Participation and performance trends in age group athletes have been investigated in endurance an... more Participation and performance trends in age group athletes have been investigated in endurance and ultraendurance races in swimming, cycling, running, and triathlon, but not in long-distance inline skating. The aim of this study was to investigate trends in participation, age, and performance in the longest inline race in Europe, the Inline One-Eleven over 111 km, held between 1998 and 2009. The total number, age distribution, age at the time of the competition, and race times of male and female finishers at the Inline One-Eleven were analyzed. Overall participation increased until 2003 but decreased thereafter. During the 12-year period, the relative participation in skaters younger than 40 years old decreased while relative participation increased for skaters older than 40 years. The mean top ten skating time was 199 ± 9 minutes (range: 189-220 minutes) for men and 234 ± 17 minutes (range: 211-271 minutes) for women, respectively. The gender difference in performance remained stable at 17% ± 5% across years. To summarize, although the participation of master long-distance inline skaters increased, the overall participation decreased across years in the Inline One-Eleven. The race times of the best female and male skaters stabilized across years with a gender difference in performance of 17% ± 5%. Further studies should focus on the participation in the international World Inline Cup races.
Job satisfaction of physicians is an important issue for performance of a health care system. The... more Job satisfaction of physicians is an important issue for performance of a health care system. The aim of the study was to evaluate the job satisfaction of primary care physicians in Switzerland and to explore associations between overall job satisfaction, individual characteristics and satisfaction with aspects of work within the practice separated by gender. This cross-sectional study was based on a job satisfaction survey. Data were collected from 176 primary care physicians working in 91 primary care practices. Job satisfaction was measured with the 10-item Warr-Cook-Wall job satisfaction scale. Stepwise linear regression analysis was performed for physicians separated by gender. The response rate was 92.6%. Primary care physicians reported the highest level of satisfaction with 'freedom of working method' (mean = 6.45) and the lowest satisfaction for 'hours of work' (mean = 5.38) and 'income' (mean = 5.49). Moreover, some aspects of job satisfaction were ...
Both France and Switzerland face a general practitioner (GP) shortage. What differences or parall... more Both France and Switzerland face a general practitioner (GP) shortage. What differences or parallels exist between the two countries with regard to the causes for this shortage? What conclusions might be drawn from a systematic comparison? Literature review with qualitative and semi-quantitative content analysis. Parallels exist in the comparing categories work contents, working structure, income and social status, medical school formation, private life, psychological motives. Differences are found in the categories biography and social selection, medical socialisation, residency. In Switzerland, residency is not uniformly structured, rarely institutionally organised and contains only few elements specific to general medicine. In France, medical socialisation not only exalts the specialists, but also strongly devaluates the GPs. By systematic analysis and comparison of both countries' pertinent literature, France and Switzerland can deepen their understanding of GP shortage. This paper identifies possible fields of action from medical school through residency up to workplace conditions that are pivotal in addressing the shortage of GPs.
Detecting elder abuse is challenging because it is a taboo, and many cases remain unreported. Thi... more Detecting elder abuse is challenging because it is a taboo, and many cases remain unreported. This study aimed to identify types of elder abuse and to investigate its associated risk factors. Retrospective analyses of 903 dossiers created at an Independent Complaints Authority for Old Age in the Canton of Zurich, Switzerland, from January 1, 2008 to October 31, 2012. Characteristics of victims and perpetrators, types of abuse, and associated risk factors related to the victim or the perpetrator were assessed. Bi- and multivariate analysis were used to identify abuse and neglect determinants. A total of 150 cases reflected at least one form of elder abuse or neglect; 104 cases were categorised as abuse with at least one type of abuse (overall 135 mentions), 46 cases were categorised as neglect (active or passive). Psychological abuse was the most reported form (47%), followed by financial (35%), physical (30%) and anticonstitutional abuse (18%). In 81% of the 150 cases at least two r...
