Anders Baerheim

ACUPUNCTURE IN THE PROPHYLAXIS OF RECURRENT LOWER URINARY TRACT INFECTION IN ADULT WOMEN

OBJECTIVE To evaluate the effect of acupuncture in the prevention of recurrent lower urinary tract infection (UTI) in adult women. DESIGN A controlled clinical trial with three arms: an acupuncture group, a sham-acupuncture group, and an untreated control group. Patients were followed for 6 months. SETTING An acupuncture clinic in Bergen, Norway. SUBJECTS Sixty-seven adult women with a history of recurrent lower UTI. MAIN OUTCOME MEASURES Acute lower UTIs during the 6-month observation period. RESULTS Eighty-five percent were free of lower UTI during the 6-month observation period in the acupuncture group, compared with 58% in the sham group (p < 0.05), and 36% in the control group (p < 0.01). There were half as many episodes of lower UTI per person-half-year in the acupuncture group as in the sham group, and a third as many as in the control group (p < 0.05). CONCLUSION Acupuncture seems a worthwhile alternative in the prevention of recurring lower UTI in women.

Quantitative sensory testing of patients with long lasting Patellofemoral pain syndrome

Background: Anterior knee pain, diagnosed as Patellofemoral Pain Syndrome (PFPS), is one of the most common musculoskeletal problems found in adolescents and young adults. There is no consensus in medical literature concerning the aetiology of the PFPS.

Guidelines, evidence, and cultural factors Comparison of four European guidelines on uncomplicated cystitis

Objective – To compare four recent guidelines on uncomplicated cystitis and to examine how cultural factors may have affected recommendations. Design – Descriptive study with a qualitative analysis of authors’ reasons for recommendations. Material – Guidelines for general practitioners published 1999–2000 from Germany, The Netherlands, Norway, and Belgium on diagnosis and treatment of uncomplicated cystitis. Opinions of the guideline authors on the influence of local factors on the recommendations were collected before and after feedback on the differences between the guidelines. Results – Few cited references were shared between the guidelines, and recommendations differed substantially, especially on diagnostic strategies and referral criteria. The authors attributed parts of the differences to local factors. German and Belgian authors stressed the need for safety in their diagnostic and therapeutic approach, while Dutch authors felt confident in their gatekeeper role and the Norwegian authors mainly relied on “the evidence”. Dutch and Belgian authors perceived patients to hold power, German authors referred to the power of the sub-specialists, while the Norwegians aimed to share power with the patient through a patient-centred approach. Conclusion – There are substantial differences even between high-standard guidelines on the same well-defined clinical entity. The selection of literature data, and diagnostic and therapeutic recommendations, seemed to be influenced by such cultural aspects as habits, the patients expectations, and the structure of the healthcare system.

Acupuncture Treatment in the Prevention of Uncomplicated Recurrent Lower Urinary Tract Infections in Adult Women

Acute lower urinary tract infections (UTIs) are common in adult women, and as many as 6% of members of the adult female population experience 3 or more episodes during a given year.1 In 1995, an estimated 11.3 million women in the United States received antibiotic treatment for at least 1 presumed UTI, resulting in associated costs of

Patients' views on importance and usefulness of plain radiography for low back pain.

1.6 billion during that year.2 Women with frequently recurrent cystitis may need prophylactic antibacterial treatment. However, such treatment may result in development of antimicrobial resistance, which is a medical problem of increasing concern.3 A recent study indicated that the rate of cystitis among cystitis-prone women treated with acupuncture was one third the rate among untreated women and half the rate among women treated by sham acupuncture (shallow needling outside known acupuncture points).4 In the present study, we sought to evaluate the effect of acupuncture treatment in preventing uncomplicated recurrent lower UTIs among adult nonpregnant women.

Peeing barbed wire: Symptom experiences in women with lower urinary tract infection

Study Design. Quantitative and qualitative cross-sectional interview study. Objectives. To investigate how patients who are referred for plain radiography because of low back pain perceive the importance and usefulness of the examination. Summary of Background Data. Up to 50% of plain radiography examinations for low back pain may be unnecessary based on clinical criteria. However, many patients have great confidence in these examinations. A further exploration of the patients’ views may indicate how their needs can be met without unnecessary use of radiography. Methods. Ninety-nine patients (65 women, 34 men) 14–91 years of age who were referred from Norwegian general practitioners for plain radiography of the lumbosacral spine were asked to rate the examination as slightly/fairly or very important (93 responded). Chi-squared tests were used to evaluate differences in rating according to age, gender, clinical history, and clinical appropriateness of the examination, as determined by comparing information in the referral form with Norwegian (NR) and British (BR) recommendations for use of radiography. Each of the 99 patients also underwent a semistructured interview that was based on questions about importance, usefulness, and reasons for the radiography referral. Answers were categorized and described using a qualitative method (template analysis). Results. Seventy-two percent (68 of 93) of patients rated radiography as very important. The proportion was higher for men than women (85%vs. 65%, P = 0.04), higher for those with worsening than those with improving/unchanged symptoms (86%vs. 65%, P = 0.03), and higher for inappropriately than appropriately referred patients (NR: 76%vs. 61%, P = 0.17; BR: 81%vs. 56%, P = 0.01). The qualitative analysis showed that the patients related their views on the importance and usefulness of receiving radiography to seven different issues: symptoms and clinical history, information and advice (especially from health care providers), need for emotional support from the physician, need for certainty and reassurance, need for symptom explanation and diagnosis, reliability of radiography compared with clinical evaluation, and expected practical consequences of the radiologic examination. Conclusions. The finding that inappropriately referred patients tended to rate their radiography referral as more important than appropriately referred patients indicates that the patient’s view may be a substantial barrier to appropriate use of radiography. The study identified seven issues underlying the patients’ views on importance and usefulness of receiving radiography. Strategies to prevent unnecessary use of plain radiography for low back pain that address these issues are suggested.

