nan Fredrik

Attitudes of swedish general practitioners and nurses to working with lifestyle change, with special reference to alcohol consumption

AIMSnTo explore the attitudes of Swedish general practitioners (GPs) and nurses to secondary alcohol prevention (early identification of, and intervention for, alcohol-related problems) and compare it to their attitudes to other important lifestyle behaviours such as smoking, stress, exercise, and overweight.nnnMETHODSnAn adjusted version of The WHO Collaborative Study Questionnaire for General Practitioners was posted to all GPs and nurses in the County of Skaraborg, Sweden; 68 GPs and 193 nurses responded.nnnRESULTSnThe importance of drinking alcohol moderately, counselling skills on reducing alcohol consumption and perceived current effectiveness in helping patients change lifestyle behaviours ranked lower than working with all the other lifestyle behaviours. The nurses rated their potential effectiveness in helping patients change lifestyle higher than that of GPs for all the lifestyle behaviours. Nurses receiving more alcohol-related education had more positive attitudes than nurses with less education. For alcohol, the GPs assessed their role adequacy, role legitimacy and motivation higher than that of the nurses. The main obstacles for the GPs to carry out alcohol intervention were lack of training in counselling for reducing alcohol consumption, time constraints, and the fact that the doctors did not know how to identify problem drinkers who have no obvious symptoms of excess consumption.nnnCONCLUSIONnGPs and the nurses estimated their alcohol-related competence as lower than working with many other health-related lifestyles. These results can be explained by lack of practical skills, lack of training in suitable intervention techniques, and unsupportive working environments. All these elements must be considered when planning secondary alcohol prevention programs in primary health care.

Attitudes and Behaviors with Regards to Androgenic Anabolic Steroids Among Male Adolescents in a County of Sweden

Aims. The aim of this study was to investigate attitudes towards androgenic anabolic steroids among male adolescents who have used anabolics compared to those who have not. Design and Setting.u2002A cross-sectional survey was performed in the year 2000 in all secondary schools in the county of Halland on the west coast of Sweden. Participants and Measurements.u2002An anonymous multiple-choice questionnaire was distributed to all classes with 14-, 16-, and 18-year-old male adolescents. The response rate was 92.7% (n = 4049). Findings. Those who admitted having used androgenic anabolic steroids differed in several ways from those who had not. Fewer believed androgenic anabolic steroids to be harmful [odds ratio (OR) = 0.15, 95% CI 0.08–0.30] and more believed that girls preferred boys with large muscles (OR = 6.1, 95% CI 3.4–11.0). They trained more often at gyms (OR = 5.6, 95% CI 3.0–10.6), drank more alcohol (OR = 4.2, 95% CI 2.0–9.1), and had used narcotic drugs more often (OR = 15.3, 95% CI 8.5–27.5) than the other male adolescents. More immigrants than native-born adolescents had used anabolics (OR = 4.2, 95% CI 2.2–7.9). Conclusion. Attitudes towards anabolics differ between users and nonusers. These aspects may be beneficial to focus on as one part of a more complex intervention program in order to change these attitudes and decrease the misuse of androgenic anabolic steroids.

Alcohol Use and Alcohol Consumption–Related Problems in Rural Vietnam: An Epidemiological Survey Using AUDIT

This study aimed to assess alcohol use and alcohol consumption–related problems in different sociodemographic groups in a rural district in Vietnam. Interviews were completed between March 2004 and July 2004. The Alcohol Use Disorder Identification Test (AUDIT) was applied to interview 3423 people, who were randomly selected in a rural district (1695 men and 1728 women). People who had an AUDIT score greater than 7 (in men) or greater than 5 (in women) were identified as having alcohol consumption–related problems. Prevalences and adjusted odds ratios of alcohol use and alcohol consumption–related problems were estimated for different subgroups of the population. Weekly and daily “binge drinking” among men were 5.7 and 3.6%, while binge drinking in women was virtually nonexistent. The prevalence of alcohol consumption–related problems was 25.5% among men and 0.7% among women. The differences between sociodemographic groups were not strong, but women who were separated, divorced, or widowed as well as those with higher education had significantly higher rates of alcohol consumption–related problems than married women and those with lower education. This study indicates an urgent need for alcohol intervention programs focused on men. However, further monitoring of alcohol use and problems among women is important to follow-up changes in consumption pattern. The studys limitations are discussed.

