Thursday 10:30 AM

 S-1. Good doctoring in a globalized, hi-tech world

Location: Háskólabíó - Main Hall

Linn Getz (organizer and chair, Iceland/Norway, This email address is being protected from spam bots, you need Javascript enabled to view it ) in co-operation with co-chair Stefan Hjörleifsson (Norway/Iceland), Andri Snær Magnason (Iceland), Magne Nylenna (co-organizer, Norway), Richard Horton (UK)

Health care has become one of the most expansive activities in contemporary societies, and technology is one of its most influential factors. The modern medical enterprise faces unprecedented organizational and moral challenges. What will the future of medicine and doctors be like, locally and globally? How can we ensure that our increasing technical capabilities are used for goals that are beneficial for individuals and societies? In this symposium, a set of very different thinkers will share their ideas regarding these matters.

Andri Snær Magnason isan Icelandic poet and intellectual writer and winner of the 2006 Icelandic Literature Award. He recently made a stir across every political party in Iceland with his book "Draumalandið" (The land of dreams). There, he tore the idea of Iceland as a future hydroelectric superpower to pieces.  Andri has now accepted the challenge to reflect upon the future of medicine and doctors.  Andri´s father is a physician, so medicine has been part of his upbringing. but he never read the Hippocratic Oath befor he started preparing for this symposium. He then reported: "I start to wonder....Is it perhaps time to add something about earth to the Oath? Is it not a core medical task to care, not only for individual patients, but for whole communities? It has been shown that if you design a "city of cars", you may expect a subsequent increase in the  population´s BMI and diseases linked to sedentary lifestyle..."Only a poet from the homeland of Björk would be so brave as to suggest a supplement to the Hippocratic Oath. But the idea to upgrade medicine´s ancient humanistic mandate with reference to today´s global reality, does not sound bad at all!

Richard Horton is editor in chief of The Lancet and a doctor-writer with strong global commitment.He is known from controversies with the world´s power elite. Whether dealing with Big Pharma, unveiling cheating medical scientists, or accusing Bush and Blair of lies regarding the death rates in Iraq, Horton never hesitates to speak his mind. YouTube bloggers praise his "forthright no-nonsense speeches about war and health issues". Upon request, Horton summarized his planned contribution as follows: "Doctors are citizens on lands without borders. Is medicine a global project? Or are doctors justifiably constrained by their national predicaments?"

Magne Nylenna is a renowned medical doctor and director of the newly established Norwegian Health Library. He will address the issue of information in a hi-tech world, He says: "Doctoring in a hi-tech world is not so much about hi-tech as about the world created by technology. One of the challenges facing doctors is what some people perceive to be an overwhelming flow of information. I will show how a national health library such as The Norwegian Electronic Health Library may aim to become a reliable cornerstone in Norwegian doctor´s thought and practice, providing easy acces to useful, updated and unbiased knowlwdge."

Linn Getz and Stefan Hjörleifsson will chair the symposium and do ther best to bind the various entries together. 

S-2. Chronic obstructive lung disease (COPD)

Epidemiology, diagnosis and treatment - the general practitioners perspective

Location: Háskólabíó - Hall 1

Jón Steinar Jónsson (chair, Iceland, e-mail: This email address is being protected from spam bots, you need Javascript enabled to view it ), Svein Höegh Henrichsen (Norway), Anders Östrem (Norway), Lill Moll Nielsen (Denmark), Georgios Stratelis (Sweden)

COPD is one of the leading causes of death worldwide. General practitioners play a major role in relation to the “epidemic” of COPD. The aim of the symposium is to present state of the art knowledge on this subject from the perspective of general practice.

In the year 2020 COPD is estimated to represent the third most common cause of death. It has been argued tha no other disease condition is so neglected by the health care system. Many studies show that many cases of COPD are missed, and that diagnosis is often delayed to a late stage.  It is generally assumed that early diagnosis and treatment represents the most effective way to deal with this enormous health problem, but there is still some scientific controversy regarding this matter.  The role of primary care workers in preventing, recognizing and tackling COPD is likely to become increasingly important in the future.

In this symposium, a group of Nordic GPs who share a special interest in COPD and pulmonary diseases will give participants an overview of relevant evidence in the area and best clinical practice guidelines regarding COPD in general preaactice. The following areas will be targeted:

Svein Höegh Henrichsen will present the burden of the disease and diagnostic strategies.

Anders Östrem will present state of the art regarding treatment issues, including treatment for exacerbations.

Lill Moll Nielsen will talk about rehabilitation for patients with COPD.

Georgios Stratelis will discuss population screening and case finding for COPD.

Jón Steinar Jónsson will summarize the symposium and be on the lookout for "take home messages".

Please note that this symposium will be followed by three workshops dealing with spirometry, smoking cessation and rehabilitation of COPD, respectively.

S-3. Are you sad, man? Clinical features of depressive syndromes in general practice

Location: Háskólabíó - Hall 2

Monica Löfvander (chair, Sweden, e-mail: This email address is being protected from spam bots, you need Javascript enabled to view it ), Ole Rikard Haavet (Norway), Lise Dyhr (Denmark), Maria Olafsdottir (Iceland), Ranja Strömberg (Sweden), Anita Korhonen (Finland), Reidun Brunvatne (Norway)  

Fewer men than women are believed to be, or become, depressed. However, do doctors recognize the sad men? Do doctors ask men that are seeking help, the right questions? Do doctors notice and acknowledge the significant clinical signs? This symposium will focus on clinical and epidemiological findings in young and middle-aged men from different socio-cultural backgrounds living in the Nordic countries.

