Positive impact on vitamin D related lifestyle of medical advice in pregnant Somali-born women and new mothers: a mixed method study in Swedish primary care.

BACKGROUND: A previous study showed that pregnant women/new mothers especially Somali-born and some Swedish-born had extremely low vitamin D levels and poor physical performance. Our study aimed to examine vitamin D related lifestyle, attitudes and behaviour before and after brief information about vitamin D, with special long-term focus on Somali-born women. METHODS: A cohort of 91 pregnant women/new mothers having serum hydroxyvitamin D (S-25-OHD) ≤ 50 nmol/L (n = 51 Somali-born with one third < 10 nmol/L of S-25-OHD) in primary health care in Sweden was targeted for intervention. Brief individual oral and visual information on vitamin D was given by doctors at baseline and after four and ten months. Questionnaires with ordinal scales on vitamin D related lifestyle of food, clothing, and outdoor activities were distributed on all occasions. Focus-group interviews with 15 women from the target-group were performed after two years. A Somali interpreter was available. RESULTS: Veiled clothing, indoor living, and a low intake of milk, cheese, and fatty fish were common in the target group. Consumption pattern had increased significantly among the Somali-born women at the four-month follow-up but declined to non-significant levels at the ten-month follow-up. The focus-group interviews showed improved understanding of vitamin D deficiency, symptoms and attitudes, but varying applied behaviours related to sun exposure. Sun exposure for the children and increased fish consumption was the most evident positive results. CONCLUSIONS: Vitamin D related lifestyle, attitudes and behaviour improved in a Somali-born group of pregnant women/new mothers with severe vitamin D deficiency. The preventive measures suggested in our study may have impact on public health in relation to bone and muscle strength and immunity especially in vitamin D deficiency risk groups. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02922803 . Date of registration: 28 September 2016.

A study of primary care physicians rating their immigrant patients' pain intensity.

BACKGROUND: Few studies focus on how physicians evaluate pain in foreign-born patients with varying cultural backgrounds. This study aimed to compare pain ratings [visual analogue scale (VAS) 0-100] done by Swedish primary care physicians and their patients, and to analyse which factors predicted physicians' higher ratings of pain in patients aged 18-45 years with long-standing disabling back pain. METHODS: The two physicians jointly carried out the somatic and psychiatric diagnostic evaluations and alternated as consulting doctor or observer. One-third of the consultations were interpreted. Towards the end of the consultations, the patients rated their pain intensity 'right now' (patients' VAS). After the patient had left, the two physicians independently rated how much pain they thought the patient had, without looking at the patient's VAS score. The mean of the two doctors' VAS values (physicians' VAS) for each patient was used in the logistic regression calculations of odds ratios (OR) in main effect models for physicians' VAS above median (md) with patient's sex, education, origin, depression, psychosocial stress and pain sites as explanatory variables. RESULTS: Physicians' VAS values were significantly lower (md 15) than patients' VAS (md 66; women md 73, men md 52). The ratings showed no significant association with whether the physician was acting as consultant or observer. The higher physician VAS was only predicted by findings of multiple pain sites. CONCLUSIONS: Physicians appear to overlook psychological and emotional aspects when rating the pain of patients from other cultural backgrounds. This finding highlights a potential problem in multicultural care settings.

[Work disability--a problem of many dimensions. Careful analysis can facilitate understanding]. / Arbetsförmåga--ett problem med många dimensioner. Medveten analys kan underlätta förståelse.

Discrepancies between patients' and medical doctors' perceptions of disability as a result of illness and impaired function, respectively, is common in clinical practice. The evaluation of chronic pain is complicated, especially in a transcultural context. A multi-dimensional diagnostic schedule used at a health care center in a multiethnic community is discussed here. It encompasses somatic and psychiatric health, psychosocial pressure, social adaptation, pain communication, attitudes toward pain, and current place of employment. This schedule is used by two primary care physicians who assess patients' ability to participate in work and the extent to which their ability might be reduced.

Attitudes towards pain and return to work in young immigrants on long- term sick leave.