Emergency departments (EDs) are overcrowded by lower acuity patients, which might be more efficie... more Emergency departments (EDs) are overcrowded by lower acuity patients, which might be more efficiently treated by general practitioners (GPs). This study evaluated the impact of triaging lower acuity patients to a new hospital-integrated general practice (HGP) on ED case-load and the reasons for choosing the ED/HGP. Patients were consecutively assessed according to the emergency severity index (ESI) to triage lower acuity patients to the HGP. Consultation numbers at the emergency centre (ED and HGP) increased by 43% between 2007 (n = 16 974) and 2011 (n = 24 331) (implementation of HGP in 2009). Although self-referrals increased significantly at the emergency centre from 54% to 63% (p <0.001), the proportion of self-referrals at the ED was significantly reduced to 48% (p = 0.007). The HGP was able to reduce the burden of increasing total consultations by 36%; 4.6% were referred back to the ED after triaging to the HGP. Overall, 95% of HGP patients were self-referred, Swiss nationa...
Beneficial and detrimental effects of various vegetarian and vegan diets on the health status are... more Beneficial and detrimental effects of various vegetarian and vegan diets on the health status are well known. Considering the growing background numbers of vegetarians and vegans, the number of vegetarian and vegan runners is likely to rise, too. Therefore, the Nutrition and Running High Mileage (NURMI) Study was designed as a comparative study to investigate the prevalence of omnivores, vegetarians, and vegans in running events and to detect potential differences in running performance comparing these three subgroups. The NURMI Study will be conducted in three steps following a cross-sectional design. Step 1 will determine epidemiological aspects of endurance runners (any distance) using a short standardized questionnaire. Step 2 will investigate dietary habits and running history from eligible participants (capable of running a half-marathon at least) using an extended standardized questionnaire. Step 3 will collect data after a running event on finishing time and final ranking as well as a post-race rating of perceived exertion, mood status, nutrient and fluid intake during the race. Our study will provide a major contribution to overcome the lack of data on the prevalence and running performance of vegetarian and vegan runners in endurance running events. We estimate the prevalence of vegetarians and vegans participating in a running event to be less compared to the respective proportion of vegetarians and vegans to the general population. Furthermore we will validate the subject&amp;amp;amp;amp;#39;s self-assessment of their respective diet. This comparative study may identify possible effects of dietary behavior on running performance und may detect possible differences between the respective subgroups: omnivorous, vegetarian and vegan runners. Trial registration Current controlled trials, ISRCTN73074080.
The link between guideline adherence and outcomes is a highly demanded issue in diabetes care. We... more The link between guideline adherence and outcomes is a highly demanded issue in diabetes care. We aimed to assess the adherence to guidelines and its impact on hospitalization using a simple set of performance measures among patients with diabetes. We performed a retrospective cohort study, using health care claims data for adult patients with treated diabetes (2011-2013). Patients were categorized into three drug treatment groups (with oral antidiabetic agents [OAs] only, in combination with insulin, and insulin only). Performance measures were based on international established guidelines for diabetes care. Multivariate logistic regression models predicted the probability of hospitalization (2013) by adherence level (2011) among all treatment groups. A total of 40,285 patients with diabetes were enrolled in 2011. Guideline adherence was quite low: about 70% of all patients received a biannual hemoglobin A1c measurement and 19.8% had undergone an annual low-density lipoprotein cholesterol test. Only 4.8% were exposed to full adherence including all performance measures (OAs: 3.7%; insulin: 7.7%; and in combination: 7.2%). Increased guideline adherence was associated with decreased probability of hospitalization. This effect was strongest in patients using OAs and insulin in combination. Our study showed that measures to reflect physicians&#39; guideline adherence in diabetes care can easily be calculated based on already available datasets. Furthermore, these measures are clearly linked with the probability of hospitalization suggesting that a better guideline adherence by physicians could help to prevent a large number of hospitalizations.