Patients that come to practice often display symptoms of being unhappy.  Depression is believed to be less common in men than in women. However, men may manifest their sadness differently than do women. There are various ways to define normal or pathological states of mind. The rating scales that measure depression are perhaps not set up for men´s ways of expressing their feelings, their loss of interest in life, or unhappiness. Sadness is a major criterion for depression but how sadness is manifested is bound to time, social circumstances, culture and probably also to gender.  This symposium presents prevalence data and various clinical aspects of major depression in young and middle-aged men of diverse backgrounds living under different circumstances in the five Nordic countries.

In western societies, boys often seem to be in good shape mentally.  In most studies, less than half as many boys were depressed compared to girls.  However, boys drop out of school twice as often as girls do, and twice as many commit suicide.  How can the GP understand these contradictions and handle the boy´s misery?  This will be discussed based on studies from Norway.  Are men unhappy due to depression or, sadly financial problems, sons of being imprisoned, or because of nightmares? Clinical experiences from a practice in Copenhagen with many psycho-socially deprived or traumatized patients will be presented, as well as study results and clinical experiences, prevalende, clinical features and treatment of depression among male refugees and traumatized war refugees in Norway.  In Sweden, Greek men, Swedish men, and Middle Eastern men with depression were found to manifest their physical and psychiatric symptoms differently.  Swedish men seldom admitted to being unhappy, Greek men suffered from fatigue and Middle Eastern men found it difficult to concentrate. Considering these differences, doctors need to approach each patient according to their ethnicity. In studies from the inner city of Stockholm,Sweden, the symptoms manifested by depressed men in open access differed from women´s manifestations.  In the Reykjanes area, Iceland, 3000 men, aged 18-80, were invited to a post survey study of mental health.  Response rate was 25%.  A chart for finding male depression was validated and cortisol levels were measured.  General information and single symptoms will be discussed.  One third of men in primary care in Vantaa, Finland, indicated symptoms of depression, often combined with heavy drinking.  Screening for both depression and alcohol use seems therefore justified, especially among high-risk groups, such as the unemployed.

Thursday 14:05 PM

S-4. Diabetes care: Improving the quality of care in persons with type 2 diabetes in primary care in the Nordic countries

Location: Háskólabíó - Main Hall

Annelli Sandbæk (chair, Denmark, e-mail: This email address is being protected from spam bots, you need Javascript enabled to view it ), Hördur Björnsson (co-chair, Iceland, e-mail: This email address is being protected from spam bots, you need Javascript enabled to view it ), Klas Winell (Finland), Thomas Drivsholm (Denmark), Tomas Fritz (Sweden), Anne Karen Jenum (Norway)

The gap between the expected and the actual standard and outcome of diabetes care have, in several countries, been the focus of research projects. We will try to illuminate the present quality of diabetes primary care in the Nordic countries. Also describe how general practitioners in the different Nordic countries try to reach the gold standard. Finally discuss the challenges in type 2 diabetes care.

Most of the Nordic countries already have or are in the process of establishing diabetes registers as a tool in their national quality projects.  These registers and studies of quality of care give a unique possibility to compare the diabetes care, in primary and secondary care, between the different countries.

The symposium consists of three parts. The first part will include a common report on the actual quality of care, in primary care, in the different countries, given with central indicators (a mixture of outcome and process indicators). The second part will consist of short reports from all the Nordic countries on experiences from quality projects and trials in the field - especially focusing on barriers for good quality and possible incentives to improve the care. In the final part we focus on the challenges we need to meet in primary care to reach the gold standard of diabetes care.

S-5. The cancer journey: Analysing the general practitioner’s role

Location: Háskólabíó - Hall 1

Jens Søndergaard (chair, e-mail: This email address is being protected from spam bots, you need Javascript enabled to view it ), Marianne Bjerager, Rikke Pilegaard Hansen, Rikke Sand Andersen, Thorbjørn Hougaard Mikkelsen, Mette Asbjørn Neergaard, Peter Vedsted (all Denmark)

The general practitioner (GP) takes care of cancer patients through several important stages from diagnosis through support during hospital treatment and help in coping with psychosocial problems after treatment to rehabilitation, and, if the disease is incurable, to palliative care in the terminal phase. Dealing with these patients is a challenge and there is a lack of knowledge about how these patients are managed in general practice. In this symposium we shall present data on factors associated with delay of diagnosis of cancer, on rehabilitation of cancer patients and on palliative home care. Finally, we will discuss future cancer research in general practice.

Delay in diagnosis and treatment of lung cancer
Marianne Bjerager, MD, GP, PhD*
A Danish GP only sees one new lung cancer case per year. The typical symptoms of lung cancer, cough and dyspnoea, are, on the other hand, very common in general practice. Based on an observational case series of 84 consecutive lung cancer patients’ delay from first presentation in primary health care to referral to secondary health care we present data on delay of diagnosis of lung cancer and factors related to delay.

