Multimorbidity: can general practitioners identify the health conditions most important to their patients? Results from a national cross-sectional study in Switzerland

Faced with patients suffering from more than one chronic condition, or multimorbidity, general practitioners (GPs) must establish diagnostic and treatment priorities. Patients also set their own priorities to handle the everyday burdens associated with their multimorbidity and these may be different from the priorities established by their GP. A shared patient-GP agenda, driven by knowledge of each other's priorities, would seem central to managing patients with multimorbidity. We evaluated GPs' ability to identify the health condition most important to their patients. Data on 888 patients were collected as part of a cross-sectional Swiss study on multimorbidity in family medicine. For the main analyses on patients-GP agreement, data from 572 of these patients could be included. GPs were asked to identify the two conditions which their patient considered most important, and we tested whether either of them agreed with the condition mentioned as most important by the patient. In the main analysis, we studied the agreement rate between GPs and patients by grouping items medically-related into 46 groups of conditions. Socio-demographic and clinical variables were fitted into univariate and multivariate models. In 54.9% of cases, GPs were able to identify the health condition most important to the patient. In the multivariate model, the only variable significantly associated with patient-GP agreement was the number of chronic conditions: the higher the number of conditions, the less likely the agreement. GPs were able to correctly identify the health condition most important to their patients in half of the cases. It therefore seems important that GPs learn how to better adapt treatment targets and priorities by taking patients' perspectives into account

Mean muscle pain and weakness, fatigue, body mass index (BMI), and age in 25(OH)D deficient (<50 nmol/l) and non-deficient (>50 nmol/l) patients.

<p>VAS, Visual analogue scale, BMI, body mass index;</p><p>^at test</p><p>Mean muscle pain and weakness, fatigue, body mass index (BMI), and age in 25(OH)D deficient (<50 nmol/l) and non-deficient (>50 nmol/l) patients.</p

Significant difference of 25-hydroxy 25(OH)D concentrations end of summer and end of winter (53.4 ± 19.9 vs. 41.6 ± 19.3 nmol/l, p<0.0001).

<p>Significant difference of 25-hydroxy 25(OH)D concentrations end of summer and end of winter (53.4 ± 19.9 vs. 41.6 ± 19.3 nmol/l, p<0.0001).</p

Correlations of patients’ muscle pain and weakness, fatigue, body mass index (BMI), and age with 25(OH)D serum concentrations.

<p>VAS, Visual analogue scale, BMI, body mass index;</p><p>^a Spearman’s rho,</p><p>^b Spearman’s rank test</p><p>Correlations of patients’ muscle pain and weakness, fatigue, body mass index (BMI), and age with 25(OH)D serum concentrations.</p

Vitamin D Deficiency in Unselected Patients from Swiss Primary Care: A Cross-Sectional Study in Two Seasons

<div><p>Background</p><p>As published data on 25-hydroxy-cholecalciferol (25(OH)D) deficiency in primary care settings is scarce, we assessed the prevalence of hypovitaminosis D, potential associations with clinical symptoms, body mass index, age, Vitamin D intake, and skin type in unselected patients from primary care, and the extent of seasonal variations of serum 25(OH)D concentrations.</p><p>Methodology/Principal Findings</p><p>25(OH)D was measured at the end of summer and/or winter in 1682 consecutive patients from primary care using an enzyme-linked immunosorbant assay. Clinical symptoms were assessed by self-report (visual analogue scale 0 to 10), and vitamin D deficiency was defined as 25(OH)D concentrations < 50 nmol/l. 25(OH)D deficiency was present in 995 (59.2%) patients. 25(OH)D deficient patients reported more intense muscle weakness (visual analogue scale 2.7, 95% confidence interval 2.5 to 2.9) and had a higher body mass index (25.9kg/m², 25.5 to 26.2) than non-deficient patients (2.5, 2.3 to 2.7; and 24.2, 23.9 to 24.5, respectively). 25(OH)D concentrations also weakly correlated with muscle weakness (Spearman’s rho -0.059, 95% confidence interval -0.107 to -0.011) and body mass index (-0.156, -0.202 to -0.108). Self-reported musculoskeletal pain, fatigue, and age were not associated with deficiency, nor with concentrations. Mean 25(OH)D concentrations in patients with vitamin D containing medication were higher (60.6 ± 22.2 nmol/l) than in patients without medication (44.8 ± 19.2 nmol/l, p < 0.0001) but still below the targeted level of 75 nmol/l. Summer and winter 25(OH)D concentrations differed (53.4 ± 19.9 vs. 41.6 ± 19.3nmol/l, p < 0.0001), which was confirmed in a subgroup of 93 patients who were tested in both seasons (p = 0.01).</p><p>Conclusion/Significance</p><p>Nearly 60% of unselected patients from primary care met the criteria for 25(OH)D deficiency. Self-reported muscle weakness and high body mass index were associated with lower 25(OH)D levels. As expected 25(OH)D concentrations were lower in winter compared to summer.</p></div

Additional file 1 of The effect of COVID-19 on mental well-being in Switzerland: a cross-sectional survey of the adult Swiss general population

Additional file 1 Questionnaire in English. Table S1 Cross-tabulation of mental health well-being reported impairment due to COVID-19 and screening questions of impaired mental health

Characteristics of the study populations assessed end of summer (month of September) and end of winter (month of March).

<p>No significant differences were found between variables assessed end of summer and end of winter (p > 0.05)</p><p>Characteristics of the study populations assessed end of summer (month of September) and end of winter (month of March).</p

xmlmate

Teaser video http://youtu.be/-yKom5mbft0 Abstract Generating system inputs satisfying complex constraints is still a challenge for modern test generators. We present XMLMATE, a search-based test generator specially aimed at XML-based systems. XMLMATE leverages program structure, existing XML schemas, and XML inputs to generate, mutate, recombine, and evolve valid XML inputs. XMLMATE is a search-based test generator. As sketched in Figure 2, it either takes a population of sample XML inputs or randomly generates one, and then systematically evolves this population over several generations to reach the desired coverage goal. To evolve inputs it applies mutation and crossover operators to individuals and favors the procreation and survival of the fittest according to a fitness function geared towards obtaining coverage and triggering exceptions. Measuring the fitness of an input requires executing the program under test; therefore, the runtime of the approach scales linearly with the runtime of the program. XMLMATE is a search-based test generator. As sketched in Figure 2, it either takes a population of sample XML inputs or randomly generates one, and then systematically evolves this population over several generations to reach the desired coverage goal. To evolve inputs it applies mutation and crossover operators to individuals and favors the procreation and survival of the fittest according to a fitness function geared towards obtaining coverage and triggering exceptions. Measuring the fitness of an input requires executing the program under test; therefore, the runtime of the approach scales linearly with the runtime of the program. Over a set of seven XML-based systems, XMLMATE detected 31 new unique failures in production code, all triggered by system inputs and thus true alarms.  </p

Symptomatic treatment approaches for AG cases among Swiss GPs.

Symptomatic treatment approaches for AG cases among Swiss GPs.</p

Perception and burden of acute gastroenteritis and campylobacteriosis in Swiss primary care.

<p>Perception and burden of acute gastroenteritis and campylobacteriosis in Swiss primary care.</p