-work services of which the contents show wide variation that is not in line with current scientific evidence. A guideline project for return-to-work practices is needed to fill the gap. More research is needed to best define monitoring and screening practices for workers on sick leave.
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Empleo , Servicios de Salud del Trabajador/organización & administración , Finlandia , Humanos , Salud Laboral , Servicios de Salud del Trabajador/provisión & distribución , Política Pública , Investigación Cualitativa , Rehabilitación Vocacional , Ausencia por EnfermedadRESUMEN
We studied the use of symptomatic medication in the treatment of acute maxillary sinusitis (AMS) in primary care and whether this use is in accordance with national guidelines. The data was collected annually in the Antimicrobial Treatment Strategies (MIKSTRA) Program in 30 primary health care centres throughout Finland during one week in November in the years from 1998 to 2002. Physicians and nurses collected the data about the diagnoses, prescription-only medicines and over the counter medicines prescribed or recommended for all patients with an infection during the study weeks. The MIKSTRA data comprised of 23.002 first consultations for an infection: 2.448 patients were diagnosed as having AMS. Altogether, 41% of them received some symptomatic medicine. Antihistamines with or without sympathomimetics were the most commonly prescribed or recommended symptomatic medicines (23% of the patients). For comparison, systemic antibacterial agents were prescribed for 93% of the AMS patients. We conclude that Finnish physicians recommend or prescribe more symptomatic medication without proven efficacy for AMS than recommended by the national guidelines. Especially, the use of antihistamines with or without sympathomimetics, mostly the combination of acrivastine and pseudoephedrine, was common although antihistamines were recommended only for patients with allergy or nasal polyps.
Asunto(s)
Adhesión a Directriz , Sinusitis Maxilar/tratamiento farmacológico , Pautas de la Práctica en Medicina , Enfermedad Aguda , Adolescente , Adulto , Anciano , Niño , Femenino , Finlandia , Antagonistas de los Receptores Histamínicos H1/uso terapéutico , Humanos , Masculino , Persona de Mediana Edad , Atención Primaria de Salud , Simpatomiméticos/uso terapéuticoRESUMEN
BACKGROUND: Symptoms and health problems caused or aggravated by work are common. In order to study perceived work ability and associated factors, including those related to work, a closer analysis was undertaken in an occupational health setting. AIMS: This study aimed to analyse self-assessed work ability and its determinants in employees seeking medical advice, with special emphasis on work-related factors. METHODS: During 723 illness-related visits to occupational physicians, questionnaires covering personal data, main health problems, their work relatedness, duration and effect on work ability were completed by the employee and physician. Factors associated with self-assessed work ability were studied in a multinomial logistic regression model. RESULTS: The majority of employees considered themselves as being able or partially able to work despite the health problem. Independent predictors of impaired work ability were mental or musculoskeletal disorders, self-assessed work relatedness of the disease, older age, blue-collar work and short duration of the symptoms. If the patient was convinced about the benefits of work-related interventions, the risk for disability was significantly reduced. CONCLUSIONS: Special attention should be paid to the recognition and modification of potential work-related causes of disability. In addition, patients with partial work ability should be encouraged to stay at work instead of taking sick leave. For effective disability management, accommodated work and other evidence-based interventions are needed at the workplace.
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Enfermedades Profesionales/psicología , Servicios de Salud del Trabajador , Autoevaluación (Psicología) , Evaluación de Capacidad de Trabajo , Adulto , Actitud Frente a la Salud , Femenino , Finlandia/epidemiología , Humanos , Masculino , Persona de Mediana Edad , Enfermedades Profesionales/clasificación , Enfermedades Profesionales/epidemiología , Servicios de Salud del Trabajador/estadística & datos numéricosRESUMEN
Lumbar radicular pain is a fairly common health problem, yet its risk factors are far from clear. There are no published systematic reviews on associations between cardiovascular or lifestyle risk factors and lumbar radicular pain or sciatica. The aim of this systematic literature review was to assess associations between these risk factors and lumbar radicular pain or sciatica. We conducted a systematic search of the Medline database for all original articles on lumbar radicular pain or sciatica published until August 2006. Twenty-two papers from 19 studies were included in the review. Overweight or obesity was associated with sciatica in most of the case-control and cohort studies. Some studies showed an increased risk of lumbar radicular pain in smokers with a long smoking history or in those with high levels of physical activity. A few case-control studies showed an association between serum C-reactive protein and sciatica. No consistent associations were found for serum lipids levels or high blood pressure. In summary, the associations of overweight, long smoking history, high physical activity and a high serum C-reactive protein level with lumbar radicular pain or sciatica were substantiated by the present review. However, more prospective studies are needed in order to further clarify these associations and the mechanisms of action.