Delay in diagnosis of cancer
Rikke Pilegaard Hansen, MD, PhD student*,
In order to develop effective interventions, targeted at reducing the delay from symptoms to treatment, it is necessary to quantify and systematically analyze all components involved in the different phases of delay. Based on a cohort study including 3138 newly diagnosed cancer patients and 474 physicians in general practice we present data on patient, GP, and secondary healthcare system delay.

Social norms of illness behaviour associated with delay in seeing a doctor
Rikke Sand Andersen, MSs(Anthropology),
It is well known that individuals respond to suspicious symptoms in different ways. The aim of this study is to increase our understanding of the relationship between social norms of illness behaviour, defined as the way symptoms are perceived, evaluated and acted upon by the patient, and the patient’s decision to consult the doctor. A number of patients have been drawn from the above cohort for qualitative interviews.

Rehabilitation of cancer patients
Thorbjørn Hougaard Mikkelsen, MSc (Soc), PhD student*
Based on qualitative interviews with former cancer patients, GPs and hospital physicians and a questionnaire survey involving 500 patients and their GPs we present the rehabilitation needs and the extent to which these needs are met by the healthcare system and addressed by the GP.

Palliative home care
Mette Asbjørn Neergaard, MD, GP, PhD student* There is only little knowledge about the delivery of care for terminally ill cancer patients in primary care. Bereaved relatives of cancer patients, GPs, home care nurses and hospital physicians all have valuable experiences in successful and unsuccessful delivery of care. Based on both qualitative interviews and questionnaires we present factors associated with successful and unsuccessful palliative home care.

Future cancer research in general practice
Peter Vedsted, MD, PhD, Senior Researcher*
This session will discuss why general practice research is essential to clinical and health services management of cancer in health care, and how general practice can be a strong partner in establishing optimal care for cancer patients.
* Research Unit for General Practice, University of Aarhus, Denmark

S-6. Promoting research in general practice. The Scandinavian Journal of Primary Health Care’s 25th Anniversary Symposium

Location: Háskólabíó - Hall 2

Jakob Kragstrup (chair, Denmark, This email address is being protected from spam bots, you need Javascript enabled to view it ), Anders Håkansson (Sweden), Anders Bærheim (Norway), Johann Agust Sigurdsson (Iceland), Irma Virjo (Finland), Annelli Sandbæk (Denmark), Guri Rortveit (Norway)

SJPHC has been part of a rapid development of general practice in the Nordic countries. Our discipline has moved into the universities and is now recognised as a medical speciality. This symposium puts focus on similarities and differences in academic general practice in the Nordic countries: possibilities of doing research, PhD programmes (“disputation”) and the post doc career. How does the future look? We also focus on the role of the Journal and invite you to drink a toast in celebration of its 25^th anniversary (the last 20 minutes of the symposium will be a reception).

The symposium starts with a summary of the history of academic general practice. What happened and why? What was the added value of general practice for the universities - and has our contribution to research and development been of value for the healthcare systems in the Nordic countries? This will be followed by a status: How is academic general practice organised today in the different countries and what is the outcome. Problems and differences with respect to recruitment, funding, PhD programmes and publishing will be discussed. We will also try a view into the future. What are the likely developments? Does the future look bright for the young doctor moving into academic general practice today? 

The Scandinavian Journal of Primary Health Care (SJPHC) has mirrored the development for 25 years. It has been a platform for publication of research from general practice and for this reason it has been supported by collective subscriptions for all members of the societies for general practice in Denmark, Finland, Iceland, Norway and Sweden. The main content of the Journal has always been peer-reviewed original articles.  This is important to fulfil our mission.  The problem is that few readers will be interested in everything from cover to cover.  Some even find research articles in a standardised format boring, and it has been a running discussion how the Journal could be made more interesting for readers.  Pages for editorial stuff are, however, “expensive”.  We have limited space (4 issues per year with 64 pages in each) and we have to reject almost 70% of the original research articles sent to us.  The so-called “Journal Impact Factor” (which is a quality measure showing how often articles in the Journal are cited in the international scientific literature) is 1.6 at present and similar to that of the other major general practice journals.

At the Scandinavian Journal of Primary Health Care we hope to be part of a continued strong development of general practice and primary health care in the next years.  There is little doubt that electronic publishing will develop further, and we expect a new interplay between the electronic journal and a paper version.

Finally, please join us for a glass of wine

S-7. Meeting the child with health problems in the consultation. High tech or old fashion communication?

Location: Háskólabíó - Hall 3

Margareta Söderström (chair/moderator, Sweden, e-mail: This email address is being protected from spam bots, you need Javascript enabled to view it ), Kirsten Lykke (Denmark), Ruth Kirk Ertmann (Denmark), Christer Petersson (Sweden), Malin André (Sweden)

This symposium will focus on children in primary health care. The consultation with the child always includes an adult / a parent. This encounter is full of pitfalls which are not very much studied. Clinical experiences and empirical results will be used to explore the meeting with the child in the consultation.