OBJECTIVE: To explore attitudes towards pain and returning to work in young immigrants on long-term sick leave because of chronic pain. DESIGN: As a part of a randomised-controlled rehabilitation programme for immigrants 16-45 years of age on sick leave > 6 weeks, the participants in the experimental group were interviewed about their attitudes towards their pain. SETTING: A primary health care centre in an immigrant district in Stockholm, Sweden. SUBJECTS: Twenty-six first generation immigrants with long-standing musculoskeletal or imprecise pain. MEASURES: Semi-structured interviews of explanatory models of pain. The content of the interviews was abstracted and categorised, with the focus on factors that might influence the rehabilitation process and especially cause pain anxiety. RESULTS: The majority of the interviewees were Turks and Southern Europeans with a median age of 38.5 years and a median sick leave of 12.0 months. Nearly all assessed themselves as having no capacity to work and two-thirds reported pain anxiety. The shared characteristics of the attitude to pain were that rest is the best treatment and that occupational work is the main etiological factor for the pain. A difference was found regarding the meaning of the pain, with one cluster of interviewees focusing on a disorder (Type I attitudes) and the other cluster focusing on the pain sensation itself (Type II attitudes). These clusters were equally large and there were no significant differences regarding ethnicity, religion, or other data between them. However, persons in the Type II cluster were generally more fatalistic about their future health and significantly more were working, at least part-time, at the 3 (p < 0.05) and 8 month (p < 0.01) follow-ups. CONCLUSION: Differences in attitudes towards pain and in qualities of pain anxiety, either focusing on the meaning of pain and its consequences or on the immediate experience of pain, might influence rehabilitation.

Rehabilitation of young immigrants in primary care. A comparison between two treatment models.

OBJECTIVE: To evaluate the effect on well-being and sickness certification of interviews and three dialogue sessions concerning ideas about pain in young immigrants suffering from longstanding, benign pain. DESIGN: A randomized clinical four-week trial between two treatment groups. SETTING: A primary health care centre, Stockholm, Sweden. SUBJECTS: 92 persons, 25-45 years of age, on sick leave > 6 weeks. MEASURES: Physical and psychiatric examinations and self-ratings of work ability and pain anxiety were made before and after the programme. Sick leave data were studied at three and eight-month follow-ups. RESULTS: 45 immigrants, mean age 38 years, mean sick leave 13 months, completed the programme. There were no significant differences in general or diagnostic data between the treatment groups. All had pain. Three-quarters reported pain anxiety. Nearly half had depressive disorders. Only ten persons had self-rated ability for part-time work. After the programme, there were significant differences in favour of the experimental group in number of participants with pain anxiety (p = 0.01), with diagnosed depression (p < 0.05), with self-rated work ability (p = 0.05), and in the number of participants who had returned to work at the eight-month follow-up (p < 0.05). CONCLUSIONS: This study indicates that, for young immigrants suffering from long-standing benign pain, a structured dialogue with focus on concepts of pain may reduce pain anxiety and depressive mood, improve self-rated work ability, and increase the prospects of successful rehabilitation back to work.

Clinical factors, psycho-social stressors and sick-leave patterns in a group of Swedish and Greek patients.

To assess patterns of illness behaviour in immigrant Greeks, 50 Greek and 50 Swedish consecutive patients were examined by a Swedish general practitioner and a Greek psychotherapist at a primary health centre in Stockholm. In addition to a physical examination an overall psychiatric assessment of the patients was made, partly with the help of rating scales. Psycho-social stressors were also rated. In spite of modest somatic and psychiatric findings, the majority of the Greek patients had been on long-term sick-leave and none of them could be rehabilitated. This illness behaviour, with passivity as the most notable response to pain, was very evident in the Greek group and was assessed as being strongly related to psycho-social stressors as well as to iatrogenic damage. All of the patients whose sick-leave had been of short duration prior to their first visit to the health centre could be rehabilitated. Psycho-social counselling given to the Greek patients in their native tongue had only marginal effect.