Medical students’ cognitive and affective attitudes towards learning and using communication skills – a nationwide cross-sectional study

OBJECTIVE To explore the contents and presentation of symptoms experienced by female patients with lower urinary tract infections. DESIGN Qualitative study based on written answers to open-ended questions on symptom experiences, analysis with Giorgis phenomenological approach, explanatory model as frame of reference. SETTING Twelve general practices in the Bergen area of Norway. SUBJECTS Ninety-four women aged 19-97 years who consulted because they suspected to have an acute cystitis and who had leucocyturia and growth of 10(5) or more uropathogens/ml in the urine. MAIN OUTCOME MEASURES Descriptions and nuances considered mainstream for cystitis or as a supplement to the traditional medical symptom descriptions. RESULTS We found a great diversity of symptoms. Typical symptom descriptions were a terrible scorch when the bladder is nearly empty, frequent need to void followed by only a few drops, sometimes so suddenly that it may go wrong, or a constant ache in the low back and belly. Subjects also described constant aching or pressure in the genital area, or they felt miserable and no good in the whole body. Specific symptoms were also localized elsewhere in the body. CONCLUSION Diverse symptom descriptions complementing previous knowledge were revealed, as well as symptoms not usually mentioned in textbooks or reviews.

The diagnosis of urinary tract infections among pregnant women in rural Tanzania; prevalences and correspondence between different diagnostic methods

Aims: We wanted to explore cognitive and affective attitudes towards communication skills among students in Norwegian medical schools. Method: 1833 (60% response rate) medical students at the four medical schools in Norway filled in questionnaires by the end of term in May 2003. The Communication Skills Attitudes Scale (CSAS) was used for assessing affective and cognitive attitudes separately. Results and conclusions: Medical students have positive attitudes towards learning and using communication skills. Cognitive and affective attitudes displayed different patterns. Being female and having worked in the health services before admission to the medical school predicted more positive scores both towards cognitive and affective attitudes. Having worked as a junior doctor during medical school predicted more positive cognitive attitudes. Cognitive attitudes towards communication skills did not vary significantly between year groups in any of the medical schools. Scores reflecting affective attitudes gradually fell for each year in all schools, but rose again in the final year in two of them. Implications for curriculum design are discussed.

Is pain in patellofemoral pain syndrome neuropathic

Background. To assess the prevalence of dysuria, dipsticks positive on nitrite and leukocyte esterase and positive Uricult® dip slides among pregnant women in rural Tanzania.

Are resistance patterns in uropathogens published by microbiological laboratories valid for general practice

ObjectiveThere is no consensus among experts regarding the etiology or management of patellofemoral pain syndrome (PFPS). Observations indicating dysfunction of the peripheral nervous system around the patellae have been reported. To what extent these sensory abnormalities cause pain has so far not been investigated. The aim of this study was to assess whether a subgroup of patients with unilateral PFPS have neuropathic pain related to the painful knee. MethodA total of 91 patients with unilateral PFPS, between 18 and 40 years of age, and a comparable group of 23 healthy participants aged 18 to 44 years were included. Level of knee function, pain intensity, and qualities were assessed. Somatosensory assessments were carried out by bedside neurologic tests and quantitative sensory testing, assessing thermal, tactile, and vibration thresholds. ResultsAmple signs of sensory aberrations with considerable heterogeneity and overlap regarding the degree and type of dysfunction of the nervous system were found in the painful area of the PFPS patients. No clear subgroup of patients with neuropathic pain or clustering of features related to neuropathic pain was identified. DiscussionThis study hypothesizes that the observed sensory aberrations may cause neuropathic pain in patients with PFPS. There is no validated method for subgrouping patients with possible neuropathic pain and in this study considerable heterogeneity and overlap regarding signs and symptoms of neuropathic pain made subgrouping even more difficult. A mechanism-based understanding of the pain is, however, essential for the selection of adequate treatment strategies in painful musculoskeletal disorders.