One way to study these consultations is to take the parents perspective. What kind of considerations do the parents have before they decide to make a physician appointment? And how do parents understand the physicians’ reasoning and handling? Results from an interview study with parents of small children form the base for this perspective.
 The most common health problem among children is infectious diseases.  Even if respiratory tract infections no longer are a considerable threat to children’s life and health, they still constitute the most common cause of acute morbidity and physician consultations. In a large diary study of symptoms in families with children high concern about infectious illness was shown to be an important determining factor for physician consultations and antibiotic prescription for small children. What are the implications of these findings for the consultation with the parents and the sick child?
 The other arena where we see children in consultations is in preventive child health care. A pressing health issue in that arena is the increasing weight among children.  How do we communicate with over weighted children and their parents?  A study of over weighted school aged children form the base for this perspective.
 Children in preventive child health care are a challenge as to both empower the parents and to identify concealed health problems or development abbreviations in the child. What makes doctors recognize children in need of special attention? And how do physicians talk about it in the consultation? A qualitative study of this interaction forms the base for this perspective.

Thursday 16:00 PM

S-8. Social solidarity or commercial profit - challenges for the 21^st century health care

Location: Háskólabíó - Main Hall

Anna Stavdal (chair, Norway, e-mail: This email address is being protected from spam bots, you need Javascript enabled to view it ), Steinar Westin (co-ordinator, Norway, e-mail: This email address is being protected from spam bots, you need Javascript enabled to view it ), Iona Heath (Great Britain)

Building on public funding, solidarity and equity, the Nordic healthcare systems can be seen as among the most ambitious and vulnerable projects in the modern, globalized world. Nordic general practitioners face numerous challenges and dilemmas linked to our dual role as both the patient’s advocate and guardian of the welfare system. How can we tackle these challenges in a creative and responsible manner?

The Nordic medical systems have much in common with the British National Health Service (NHS) and also the healthcare models in a handful of other countries. However, the combination of public funding, solidarity and equity may be about to become extinct in a world where health care is opened up to private profit and so undergoing a process of commodification. Under the pressure of globalisation and market forces, even Nordic GPs are facing a demanding task when trying to transform high political ideals into practical reality. This happens at a time when countries in the developing world and China as well are showing an increasing interest in the health care organisation of the Nordic countries.
 In this symposium, we will explore the roots and reasons of the welfare state institutions, with free education for all, (almost) free health care for all, and the struggle for social justice and equity. Leading social entrepreneurs from both sides of the North Sea contributed to social contracts and compromises between classes and interests during and after the Second World War, profoundly affecting the ethos and provision of health care in our part of the world. There is a line from Bismarck, via Beveridge and Bevan with his 1948 NHS reform, to today’s issues of health care organisation.
 There are conflicting trends is today’s primary care: Norway adopted a list based system for general practice in 2001, one aim being to increase equity and reduce the amount of “doctor shopping”. At the same time market based solutions may undermine ideals of equity and continuity of care: Walk-in-clinics”, various centres for “instant care”, and direct access to specialized care are introduced in Nordic and even more so in British cities.
 The symposium will make reference to the seminal Lancet paper “The Inverse Care Law” from 1971, by our colleague Julian Tudor Hart. His ideas of patients as co-producers of health and social value, rather than part of a provider/consumer relationship are now interestingly and forcefully explored in his recent (2006) book “The political economy of health care”. We expect him to send a message to the symposium, inspiring questions like these: Is it possible for the profession of medicine to offer an alternative vision to the current capitulation to the medical-industrial complex? Why are market solutions not cost-effective? (“Where there were formally one hundred nurses, there are now one hundred economists.”) How might the Nordic-UK model of healthcare be reinvigorated to respond to the challenge of commercialisation by rediscovering the power of mutuality, social cohesion and inclusivity?
 
PS: Julian Tudor Hart actually has sent a message, here one paragraph cited:
“We in the UK need you in Scandinavia to teach us, not the other way round to help us regain confidence in solidarity, and a proper contempt for profit as motivation for our work. For the past quarter century our leading politicians and professionals have travelled to USA to have their brains washed and their pockets filled in the socially most primitive, but technologically most advanced nation on earth.Only a trickle of pilgrims has travelled to Scandinavia. We need to reverse this by work at both ends.”
Julian Tudor Hart, April 2007

Friday 10:30 AM

S-9. Cardiovascular preventive medicine - dangers and possibilities

Location: Háskólabíó - Main Hall

Irene Hetlevik (chair, Norway, This email address is being protected from spam bots, you need Javascript enabled to view it ), Henrik Sångren (Denmark), Eivind Meland (Norway), Karen-Dorthe Bach Nielsen (Denmark), Thomas Mildestvedt (Norway)

The symposium will highlight several important aspects of cardiovascular preventive medicine. The presenters will focus on qualitative as well as quantitative research, and discuss public health implications as well as clinical and motivational aspects of cardiovascular disease prevention.

1. Accompaniments of hypertension: Changes in perception of body, biography and concept of self.  Following a diagnosis of hypertension patients gradually develop an altered sense of their body. What was perceived as normal everyday bodily sign before the diagnosis, now takes on a different meaning, as these sensations turn into monitors of hypertension. Being diagnosed with hypertension also initiates a process in which patients re-evaluate their lives, building on their biographical experiences, which is re-told and re-interpreted in the light of their hypertension.

2. Preventive cardiology and inequality in cardiovascular health. The point of departure is the epidemiology behind cardiovascular epidemiology: how social determinants and psychosocial stressors influence risk factors and psycho-neuro-hormonal mechanisms leading to heart disease. We further discuss if the “Inverse care law” and “the Matthew effect” should discourage us from engaging in preventive efforts. Or on the contrary: should the social and other inequalities stimulate us for a more proactive preventive role?