In major marathon races such as the 'World Marathon Majors', female and male East African... more In major marathon races such as the 'World Marathon Majors', female and male East African runners particularly from Ethiopia and Kenya are the fastest. However, whether this trend appears for female and male Ethiopians and Kenyans at recreational level runners (i.e. races at national level) and in shorter road races (e.g. in half-marathon races) has not been studied yet. Thus, the aim of the present study was to examine differences in the performance and the age of female and male runners from East Africa (i.e. Ethiopians and Kenyans) between half- and full marathons. Data from 508,108 athletes (125,894 female and 328,430 male half-marathoners and 10,205 female and 43,489 male marathoners) originating from 126 countries and competing between 1999 and 2014 in all road-based half-marathons and marathons held in one country (Switzerland) were analysed using Chi square (χ(2)) tests, mixed-effects regression analyses and one-way analyses of variance. In half-marathons, 48 women (...
Participation and performance trends for age group marathoners have been investigated for large c... more Participation and performance trends for age group marathoners have been investigated for large city marathons such as the 'New York City Marathon' but not for mountain marathons. This study investigated participation and trends in performance and sex difference in the mountain marathon 'Jungfrau Marathon' held in Switzerland from 2000 to 2014 using single and mixed effects regression analyses. Results were compared to a city marathon (Lausanne Marathon) also held in Switzerland during the same period. Sex difference was calculated using the equation ([race time in women] - [race time in men]/[race time in men] × 100). Changes in sex differences across calendar years and were investigated using linear regression models. In 'Jungfrau Marathon', participation in all female and male age groups increased with exception of women in age groups 18-24 and men in age groups 30-34, 40-44 and 60-64 years where participation remained unchanged. In 'Lausanne Marathon&...
Age and performance trends of elite and recreational marathoners are well investigated, but not f... more Age and performance trends of elite and recreational marathoners are well investigated, but not for half-marathoners. We analysed age and performance trends in 508,108 age group runners (125,894 female and 328,430 male half-marathoners and 10,205 female and 43,489 male marathoners) competing between 1999 and 2014 in all flat half-marathons and marathons held in Switzerland using single linear regression analyses, mixed-effects regression analyses and analyses of variance. The number of women and men increased across years in both half-marathons and marathons. There were 12.3 times more female half-marathoners than female marathoners and 7.5 times more male half-marathoners than male marathoners. For both half-marathons and marathons, most of the female and male finishers were recorded in age group 40-44 years. In half-marathons, women (10.29 ± 3.03 km/h) were running 0.07 ± 0.06 km/h faster (p < 0.001) than men (10.22 ± 3.06 km/h). Also in marathon, women (14.77 ± 4.13 km/h) were...
Performance trends in elite freestyle swimmers are well known, but not for master freestyle swimm... more Performance trends in elite freestyle swimmers are well known, but not for master freestyle swimmers. We investigated trends in participation, performance, and sex difference in performance of 65,584 freestyle master swimmers from 25-29 to 85-89 years competing in FINA World Masters Championships between 1986 and 2014. The men-to-women ratio was calculated for each age group, and the trend across age groups was analyzed using single linear regression analysis. Trends in performance changes were investigated using a mixed-effects regression model with sex, distance, and calendar year as fixed variables. Participation increased in women and men in older age groups (i.e., 40 years and older). Women and men improved race times across years in all age groups and distances. For age groups 25-29 to 75-79 years, women were slower than men, but not for age groups 80-84 to 85-89 years. In 50, 100, and 200 m, women reduced the sex difference from 1986 to 2014 in age groups 30-34 to 75-79 years...