Asunto(s)
Enfermedades Cardiovasculares/epidemiología , Estilo de Vida , Dolor de la Región Lumbar/epidemiología , Radiculopatía/epidemiología , Ciática/epidemiología , Comorbilidad , Humanos , Dolor de la Región Lumbar/fisiopatología , Región Lumbosacra , Radiculopatía/fisiopatología , Factores de Riesgo , Ciática/fisiopatologíaRESUMEN
OBJECTIVE: Both clinical and epidemiologic studies have shown an association between atherosclerotic changes in the aorta or lumbar arteries and lumbar disc degeneration. However, the association between atherosclerosis and sciatica remains unknown. The aim of this study was to investigate the association between carotid intima-media thickness and sciatica. METHODS: The target population consisted of people aged 45 to 74 years, who had participated in a Finnish nationwide population study during the period 2000 to 2001 and lived within 200 km of the 6 study clinics. Of the 1867 eligible subjects, 1386 (74%) were included in the study. We used high-resolution B-mode ultrasound imaging to measure intima-media thickness, and local or radiating low back pain was determined by a standard interview and clinical signs of sciatica through a physician's clinical examination. RESULTS: Carotid intima-media thickness was associated with continuous radiating low back pain and with a positive unilateral clinical sign of sciatica among men only. After adjustment for potential confounders, each standard deviation (0.23 mm) increment in carotid intima-media thickness showed an odds ratio of 1.6 (95% confidence interval 1.1-2.3) for continuous radiating low back pain and 1.7 (95% confidence interval 1.3-2.1) for a positive unilateral clinical sign of sciatica. Carotid intima-media thickness was not associated with local low back pain. CONCLUSION: Sciatica may be a manifestation of atherosclerosis, or both conditions may share common risk factors.
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Arterias Carótidas/diagnóstico por imagen , Enfermedades de las Arterias Carótidas/diagnóstico por imagen , Enfermedades de las Arterias Carótidas/epidemiología , Ciática/epidemiología , Distribución por Edad , Anciano , Trastornos Cerebrovasculares/epidemiología , Diabetes Mellitus/epidemiología , Femenino , Finlandia/epidemiología , Cardiopatías/epidemiología , Humanos , Dolor de la Región Lumbar/epidemiología , Masculino , Persona de Mediana Edad , Oportunidad Relativa , Factores de Riesgo , Distribución por Sexo , Fumar/epidemiología , Túnica Íntima/diagnóstico por imagen , Túnica Media/diagnóstico por imagen , UltrasonografíaRESUMEN
OBJECTIVE: To investigate the role of hand dominance in common upper extremity musculoskeletal disorders (UEMSD) in a population study. METHODS: The target population consisted of a representative sample of people aged 30 years or older residing in Finland during 2000-2001. Of the 7977 eligible subjects, 6254 (78.4%) were included in the study. RESULTS: The prevalence of UEMSD was as follows: rotator cuff tendinitis 3.8%, bicipital tendinitis 0.5%, lateral epicondylitis 1.1%, medial epicondylitis 0.3%, carpal tunnel syndrome (CTS) 3.8%, and surgery due to CTS 1.3%. CTS was 2.5 times as prevalent in women as men, whereas the other UEMSD were as common in both sexes. Rotator cuff and bicipital tendinitis and medial epicondylitis were more prevalent in the dominant arm only in women, whereas lateral epicondylitis was more prevalent in the dominant elbow in both sexes. The higher prevalence of rotator cuff and bicipital tendinitis in the dominant side persisted beyond working age. The prevalence of CTS did not differ by hand dominance. Dominant hand had been operated more frequently for CTS in women. CONCLUSION: Our findings show that UEMSD are more prevalent in the dominant than nondominant arm mainly in women. For shoulder tendinitis, the difference persists throughout adult age. Physical load factors may have long-lasting effects on the shoulder and they may play a greater role in women than men.