Implementing training and support, financial reimbursement, and referral to an internet-based brief advice program to improve the early identification of hazardous and harmful alcohol consumption in primary care (ODHIN) : study protocol for a cluster randomized factorial trial

BackgroundThe European level of alcohol consumption, and the subsequent burden of disease, is high compared to the rest of the world. While screening and brief interventions in primary healthcare are cost-effective, in most countries they have hardly been implemented in routine primary healthcare. In this study, we aim to examine the effectiveness and efficiency of three implementation interventions that have been chosen to address key barriers for improvement: training and support to address lack of knowledge and motivation in healthcare providers; financial reimbursement to compensate the time investment; and internet-based counselling to reduce workload for primary care providers.Methods/designIn a cluster randomized factorial trial, data from Catalan, English, Netherlands, Polish, and Swedish primary healthcare units will be collected on screening and brief advice rates for hazardous and harmful alcohol consumption. The three implementation strategies will be provided separately and in combination in a total of seven intervention groups and compared with a treatment as usual control group. Screening and brief intervention activities will be measured at baseline, during 12 weeks and after six months. Process measures include health professionals’ role security and therapeutic commitment of the participating providers (SAAPPQ questionnaire). A total of 120 primary healthcare units will be included, equally distributed over the five countries. Both intention to treat and per protocol analyses are planned to determine intervention effectiveness, using random coefficient regression modelling.DiscussionEffective interventions to implement screening and brief interventions for hazardous alcohol use are urgently required. This international multi-centre trial will provide evidence to guide decision makers.Trial registrationClinicalTrials.gov. Trial identifier: NCT01501552

Alcoholism and depression in a Swedish female population: co-morbidity andrisk factors

Objective: Our aims were to study associations between depressive disorders and alcohol dependence/abuse (ADA) in a female population‐based sample, and to identify risk indicators common to both depressive disorders and ADA.

Sick-leave among women and the role of psychiatric disorder

The aim was to assess sick-leave among women in relation to psychiatric disorder. A stratified population-based sample of women in Gothenburg were interviewed and diagnoses were made according to DSM-III-R. Sick-leave data was obtained for a ten year period. Women with psychiatric disorder had higher rates of sick-leave, compared to women without such disorders, in analyses taking into account age, socio-economic status, physical health, marital status and motherhood. Presence of psychiatric and physical illness were both independently associated with higher sick-leave. Highest sick-leave was found among those with a combination of psychiatric and physical morbidity. Psychiatric disorder is an important factor in sick-leave among women, especially regarding length of absence.

Improving the delivery of brief interventions for heavy drinking in primary health care: outcome results of the Optimizing Delivery of Health Care Intervention (ODHIN) five-country cluster randomized factorial trial

AIMnTo test if training and support, financial reimbursement and option of referring screen-positive patients to an internet-based method of giving advice (eBI) can increase primary health-care providers delivery of Alcohol Use Disorders Identification Test (AUDIT)-C-based screening and advice to heavy drinkers.nnnDESIGNnCluster randomized factorial trial with 12-week implementation and measurement period.nnnSETTINGnPrimary health-care units (PHCU) in different locations throughout Catalonia, England, the Netherlands, Poland and Sweden.nnnPARTICIPANTSnA total of 120 PHCU, 24 in each of Catalonia, England, the Netherlands, Poland and Sweden.nnnINTERVENTIONSnPHCUs were randomized to one of eight groups: care as usual, training and support (TS), financial reimbursement (FR) and eBI; paired combinations of TS, FR and eBI, and all of FR, TS and eBI.nnnMEASUREMENTSnThe primary outcome measure was the proportion of eligible adult (age 18+ years) patients screened during a 12-week implementation period. Secondary outcome measures were proportion of screen-positive patients advised; and proportion of consulting adult patients given an intervention (screening and advice to screen-positives) during the same 12-week implementation period.nnnFINDINGSnDuring a 4-week baseline measurement period, the proportion of consulting adult patients who were screened for their alcohol consumption was 0.059 per PHCU (95% CI 0.034 to 0.084). Based on the factorial design, the ratio of the logged proportion screened during the 12-week implementation period was 1.48 (95% CIxa0=xa01.13-1.95) in PHCU that received TS versus PHCU that did not receive TS; for FR, the ratio was 2.00 (95% CIxa0=xa01.56-2.56). The option of referral to eBI did not lead to a higher proportion of patients screened. The ratio for TS plus FR was 2.34 (95% CIxa0=xa01.77-3.10), and the ratio for TS plus FR plus eBI was1.68 (95% CIxa0=xa01.11-2.53).nnnCONCLUSIONSnProviding primary health-care units with training, support and financial reimbursement for delivering Alcohol Use Disorders Identification Test-C-based screening and advice to heavy drinkers increases screening for alcohol consumption. Providing primary health-care units with the option of referring screen-positive patients to an internet-based method of giving advice does not appear to increase screening for alcohol consumption.

