[Student education in a laboratory for general practice skills]. / Studentundervisning i allmennmedisinsk ferdighetslaboratorium.

Clinical skills, like questioning and examining a patient, are developed gradually throughout the years of medical training. Basic skills should be mastered on graduation, but the teaching of skills in most medical schools is not systematic. We evaluated a pilot teaching project in a general practice (GP) skills laboratory. Students were randomised to an intervention group and a control group. Teaching was performed in small groups of one GP instructor and six students and consisted of four weekly three-hour sessions. For the control group, teaching was delayed until after evaluation. Evaluation of practical skills and communication skills was made with the students in random order by GP evaluators who did not know about the randomisation procedure. Each skill was scored as satisfactory or not satisfactory for each of five procedural elements. 56 fourth-year medical students volunteered. Evaluation was performed for 19 (68%) students in the training group and 18 (64%) in the control group. The training group performed better on practical skills, average score 9.7 (95% confidence interval 7.4 to 12.1) vs. 5.5 (3.2 to 7.8), (p = 0.01). There was no significant difference for communication skills, 7.7 (5.6 to 9.8) vs. 6.7 (4.6 to 8.7). Teaching clinical skills in a general practice skills laboratory is feasible. Practical skills may improve rapidly, at least for short-time performance, while our brief teaching in communication skills was not proved to be effective.

[A new minimally invasive surgical method for stress incontinence in women]. / Ny og minimalt invasiv operasjonsmetode ved stressinkontinens hos kvinner.

Present surgical methods in the treatment of female urinary incontinence require relatively extensive surgery and several days in hospital. 84 consecutive patients (age 34-78 years) with proven stress incontinence were operated with the new tension-free vaginal tape procedure (TVT) and studied prospectively from November 1996 to August 1998. The operation was carried out under local anaesthesia, a procedure which allows the surgeon to check during the operation that continence is achieved. 52 patients (62%) were discharged from the hospital the same day. After four months, 79 out of 82 patients (96%) were cured or had improved considerably. No serious complications occurred. Four patients experienced various degrees of retention. The tension-free vaginal tape method seems to be an effective minimal invasive surgical procedure for the treatment of female stress incontinence. However, randomized controlled studies and long term follow-up are needed for a more complete evaluation of its merits versus the Burch colposuspension which is considered the "gold standard".

[Professional conditions and satisfaction in general practice in 1993. Practice profile of Norwegian primary physicians]. / Faglige vilkår og tilfredshet i allmennpraksis i 1993. Norske primaerlegers praksisprofil.

European study of General Practice (GP) task profiles was carried out in 30 European countries in 1993. We analyzed the Norwegian results. 164 primary care physicians, 51% of a random sample, answered a questionnaire. 147 kept a diary on their practice for one week. Compared with results from two earlier studies performed 15 years ago, the proportion of female GPs had doubled to 25%, there were more group practices, more time was spent on vocational training and continuous education, and night service was less frequent than in 1978. 45% were specialists in general practice and 7% in community medicine. Job satisfaction was high, and highest for women, fee-for-service GPs on contract, and GPs who cooperated with other health professionals.

[Working hours and productivity of curative services in general practice in 1993. Practice profile of Norwegian primary physicians]. / Arbeidstid og produksjon av kurative tjenester i allmennpraksis i 1993. Norske primaerlegers praksisprofil.

In a survey of task profiles in General Practice 164 general practitioners (GPs) in Norway, 51% of a random sample, answered a questionnaire and 147 doctors also kept a diary on their practice for one week, specifying their activities throughout the day. Men reported working more hours per week than women, and practitioners working on a fee-for-service basis had more consultations than colleagues on a fixed salary. Fixed salary GPs spent more time on emergency service. More women than men had part time jobs. The number of GPs has doubled from 1978 to 1993, but the total workload for a GP is approximately the same. The population must have doubled its consumption of primary health care services over this 15 year period.

[Priorities in community nursing services to the elderly--do we assist those who need it most? A study from the Northern district of Bodø]. / Prioritering av hjemmesykepleie til eldre--yter vi hjelp der behovet er størst?