Referrals from primary to secondary care reflect a crucial role of primary care physicians (PCPs)... more Referrals from primary to secondary care reflect a crucial role of primary care physicians (PCPs). Most referral rates are based on the number of consultations, rather than on the number of problems addressed during consultations (reasons for encounter = RFE). The aim of the study was to update data on consultations, RFE and referrals in Swiss primary care and calculate a referral rate based on RFE rather than on the number of consultations. Cross-sectional study in Swiss primary care. PCPs collected data on consultations on 15 different days in three nonconsecutive months in 2012/2013. Demographic data of patients and up to six RFE per consultation were collected. For each RFE the PCP had to indicate whether a referral was initiated. Data were analysed using descriptive statistics. Ninety PCPs (18.9% females) participated and 24 774 consultations with 42 890 RFE (corresponding to 1.73 [standard deviation 1.07] RFE per consultation) were recorded. A total of 2 427 RFE (of 2 341 consultations) led to a referral, corresponding to a referral rate of 9.44% (95% confidence interval [CI] 9.08-9.81%) based on consultations and 5.65% (95% CI 5.43-5.87%) based on the number of RFE. An average of 1.7 RFE per consultation and a broad clinical spectrum of problems were presented in primary care; nevertheless, 94.3% of all problems were solved in primary care, reflecting the crucial role of PCPs as a coordinator of healthcare.
Paracetamol is the first choice mediation for osteoarthritis. The analgetic potential of NSAIDs i... more Paracetamol is the first choice mediation for osteoarthritis. The analgetic potential of NSAIDs is slightly higher and they also have some antiphlogistic effect, but their use has to be strictly limited to a short period of time. They should mainly be used in the therapy of the acute and painful phase of osteoarthritis. Among the NSAIDs, Diclofenac is the medication of first choice. In patients with an increased risk of gastrointestinal complications, a protonpumpinhibitor should be added. Patients with cardiovascular risk factors should receive NSAIDs only in case of no appropriate alternative treatments. Opioids have their place in osteoarthritis treatment and should be part of an individualized pain regime, which should also contain a pain diary and proactive monitoring. It is important to emphasize the positive effects of physical activity on the function of the joints as well as the negative effect of overweight and immobility.
Participation and performance trends in age group athletes have been investigated in endurance an... more Participation and performance trends in age group athletes have been investigated in endurance and ultraendurance races in swimming, cycling, running, and triathlon, but not in long-distance inline skating. The aim of this study was to investigate trends in participation, age, and performance in the longest inline race in Europe, the Inline One-Eleven over 111 km, held between 1998 and 2009. The total number, age distribution, age at the time of the competition, and race times of male and female finishers at the Inline One-Eleven were analyzed. Overall participation increased until 2003 but decreased thereafter. During the 12-year period, the relative participation in skaters younger than 40 years old decreased while relative participation increased for skaters older than 40 years. The mean top ten skating time was 199 ± 9 minutes (range: 189-220 minutes) for men and 234 ± 17 minutes (range: 211-271 minutes) for women, respectively. The gender difference in performance remained stable at 17% ± 5% across years. To summarize, although the participation of master long-distance inline skaters increased, the overall participation decreased across years in the Inline One-Eleven. The race times of the best female and male skaters stabilized across years with a gender difference in performance of 17% ± 5%. Further studies should focus on the participation in the international World Inline Cup races.
Job satisfaction of physicians is an important issue for performance of a health care system. The... more Job satisfaction of physicians is an important issue for performance of a health care system. The aim of the study was to evaluate the job satisfaction of primary care physicians in Switzerland and to explore associations between overall job satisfaction, individual characteristics and satisfaction with aspects of work within the practice separated by gender. This cross-sectional study was based on a job satisfaction survey. Data were collected from 176 primary care physicians working in 91 primary care practices. Job satisfaction was measured with the 10-item Warr-Cook-Wall job satisfaction scale. Stepwise linear regression analysis was performed for physicians separated by gender. The response rate was 92.6%. Primary care physicians reported the highest level of satisfaction with 'freedom of working method' (mean = 6.45) and the lowest satisfaction for 'hours of work' (mean = 5.38) and 'income' (mean = 5.49). Moreover, some aspects of job satisfaction were ...