3. Long-term impact of elevated cardiovascular risk detected by screening.  Elevated cardiovascular risk is experienced as alarming. Life-style changes are initiated but limited if quality of life is affected adversely. Cardiovascular risk is given less attention when stressful circumstances occur in life, or if other results are normal.  Supporting people's self-efficacy, doctors must be aware of individuals “pain limits” for life style changes and prevent experiences of powerlessness.

4. What are the enabling factors in the rehabilitation after heart disease. We discuss different motivational theories and their relevance for clinical preventive work, and present and discuss studies that might document their evidence. We will present concepts like self-determination, autonomy support, self efficacy and outcome expectancies, and discuss how these concepts may fit in during consultations and dialogues that are characterised by respect and motivational enablement. All presentations will be based on the presenters´ research as well as relevant work performed by others.

S-10. Use of antibiotics and bacterial resistance

Location: Háskólabíó - Hall 1

Morten Lindbæk (chair, Norway e-mail: This email address is being protected from spam bots, you need Javascript enabled to view it ) Sigvard Mölstad (Sweden), Svein Gjelstad (Norway), Vilhjálmur Ari Arason (Iceland), Lars Bjerrum (Denmark)

Is it possible to improve GPs antibiotic prescription habits in respiratory tract infections? This symposium organized by GRIN (General practice Respiratory tract Infections Network) will demonstrate four Nordic studies that show the relation between antibiotic use and resistance and intervention studies to change GP’s prescription habits.

1. Vilhjálmur Ari Arason: Otitis media and pneumococcal resistance.  Acute otitis media in children are the most common reasons for visiting a doctor in primary health care. The prevalence of penicillin-resistant Streptococcus pneumoniae is highest in countries with relatively unrestricted antimicrobial use. It has been low in northern Europe except Iceland where strong association has been shown with carriage of these penicillin-resistant pneumococci among children.
An association has also been observed on the community level between the prescription of oral antimicrobials, changes in prescriptions habits among the GPs in some areas, specifically for acute otitis media, and the cumulative prevalence of tympanostomy tube placements. Parents' expectations of antimicrobial prescriptions are also associated with the doctor's handling of upper respiratory tract infections. The possibility of a causative, positive correlation between antimicrobial drug (over)use for acute otitis media, future episodes of acute otitis media and tympanostomy tube placement later warrants further investigation.

2. Sigvard Mölstad: Results from the work of STRAMA from 1994.   STRAMA was initiated in 1994. The programme includes surveillance of antibiotic use and resistance, implementation of rational use of antibiotics and development of new knowledge. The main goal is to preserve the effectiveness of antimicrobial agents.Yearly validated data on antibiotic use and resistance were made publicly available on a website. Multidisciplinary STRAMA-groups were formed in each county to disseminate knowledge and implement rational antibiotic use. Studies were performed on indications for antibiotic use in out-patient care, hospital care and nursing homes.
Between 1995 and 2004 antibiotic use for out-patients decreased from 15.7 to 12.6 DDD/TID and from 536 to 410 prescriptions/1000 inhabitants and year. The reduction was most prominent for children 5-14 years old (52%) and for macrolides (65%). During the period, the number of hospital admissions for acute mastoiditis, rhinosinusitis and quinsy was stable or declining. Although the penicillin resistant S. pneumoniae was curbed, the national frequency increased from 4 to 6%.

3. Svein Gjelstad: Results from a pedagogic group based intervention in general practice  The aim of this project was to test a model for improving GPs' prescribing practice with an intervention comprised by peer-based, industry-independent drug education targeting the existing continuing medical education peer groups..
The evaluation of this model was conducted as an intervention trial based on cluster randomisation (a peer group representing a cluster).A group of GP specialists, the peer academic detailers (PADs), were trained in the intervention topic, and in communication and pedagogic skills. Each PAD served three peer groups. 40 groups were randomized to intervention for assessing use of antibiotic drugs in respiratory tract infections. 39 groups completed the study. 41 groups were controls. Preliminary results will be presented.

4. Lars Bjerrum: The Happy Audit project   To reduce the occurrence of bacterial resistance by improving the diagnostic tools in order to distinguish between viral and bacterial infections and by using only the appropriate antibiotics in suspected bacterial infections.
The Audit Project Odense (APO) quality development method has been developed and successfully tested among GPs in the Nordic countries. In this project APO will be used at a European level involving some 400 GPs from 12 regions with different cultural background and different organisation of primary health care. Based on results from audit registrations, the team will develop locally adapted intervention programmes, including guidelines, courses for GPs, workshops and patient information leaflets for improving the quality of antibiotic prescription. Research on the effect of preventive measures will be performed by analysing audit registrations carried out before and after the intervention period. Recommendations for health policy at a political level will be prepared. Participant countries: Denmark, Sweden, Lithuania, Russia, Spain, France, Argentina

S-11. Tracing depression among adolescents

Location: Háskólabíó - Hall 2

Frede Olesen (chair, Denmark, e-mail: This email address is being protected from spam bots, you need Javascript enabled to view it ), Ole Rikard Haavet (Norway), Manjit Sirpal (Norway), Kaj Sparle Christensen (Denmark), Wenche Haugen (Denmark)

The proportion of adolescents suffering from depressive disorders is increasingly high. Depressive disorders may be hard to distinguish from adjustment disorders in general practice. How could GPs improve their diagnostic performance in order to improve mental health care among adolescents?