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Lateralidad Funcional , Enfermedades Musculoesqueléticas/fisiopatología , Extremidad Superior/fisiopatología , Síndrome del Túnel Carpiano/fisiopatología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Músculo Esquelético/patología , Músculo Esquelético/fisiopatología , Enfermedades Musculoesqueléticas/patología , Factores Sexuales , Estrés Mecánico , Tendinopatía/patología , Tendinopatía/fisiopatología , Extremidad Superior/patología , Soporte de PesoRESUMEN
BACKGROUND: Management of acute maxillary sinusitis (AMS) is not optimal; antibiotics are often prescribed for viral sinusitis, which leads to many problems including those with antimicrobial resistance. Guidelines have been proposed as a means to change the professional practices. OBJECTIVE: Our aim was to study whether a nationwide guidelines implementation programme has an effect on the management of AMS in primary care. METHODS: A multi-centre randomized controlled trial was conducted in 30 health centres (HCs) covering a population of 819 777 people from 1998 to 2002. The participating HCs were randomized to implement guidelines either according to a problem-based learning (PBL) or an academic detailing (AD) method facilitated by local GPs. Data were gathered during 1 week in November in all study years and also from external control HCs in 2002. The main outcome measure was compliance with the key points of AMS management in national Current Care guidelines. RESULTS: Implementation of guidelines produced minor changes towards the recommended practices in the management of AMS. Use of the first-line drug amoxicillin increased slightly (from 39% to 48% in AD centres and from 33% to 45% in PBL centres, controls 40%). Proportion of courses of antibiotics with recommended duration increased in MIKSTRA study centres (from 34% to 40% in AD centres and from 32% to 47% in PBL centres, controls 43%). CONCLUSIONS: A nationwide guidelines implementation project produced modest changes in the management of AMS. There were no significant differences between AD and PBL education methods. Less than half the HCs were able to realize the project as intended, which decreases the internal validity of the study. The guidelines implementation might have benefited of more focussed targets and approaches that took into account the problems and practices of each HC.
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Medicina Familiar y Comunitaria , Sinusitis Maxilar/tratamiento farmacológico , Pautas de la Práctica en Medicina/normas , Enfermedad Aguda , Antiinfecciosos , Farmacorresistencia Microbiana , Finlandia , Guías como Asunto , Humanos , Sinusitis Maxilar/virología , Medicina EstatalRESUMEN
OBJECTIVES: Acute otitis media (AOM) is one of the most common diseases of childhood, representing a major disease burden on the society. New evidence-based guidelines for AOM, focusing on children under 7 years of age, were introduced in Finland in 1999. The aim of this study was to evaluate the cost-effectiveness of implementing those guidelines in Finland. METHODS: A 5-year prospective trial was conducted in thirty community primary healthcare centers in Finland. All AOM patients between 0 and 6 years of age visiting the study health centers for the first time, for this episode of illness, during 1 week in November 1998 (n = 579) and November 2002 (n = 369) were included in this study. The outcome measure was the percentage of symptom-free patients. RESULTS: The mean direct cost of an AOM episode per patient stayed almost the same after implementing the guidelines, euro152 in 1998 and euro150 in 2002. After implementing the guidelines, the percentage of symptom-free patients was 10 percentage points higher than before the guidelines. The treatment after the implementation of the guidelines, thus, was a dominant strategy. CONCLUSIONS: Implementing the guidelines to the treatment of AOM in children was associated with extra health benefits at slightly lower direct costs and, thus, is a dominant strategy. The focus of this study was on the short-term effects of the treatment; including long-term effects in the analysis might affect the results.