Both France and Switzerland face a general practitioner (GP) shortage. What differences or parall... more Both France and Switzerland face a general practitioner (GP) shortage. What differences or parallels exist between the two countries with regard to the causes for this shortage? What conclusions might be drawn from a systematic comparison? Literature review with qualitative and semi-quantitative content analysis. Parallels exist in the comparing categories work contents, working structure, income and social status, medical school formation, private life, psychological motives. Differences are found in the categories biography and social selection, medical socialisation, residency. In Switzerland, residency is not uniformly structured, rarely institutionally organised and contains only few elements specific to general medicine. In France, medical socialisation not only exalts the specialists, but also strongly devaluates the GPs. By systematic analysis and comparison of both countries&amp;amp;amp;amp;#39; pertinent literature, France and Switzerland can deepen their understanding of GP shortage. This paper identifies possible fields of action from medical school through residency up to workplace conditions that are pivotal in addressing the shortage of GPs.
Detecting elder abuse is challenging because it is a taboo, and many cases remain unreported. Thi... more Detecting elder abuse is challenging because it is a taboo, and many cases remain unreported. This study aimed to identify types of elder abuse and to investigate its associated risk factors. Retrospective analyses of 903 dossiers created at an Independent Complaints Authority for Old Age in the Canton of Zurich, Switzerland, from January 1, 2008 to October 31, 2012. Characteristics of victims and perpetrators, types of abuse, and associated risk factors related to the victim or the perpetrator were assessed. Bi- and multivariate analysis were used to identify abuse and neglect determinants. A total of 150 cases reflected at least one form of elder abuse or neglect; 104 cases were categorised as abuse with at least one type of abuse (overall 135 mentions), 46 cases were categorised as neglect (active or passive). Psychological abuse was the most reported form (47%), followed by financial (35%), physical (30%) and anticonstitutional abuse (18%). In 81% of the 150 cases at least two r...
Emergency departments (EDs) are overcrowded by lower acuity patients, which might be more efficie... more Emergency departments (EDs) are overcrowded by lower acuity patients, which might be more efficiently treated by general practitioners (GPs). This study evaluated the impact of triaging lower acuity patients to a new hospital-integrated general practice (HGP) on ED case-load and the reasons for choosing the ED/HGP. Patients were consecutively assessed according to the emergency severity index (ESI) to triage lower acuity patients to the HGP. Consultation numbers at the emergency centre (ED and HGP) increased by 43% between 2007 (n = 16 974) and 2011 (n = 24 331) (implementation of HGP in 2009). Although self-referrals increased significantly at the emergency centre from 54% to 63% (p <0.001), the proportion of self-referrals at the ED was significantly reduced to 48% (p = 0.007). The HGP was able to reduce the burden of increasing total consultations by 36%; 4.6% were referred back to the ED after triaging to the HGP. Overall, 95% of HGP patients were self-referred, Swiss nationa...
Beneficial and detrimental effects of various vegetarian and vegan diets on the health status are... more Beneficial and detrimental effects of various vegetarian and vegan diets on the health status are well known. Considering the growing background numbers of vegetarians and vegans, the number of vegetarian and vegan runners is likely to rise, too. Therefore, the Nutrition and Running High Mileage (NURMI) Study was designed as a comparative study to investigate the prevalence of omnivores, vegetarians, and vegans in running events and to detect potential differences in running performance comparing these three subgroups. The NURMI Study will be conducted in three steps following a cross-sectional design. Step 1 will determine epidemiological aspects of endurance runners (any distance) using a short standardized questionnaire. Step 2 will investigate dietary habits and running history from eligible participants (capable of running a half-marathon at least) using an extended standardized questionnaire. Step 3 will collect data after a running event on finishing time and final ranking as well as a post-race rating of perceived exertion, mood status, nutrient and fluid intake during the race. Our study will provide a major contribution to overcome the lack of data on the prevalence and running performance of vegetarian and vegan runners in endurance running events. We estimate the prevalence of vegetarians and vegans participating in a running event to be less compared to the respective proportion of vegetarians and vegans to the general population. Furthermore we will validate the subject&amp;amp;amp;amp;#39;s self-assessment of their respective diet. This comparative study may identify possible effects of dietary behavior on running performance und may detect possible differences between the respective subgroups: omnivorous, vegetarian and vegan runners. Trial registration Current controlled trials, ISRCTN73074080.