We wanted increased insight into what factors are important for old people's ability to take care of themselves without assistance from the community nursing service. We compared a group of clients and a matched control group, each counting 40 persons. A structured interview was conducted during one home visit to each person. The questions dealt with health conditions, social factors and physical surroundings. The control group showed less functional disability, used fewer drugs and considered their own health to be better than the client group did. The control group said they had visitors more often. Both groups had a shortage of technical remedies for improving everyday functions. Untreated depression was diagnosed in both groups. The study shows that failing health, particularly in relation to functional disability, is the main factor for selection for community nursing service in the area of study.

[Air pollution, eczema and asthma in Sør-Varanger. Is the high consumption of corticosteroid ointments caused by increased tendency for eczema?]. / Luftforurensning, eksem og astma i Sør-Varanger. Skyldes høyt forbruk av kortikosteroidsalver øket eksemtendens?

Many investigations suggest that a high degree of air-borne pollution increases the prevalence of diseases like asthma and eczema. Sør-Varanger Municipality in Finnmark County in the north of Norway receives much air-borne pollution from domestic industry and from the metallurgic industry on the Kola peninsula in North-Western Russia. We have investigated indirect parameters of morbidity caused by asthma and eczema by analyzing data on drug consumption and hospital admissions. In Sør-Varanger there is high consumption of corticosteroids for dermatological use. Consumption of anti-asthmatic drugs and number of admissions to hospital for asthma and eczema were no higher than expected. We suspect that air-borne pollution, particularly the heavy metal nickel, increases the prevalence and perhaps worsens the degree of eczema in Sør-Varanger.

Patients with sexually transmitted disease: a well-defined HIV risk group in general practice?

Since patients with sexually transmitted disease (STD) form the most apparent risk group for HIV infection in general practice, differences in sexual behaviour in patients with and without STD were studied. Patients fulfilling at least one of four clinical criteria for suspicion of STD were offered four microbiological tests and a serological HIV test and were asked to complete a questionnaire concerning possible HIV exposure. Control patients were selected from a sample of ordinary consulting patients in general practice, without clinical suspicion of STD. The answers to the questionnaires given by six male and 52 female patients with a positive microbiological test for STD were compared with answers given by control patients matched for sex, age, education and geographical region. Females with STD had multiple male partners more often than controls. STD patients were more uncertain whether they had had sex with a HIV-positive person, and they reported more previous gonorrhea than the control patients. The proportion of patients who reported practicing oral sex was the same in both groups, while data for anal sex were insufficient. There were no significant differences in the use of condoms with a new partner, although there was a higher proportion of never-users of condoms among the STD patients. Identifying STD patients on clinical grounds is difficult in general practice. Clinical criteria have limited sensitivity because of asymptomatic infections, and the specificity is low. Patients with microbiologically confirmed STD should receive HIV-related attention, but attention to STD patients alone is not enough. Many people without STD have sexual behaviour which may exposure them to the HIV virus. The only means to a selective approach is increased attention to an appropriate sexual medical history.

Inter-observer variation on registration of signals of cancer.

Previous studies have dealt with the role of seven warning signals of cancer in public health education and cancer diagnostics in general practice. Registrations of warning signals from medical records have some inconveniences common to most retrospective record studies. In the present inter-observer variation study it is found that agreement is good for warning signals in cancer patients when the warning signal has a probable connection with the disease. In control patients, and for more incidentally occurring warning signals in cancer patients, agreement is not so good. It seems that reproducible registrations from records are possible when there is a precise definition of what to look for and the data are relevant to the patient's disease. This study stresses the importance of good record keeping in medical practice.

The value of warning signals of cancer in general practice.

Seven warning signals of cancer are poor diagnostic indicators of cancer, but for some patients awareness of warning signals may help reducing diagnostic delay. The usefulness of warning signals recorded by general practitioners at consultation is evaluated for a group of 80 patients who developed cancer 0-18 months after the consultation. Warning signals of cancer were recorded at the consultations in 20 cancer patients and in 13 matched control patients. For three cancer patients the warning signal was considered not related to the cancer. Recognition of warning signals related to the cancer disease was considered useful for nine out of 17 patients, somewhat useful for five and hardly useful at all for three patients.