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Adhesión a Directriz/economía , Otitis Media/economía , Otitis Media/terapia , Guías de Práctica Clínica como Asunto , Enfermedad Aguda , Niño , Preescolar , Análisis Costo-Beneficio , Femenino , Finlandia , Costos de la Atención en Salud/estadística & datos numéricos , Humanos , Lactante , Masculino , Otitis Media/diagnósticoRESUMEN
Epicondylitis is a common disorder of the arm, yet the role of individual- and work-related factors has not been addressed in a population study. The aims of this study were to estimate the prevalence of lateral and medial epicondylitis and to investigate their risk factors. The target population of this study comprised a representative sample of people aged 30-64 years residing in Finland during 2000-2001. Of the 5,871 subjects, 4,783 (81.5%) were included in this study. The prevalence of definite lateral epicondylitis was 1.3%, and that of medial epicondylitis was 0.4%. The prevalence did not differ between men and women and was highest in subjects aged 45-54 years. Current smoking (adjusted odds ratio (OR) = 3.4, 95% confidence interval (CI): 1.4, 8.3) and former smoking (OR = 3.0, 95% CI: 1.3, 6.6) were associated with definite lateral epicondylitis. An interaction (p = 0.002) was found between repetitive movements of the arms and forceful activities for the risk of possible or definite lateral epicondylitis (for both repetitive and forceful activities vs. no such activity: OR = 5.6, 95% CI: 1.9, 16.5). Smoking, obesity, repetitive movements, and forceful activities independently of each other showed significant associations with medial epicondylitis. Epicondylitis is relatively common among working-age individuals in the general population. Physical load factors, smoking, and obesity are strong determinants of epicondylitis.
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Codo de Tenista/epidemiología , Codo de Tenista/etiología , Adulto , Distribución de Chi-Cuadrado , Trastornos de Traumas Acumulados/complicaciones , Trastornos de Traumas Acumulados/epidemiología , Femenino , Finlandia/epidemiología , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Obesidad/complicaciones , Obesidad/epidemiología , Vigilancia de la Población , Prevalencia , Factores de Riesgo , Fumar/efectos adversos , Fumar/epidemiología , Estrés MecánicoRESUMEN
Most treatment recommendations for acute otitis media favour active use of pain relief medication. These data comprised 3059 Finnish primary care acute otitis media patients. We found that 10.4% of the patients were prescribed or recommended analgesics, which is in contrast to treatment recommendations.
Asunto(s)
Analgésicos/uso terapéutico , Antibacterianos/uso terapéutico , Antiinflamatorios no Esteroideos/uso terapéutico , Otitis Media/tratamiento farmacológico , Dolor/tratamiento farmacológico , Pautas de la Práctica en Medicina , Enfermedad Aguda , Adolescente , Adulto , Niño , Preescolar , Recolección de Datos , Finlandia , Humanos , Lactante , Dolor/etiología , Atención Primaria de SaludRESUMEN
BACKGROUND: A national 5-year follow-up study of infection-specific antibiotic use in primary care was conducted to see if prescribing practices change after implementing new treatment guidelines. METHODS: The data were collected during 1 week of November each year from 1998 to 2002 from 30 health care centers that covered a total population of 819,777 persons and in 2002 from 20 control health care centers that covered a population of 545,098 persons. National guidelines for 6 major infections (otitis media, sinusitis, throat infection, acute bronchitis, urinary tract infection, and bacterial skin infection) were published in 1999-2000. Multifaceted interventions were performed by local trainers teaching his or her coworkers, supported by feedback and patient and public information. RESULTS: The 6 infections targeted for intervention, together with unspecified upper respiratory tract infection constituted 80%-85% of all infections. The proportion of patients who received prescriptions for antibiotics did not change significantly. However, use of first-line antibiotics increased for all infections, and the change was significant for sinusitis (P<.001), acute bronchitis (P=.015), and urinary tract infections (P=.009). Also, the percentage of antibiotic treatments prescribed for the recommended duration increased significantly. Correct prescribing for respiratory tract infections improved by 6.4 percentage units (P<.001). However, there was no statistically significant difference in performance between study and control health care centers at follow-up. CONCLUSIONS: Moderate qualitative improvements in antibiotic use were observed after multifaceted intervention, but prescribing for unjustified indications, mainly acute bronchitis, did not decrease. Obtained infection-specific information on management of patients with infections in primary health care is an important basis for planning targeted interventions in the future.