The link between guideline adherence and outcomes is a highly demanded issue in diabetes care. We... more The link between guideline adherence and outcomes is a highly demanded issue in diabetes care. We aimed to assess the adherence to guidelines and its impact on hospitalization using a simple set of performance measures among patients with diabetes. We performed a retrospective cohort study, using health care claims data for adult patients with treated diabetes (2011-2013). Patients were categorized into three drug treatment groups (with oral antidiabetic agents [OAs] only, in combination with insulin, and insulin only). Performance measures were based on international established guidelines for diabetes care. Multivariate logistic regression models predicted the probability of hospitalization (2013) by adherence level (2011) among all treatment groups. A total of 40,285 patients with diabetes were enrolled in 2011. Guideline adherence was quite low: about 70% of all patients received a biannual hemoglobin A1c measurement and 19.8% had undergone an annual low-density lipoprotein cholesterol test. Only 4.8% were exposed to full adherence including all performance measures (OAs: 3.7%; insulin: 7.7%; and in combination: 7.2%). Increased guideline adherence was associated with decreased probability of hospitalization. This effect was strongest in patients using OAs and insulin in combination. Our study showed that measures to reflect physicians&#39; guideline adherence in diabetes care can easily be calculated based on already available datasets. Furthermore, these measures are clearly linked with the probability of hospitalization suggesting that a better guideline adherence by physicians could help to prevent a large number of hospitalizations.
In major marathon races such as the 'World Marathon Majors', female and male East African... more In major marathon races such as the 'World Marathon Majors', female and male East African runners particularly from Ethiopia and Kenya are the fastest. However, whether this trend appears for female and male Ethiopians and Kenyans at recreational level runners (i.e. races at national level) and in shorter road races (e.g. in half-marathon races) has not been studied yet. Thus, the aim of the present study was to examine differences in the performance and the age of female and male runners from East Africa (i.e. Ethiopians and Kenyans) between half- and full marathons. Data from 508,108 athletes (125,894 female and 328,430 male half-marathoners and 10,205 female and 43,489 male marathoners) originating from 126 countries and competing between 1999 and 2014 in all road-based half-marathons and marathons held in one country (Switzerland) were analysed using Chi square (χ(2)) tests, mixed-effects regression analyses and one-way analyses of variance. In half-marathons, 48 women (...
Participation and performance trends for age group marathoners have been investigated for large c... more Participation and performance trends for age group marathoners have been investigated for large city marathons such as the 'New York City Marathon' but not for mountain marathons. This study investigated participation and trends in performance and sex difference in the mountain marathon 'Jungfrau Marathon' held in Switzerland from 2000 to 2014 using single and mixed effects regression analyses. Results were compared to a city marathon (Lausanne Marathon) also held in Switzerland during the same period. Sex difference was calculated using the equation ([race time in women] - [race time in men]/[race time in men] × 100). Changes in sex differences across calendar years and were investigated using linear regression models. In 'Jungfrau Marathon', participation in all female and male age groups increased with exception of women in age groups 18-24 and men in age groups 30-34, 40-44 and 60-64 years where participation remained unchanged. In 'Lausanne Marathon&...