A study group on depression in adolescents has recently been established. A multi-centred study involving the Section for General Practice, University of Oslo, and the Research Unit for General Practice, University of Aarhus is currently in progress. Adolescents aged 14-16 years are invited for depression screening using a self report questionnaire (including the SCL and WHO-5) and three verbally asked key questions. Diagnostic evaluation is performed using the depression module of the CIDI interview. The CIDI diagnoses will be compared with GPs’ awareness of any current depressive disorder. Results will be presented and discussed at the symposium.

1. Ole Rikard Haavet: Literature suggests a high prevalence, but poor GP identification of depression in adolescents. Non-recognition may partly be associated with GPs’ lack of regular contact with young people, lack of diagnostic skills and instruments, and with families’ lack of awareness of depressive symptoms in adolescents. Should general practice adopt new strategies in order to improve recognition rates?

2. Manjit Sirpal: High risk screening for depression is recommended among adults. Which demographic and ethnic characteristics are associated with increased risk of depressive disorders among adolescents? Should high risk screening be recommended among youngsters?

3. Kaj Sparle Christensen: Routine screening for depression seems of little benefit among adults in general practice. Is opportunistic screening for depression in adolescents likely to be more effective than usual GP identification? If so, which questionnaire is the most valid and suitable to be recommended?

4. Wenche Haugen: Three key questions have been found valid in diagnosing depression among adults. Will the same questions be as valid in diagnosing depression among adolescents?

Further information: available on www.ungdep.au.dk

Friday 14:05 PM

S-12. Functional gastrointestinal disorders - current knowledge and future challenges

Location: Háskólabíó - Main Hall

Pål Kristensen and Irene Hetlevik (chairs, Norway, e-mail: This email address is being protected from spam bots, you need Javascript enabled to view it ), Niek de Wit (Holland), Hermod Petersen (Norway), Ture Ålander (Sweden), Anna Luise Kirkengen (Norway)

Functional dyspepsia and irritable bowel disease are frequent, but insufficiently understood and treated. The aim of this symposium is to give the general practitioner a state of the art including reflections upon how life events, thoughts and perceptions may result in symptoms that can be referred to the brain-gut axis. In addition, we shall present the best diagnostic and therapeutic approaches in general practice.

1. Niek de Wit: What can research tell about aetiology, patophysiology, diagnostic approach, and effect of treatment?   The majority of the gastrointestinal complaints that are presented in general practice have a functional background; functional reflux disease, dyspepsia and irritable bowel syndrome constitute between 5 to 10% of all consultations in primary care. Diagnosing functional GI syndromes in general practice is essentially based on the patient‘s symptoms. Expert based diagnostic criteria (such as the Rome lll) have poor validity in general practice, and diagnostic tests hardly contribute to the diagnosis. Many factors are reported to be associated with functional GI syndromes (infections, motility disorders, genetic and neuro-immunologic factors) but a unique causal mechanism is lacking. Intestinal hypersensitivity in relation to altered cerebral cognition (the “brain gut axis”) is generally considered the key concept in the generation of symptoms. Patients with dyspepsia and IBS share common clinical features with other functional syndromes: a high psychosocial burden, altered pain perception, high co-morbidity, high consultation rates and impaired quality of life. The effectiveness of therapeutic interventions is limited. Drug treatment is usually not more effective than placebo (the placebo effect  may reach up to 50%). Life style changes and psychological interventions (CBT, hypnotherapy) may be more effective, but the quality of research so far is disappointing.

2. Hermod Petersen: Side views from a somewhat ”distorted” professor emeritus in gastroenterology.  Can an academic gastroenterologist be a treat to general practice in relation to functional gastrointestinal disorders (FGD)? If yes, what is the solution? What is important when deciding about the need for endoscopies in patients with FGD? What are their most important therapeutic needs? Is there a risk of overemphasizing the psychopathology in patients with FGD?

3. Ture Ålander: A study from Östhammar, Sweden, of dyspepsia and IBS and the role of sexual, physical and emotional abuse in childhood and adulthood.  Research has reported a high prevalence of FGIDs in women who have experienced domestic violence and conversely a high prevalence of abuse in people with FGID. However, most work in this area has excluded men. Our population based study found that in the group with longstanding FGID, a remarkable high proportion, 75% women and 25% men, have experienced sexual, physical or emotional abuse. The implications for the family physician will be discussed.

4. Anna Luise Kirkengen: Abdominal "pains" - are they painful expressions of painful impressions?  Current pain research has documented a disturbing and confusing coexistence of "pains" in many people. The abdominal region seems to harbour a range of possible, apparently different and co-occurring pains. The phenomenon has been termed "overlap of pains" by researchers. "Overlapping pains" transgress the body scheme of medicine. Are such pains to be regarded as medical artefacts? Do they call for interdisciplinary approach? Are they covert expressions for hidden impressions? Do such pains challenge medical theory?