Improving the delivery of brief interventions for heavy drinking in primary health care: outcome results of the ODHIN five country cluster randomized factorial trial

AIMnTo test if training and support, financial reimbursement and option of referring screen-positive patients to an internet-based method of giving advice (eBI) can increase primary health-care providers delivery of Alcohol Use Disorders Identification Test (AUDIT)-C-based screening and advice to heavy drinkers.nnnDESIGNnCluster randomized factorial trial with 12-week implementation and measurement period.nnnSETTINGnPrimary health-care units (PHCU) in different locations throughout Catalonia, England, the Netherlands, Poland and Sweden.nnnPARTICIPANTSnA total of 120 PHCU, 24 in each of Catalonia, England, the Netherlands, Poland and Sweden.nnnINTERVENTIONSnPHCUs were randomized to one of eight groups: care as usual, training and support (TS), financial reimbursement (FR) and eBI; paired combinations of TS, FR and eBI, and all of FR, TS and eBI.nnnMEASUREMENTSnThe primary outcome measure was the proportion of eligible adult (age 18+ years) patients screened during a 12-week implementation period. Secondary outcome measures were proportion of screen-positive patients advised; and proportion of consulting adult patients given an intervention (screening and advice to screen-positives) during the same 12-week implementation period.nnnFINDINGSnDuring a 4-week baseline measurement period, the proportion of consulting adult patients who were screened for their alcohol consumption was 0.059 per PHCU (95% CI 0.034 to 0.084). Based on the factorial design, the ratio of the logged proportion screened during the 12-week implementation period was 1.48 (95% CIxa0=xa01.13-1.95) in PHCU that received TS versus PHCU that did not receive TS; for FR, the ratio was 2.00 (95% CIxa0=xa01.56-2.56). The option of referral to eBI did not lead to a higher proportion of patients screened. The ratio for TS plus FR was 2.34 (95% CIxa0=xa01.77-3.10), and the ratio for TS plus FR plus eBI was1.68 (95% CIxa0=xa01.11-2.53).nnnCONCLUSIONSnProviding primary health-care units with training, support and financial reimbursement for delivering Alcohol Use Disorders Identification Test-C-based screening and advice to heavy drinkers increases screening for alcohol consumption. Providing primary health-care units with the option of referring screen-positive patients to an internet-based method of giving advice does not appear to increase screening for alcohol consumption.

The role of gendered conceptions in treatment seeking for alcohol problems.

The aim of this study was to explore the inducements for treatment-seeking for alcohol problems in women and men. Specifically we wanted to identify what promoted or hindered treatment-seeking in women and men, respectively, and to what extent femininity and masculinity was reflected in the context of treatment seeking. Data was obtained from open interviews with five women and seven men within a month after their first entry into alcohol treatment. A content analysis was performed using gender as the sorting factor. Promoting factors for treatment seeking in men were characterized by belief in their own capability, and looking to the future; whereas the women placed importance on pressure from someone significant, and sharing the problem with others. Hindrances for both women and men were feelings of shame and the significant role alcohol had in their lives. The women perceived alcohol problems as incompatible with femininity, and this made them avoid talking openly about their problems, which hence hindered treatment seeking. These findings showed that the value of alcohol as a gendered symbol still exists, which could be perceptible in promoting and hindering factors for treatment seeking in women and men. These factors could be useful to consider by professionals both in the primary healthcare system and in the social services. Future research should address treatment seeking in relation to both cultural and gendered constructions and their influence on the perceptions and behaviour of women and men with alcohol problems.

Professional's Attitudes Do Not Influence Screening and Brief Interventions Rates for Hazardous and Harmful Drinkers: Results from ODHIN Study

AIMSnTo determine the relation between existing levels of alcohol screening and brief intervention rates in five European jurisdictions and role security and therapeutic commitment by the participating primary healthcare professionals.nnnMETHODSnHealth care professionals consisting of, 409 GPs, 282 nurses and 55 other staff including psychologists, social workers and nurse aids from 120 primary health care centres participated in a cross-sectional 4-week survey. The participants registered all screening and brief intervention activities as part of their normal routine. The participants also completed the Shortened Alcohol and Alcohol Problems Perception Questionnaire (SAAPPQ), which measure role security and therapeutic commitment.nnnRESULTSnThe only significant but small relationship was found between role security and screening rate in a multilevel logistic regression analysis adjusted for occupation of the provider, number of eligible patients and the random effects of jurisdictions and primary health care units (PHCU). No significant relationship was found between role security and brief intervention rate nor between therapeutic commitment and screening rate/brief intervention rate. The proportion of patients screened varied across jurisdictions between 2 and 10%.nnnCONCLUSIONnThe findings show that the studied factors (role security and therapeutic commitment) are not of great importance for alcohol screening and BI rates. Given the fact that screening and brief intervention implementation rate has not changed much in the last decade in spite of increased policy emphasis, training initiatives and more research being published, this raises a question about what else is needed to enhance implementation.