Age and performance trends of elite and recreational marathoners are well investigated, but not f... more Age and performance trends of elite and recreational marathoners are well investigated, but not for half-marathoners. We analysed age and performance trends in 508,108 age group runners (125,894 female and 328,430 male half-marathoners and 10,205 female and 43,489 male marathoners) competing between 1999 and 2014 in all flat half-marathons and marathons held in Switzerland using single linear regression analyses, mixed-effects regression analyses and analyses of variance. The number of women and men increased across years in both half-marathons and marathons. There were 12.3 times more female half-marathoners than female marathoners and 7.5 times more male half-marathoners than male marathoners. For both half-marathons and marathons, most of the female and male finishers were recorded in age group 40-44 years. In half-marathons, women (10.29 ± 3.03 km/h) were running 0.07 ± 0.06 km/h faster (p < 0.001) than men (10.22 ± 3.06 km/h). Also in marathon, women (14.77 ± 4.13 km/h) were...
Performance trends in elite freestyle swimmers are well known, but not for master freestyle swimm... more Performance trends in elite freestyle swimmers are well known, but not for master freestyle swimmers. We investigated trends in participation, performance, and sex difference in performance of 65,584 freestyle master swimmers from 25-29 to 85-89 years competing in FINA World Masters Championships between 1986 and 2014. The men-to-women ratio was calculated for each age group, and the trend across age groups was analyzed using single linear regression analysis. Trends in performance changes were investigated using a mixed-effects regression model with sex, distance, and calendar year as fixed variables. Participation increased in women and men in older age groups (i.e., 40 years and older). Women and men improved race times across years in all age groups and distances. For age groups 25-29 to 75-79 years, women were slower than men, but not for age groups 80-84 to 85-89 years. In 50, 100, and 200 m, women reduced the sex difference from 1986 to 2014 in age groups 30-34 to 75-79 years...
Referrals from primary to secondary care reflect a crucial role of primary care physicians (PCPs)... more Referrals from primary to secondary care reflect a crucial role of primary care physicians (PCPs). Most referral rates are based on the number of consultations, rather than on the number of problems addressed during consultations (reasons for encounter = RFE). The aim of the study was to update data on consultations, RFE and referrals in Swiss primary care and calculate a referral rate based on RFE rather than on the number of consultations. Cross-sectional study in Swiss primary care. PCPs collected data on consultations on 15 different days in three nonconsecutive months in 2012/2013. Demographic data of patients and up to six RFE per consultation were collected. For each RFE the PCP had to indicate whether a referral was initiated. Data were analysed using descriptive statistics. Ninety PCPs (18.9% females) participated and 24 774 consultations with 42 890 RFE (corresponding to 1.73 [standard deviation 1.07] RFE per consultation) were recorded. A total of 2 427 RFE (of 2 341 consultations) led to a referral, corresponding to a referral rate of 9.44% (95% confidence interval [CI] 9.08-9.81%) based on consultations and 5.65% (95% CI 5.43-5.87%) based on the number of RFE. An average of 1.7 RFE per consultation and a broad clinical spectrum of problems were presented in primary care; nevertheless, 94.3% of all problems were solved in primary care, reflecting the crucial role of PCPs as a coordinator of healthcare.
Paracetamol is the first choice mediation for osteoarthritis. The analgetic potential of NSAIDs i... more Paracetamol is the first choice mediation for osteoarthritis. The analgetic potential of NSAIDs is slightly higher and they also have some antiphlogistic effect, but their use has to be strictly limited to a short period of time. They should mainly be used in the therapy of the acute and painful phase of osteoarthritis. Among the NSAIDs, Diclofenac is the medication of first choice. In patients with an increased risk of gastrointestinal complications, a protonpumpinhibitor should be added. Patients with cardiovascular risk factors should receive NSAIDs only in case of no appropriate alternative treatments. Opioids have their place in osteoarthritis treatment and should be part of an individualized pain regime, which should also contain a pain diary and proactive monitoring. It is important to emphasize the positive effects of physical activity on the function of the joints as well as the negative effect of overweight and immobility.
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Papers by Thomas Rosemann