This symposium is a result of collaboration in the European Society for Primary Care Gastroenterology: www.espcg.org

S-13. Medically unexplained symptoms - concept and classification

Location: Háskólabíó - Hall 1

Marianne Rosendal (chair, Denmark, e-mail: This email address is being protected from spam bots, you need Javascript enabled to view it ), Henriette Schou Hansen (Denmark), Mette Bech Risør (Denmark)

The concept of medically unexplained symptoms (MUS) takes on different properties according to our point of departure; i.e. whether we consider the researcher’s, the GP’s or the patient’s perspective. We will present perspectives from the three domains and discuss the challenge of developing a mutual meaningful classification of MUS.

S-14. Traffic medicine in the Nordic countries - the role of the GP

Location: Háskólabíó - Hall 2

Lars Englund (chair, Sweden, e-mail: This email address is being protected from spam bots, you need Javascript enabled to view it ), Haraldur O. Tomasson (Iceland), Veikko Viitasalo (Finland), Mikkel Vass (Denmark), Svein Aarseth (Norway)

What does practice among GPs in the Nordic countries look like when it comes to finding medically unfit car drivers? What is working well and what difficulties do the rules and regulations in the different countries give GPs? What role do the GPs play in rehabilitation and medical controls after a conviction of drunk driving?

 Traffic medicine could be defined as the contribution that the medical profession can give to traffic safety. It contains considerations pre crash, at crash and post crash, involving both the vehicle and the road, but most of all the driver.
 The percentage of all holders of a drivers license that are older than 65 is increasing in all Western countries. In Sweden this means that 1 million older persons out of all 5.5 million (18%) today has a license to drive a personal car. The figure will continue to rise and as most persons born in the 1940-50:s has reached this age we will find a figure in the year 2020 that has doubled up to 2 million older drivers in Sweden. As persons in this age also have been car divers for all their life they will continue to drive which also means that a higher percentage of elderly persons are active drivers. Especially the percentage of older female drivers will rise steeply.
 Many of the older drivers are very fit but we will see an increasing number of persons with age-related diseases that can affect their fitness to drive. Thus there is a need to ensure that persons with diseases that make them dangerous in traffic will be sorted out. In this process society needs the help of doctors and in most cases this doctor will be the local GP. The role of the GP differs in the Nordic countries where some has an obligation for the GP to report to the authorities when a patient is unfit to drive while in other countries there are periodic medical examinations or obligations for the drivers themselves to report.
 The diseases that are most prominent in elderly persons are the ones that affect cognitive functioning as in dementia and with sequelae after a stroke. The dangers in traffic makes these persons at increased risk in accidents at intersections and when not yielding for traffic on a road with more heavy traffic.
 Apart from this there is also the role of the GP when it comes to persons (of all ages) with a diagnosis of dependency or abuse of alcohol. In most Nordic countries a person who had his license revoked after a drunk driving conviction has to prove that he is sober enough to get his license back by giving blood samples and by meeting the GP over a period of time.
 This symposium aims to compare the different roles of the GP in the Nordic countries when it comes to dealing with elderly unfit drivers and with the medical examination of drunk drivers who wants their license back. What are the advantages and draw-backs of the different systems as far as the GP is concerned?

S-15. Preventive mental health work and early interventions in primary care

Location: Háskólabíó - Hall 3

Maria Vuorilehto (chair, e-mail: This email address is being protected from spam bots, you need Javascript enabled to view it ), Anita Korhonen (both Finland)

The symposium will highlight experiences from four programs developing prevention and treatment facilities of depression in primary care, in maternity and child health clinics, and in schools in Finland.

Depression is a highly prevalent, recurrent, clinically heterogeneous and severe illness. It imposes a substantial burden by inflicting continuous pain and suffering on individuals and their families. About a fifth of the population will experience a clinically significant episode of depression at some point in their lives. In primary health care, about 10% of unselected patients suffer from a depressive disorder. Patients with major depressive episodes comprise about half of all visits to psychiatric care in psychiatric settings. However, not more than half of these are usually recognized to suffer from depression. Further, in maternity and child health clinics 10-15% of all mothers giving birth are affected by postpartum depression. Despite of numerous recommendations and development projects undertreatment of depression in primary care and in maternity and child health clinics is unfortunately common in Finland.
 In City of Vantaa, Finland, based on various studies, clinical experience and a pilot study primary health care organization started two programs to develop treatment facilities of depression in primary care: 1. Depression nurse specialist (DNS) in primary health care, and 2. Depression screening and treatment in maternity and child health clinics. Depression Nurse specialist -program emphasizes a close collaboration with DNS, general practitioner (GP) and consultant psychiatrist. GP diagnoses the patients and starts the medication, DNS meets the patients from 4 to 6 times, and psychiatrist is available for consultations from the very beginning. A study on the outcome of the program (n = 108) was carried out in winter 2006. Preliminary results will be available in spring 2007.
 The very basic aim of the Depression screening and treatment in maternity and child health clinics -program was to develop treatment facilities for mothers with postpartum depression, and to help other workers in recognizing and treatment of depression. In this program GP diagnoses mothers and starts the medication if needed, Mental Health Nurse meets mothers and their babies from 4 to 8 times, individually or in groups. A psychiatrist is available for consultations. Continuous education and counseling related to depression and other mental health problems is organized to other personnel working in clinics. Based on unofficial statistics it seems that the need of child and acute psychiatric hospitalization have decreased in the area where the project is carried out. A further study is needed in evaluating the effectiveness of this project.

Friday 16:00 PM

S-16. Chronic care: General practices as main coordinators - implications for practice organisation

Location: Háskólabíó – Main Hall

Søren Friborg (chair, e-mail: This email address is being protected from spam bots, you need Javascript enabled to view it ), Lars Rytter, Tina Eriksson, Peter Vedsted, Per Grinsted (all Denmark)

Chronic care that supports patients’ self care and complies with clinical guidelines and seamless pathways within and between sectors leads to better patient satisfaction, quality of care and cost-effectiveness. The Danish National Health Board recently recommended that general practice take on the role as main coordinators of chronic care. But what does that role imply?

In Denmark, 30-40% of the population lives with one or more chronic conditions. Due to longevity and lifestyle of populations, increased and improved diagnostic procedures, treatments and follow-up the number of patients in need of chronic care will further increase substantially. This will definitely mean an increased workload in general practice. At the same time, evidence about inferior quality of chronic care necessitates that new standards of care are being introduced as well as new ways to secure standards. One of the main challenges for general practice is to help secure chronic diseased patients high standard care in close cooperation with among others the specialised health care sector and the municipalities.
 In Denmark measures to actively secure high quality chronic care are being introduced in diabetes care. A set of quality indicators has been agreed on between sectors and a data capture unit has been developed that makes it possible to measure quality of care in both primary and secondary sector. A general practice specific database has been developed to register data and feed them back to GPs. Moreover risk stratification criteria were developed in order to secure patients the appropriate level of care.
 Besides a need to support and focus on clinical quality, many patients with chronic conditions also experience unsatisfactory managed pathways, e.g. is transfer of patients between sectors not always well organised. In Denmark as well as in other Nordic countries a system of practice coordinators has been put in place to develop shared care and cooperation between practice and hospital. However, in order to secure seamless chronic care, the different responsibilities for the disease management must be clear, placed and agreed on. In Denmark, the National Board of Health recently suggested that general practice take on the responsibility as main coordinators of chronic care management. This role implies several tasks along being proactive and well-prepared. These tasks are e.g. registration of patients with chronic disease, use of reminders, guidelines to set treatment goals, stratification to care level, support patient’s self care, collecting quality data.
 To support the practices in taking on the role as coordinators of care, general practice organisations need to be involved in establishing agreed disease management programs, evidence based guidelines, use of information technology, organisational development of practices and support patient education initiatives.

 S-17. Strengthening primary health care throughout Europe - The European Forum for Primary Care

Location: Háskólabíó – Hall 1

Danica Rotar Pavlic (vice-chair, Slovenia, e-mail: This email address is being protected from spam bots, you need Javascript enabled to view it ), Jan De Maeseneer (chair, Belgium, e-mail: This email address is being protected from spam bots, you need Javascript enabled to view it ), Diederik Aarendonk (coordinator, Holland, e-mail: This email address is being protected from spam bots, you need Javascript enabled to view it )

Strong primary care produces better health outcomes against lower costs, but does not emerge spontaneously. It requires appropriate conditions at the health care system level and in actual practice. Health systems all over Europe are strengthening primary care. Therefore, there is a strong need to collect and share information about what incentive structures and strategies matter.

Aim
By spreading information on Forum activities we are aiming to
- increase involvement of the Nordic Primary Care community in shaping PC in Europe
- shape Future activities and networking of Forum
- lobby in European parliament by establishing a pan European clearing house on organisational aspects of Primary health care and
- exchange examples of best practices in Europe

Methods
The Forum offers opportunities for exchange and it offers to its members information on good and bad practices in primary care through its website and through workshops, seminars and position papers. In addition, it provides news and documents on policy developments at national and international levels. This linking up between policy and practice is a main characteristic of the way the Forum operates. The Forum seeks to communicate its values and vision on health and health care to policymakers at national and international (EU) levels, wherever this may be opportune. The Forum assists in formulating the research agenda.

Who is benefiting from the activities of the Forum?
- The new member states or more in general countries in Eastern and southern Europe that are reforming their health care system. For these countries the Forum provides benefits at all levels: local and national, and in practical and policy matters.
- Local initiatives in countries with a less strong primary care system. It is easier to go against mainstream developments with support from others that show that strong primary care is possible and beneficial to the population’s health.
- Innovators in countries with a strong primary care system. Primary care is not static and also in these countries, individuals and organizations are constantly innovating.
- Policy makers
- Researchers

Results
The European Forum for Primary Care is organizing study visits for policy makers and other professionals working in the field of Primary Care. The first option for subscribing was the multi-country study visit in March 2007, entitled »Working in Multidisciplinary Primary Care Teams, the North Sea tour«.
For a strong primary care within Europe the European Forum for Primary Care presents the process of producing position papers on the following specific sub-domains:
- The management of chronic care conditions in Europe with special reference to diabetes: the pivotal role of Primary Care - Position Paper 2006
- Mental Health in Europe, role and contribution of Primary Care - Position Paper 2006
- Encouraging the people of Europe to practise self care: the primary care perspective - Position Paper 2006
For this year we are planning more study visits, training seminar in Budapest and we are going to publish more Position Papers

Conclusion
The EFPC will connect three groups of interested parties: the health care field, policy makers, and the evaluators of health care information. The symposium will serve as a stimulant of the Forum’s activities among Nordic Primary Care practitioners and researchers.