BackgroundIn many countries, substitution of physicians by nurses has become common due to the shortage of physicians and the need for high-quality, affordable care, especially for chronic and multi-morbid patients. We examined the evidence on the clinical effectiveness and care costs of physician-nurse substitution in primary care.MethodsWe systematically searched OVID Medline and Embase, The Cochrane Library and CINAHL, up to August 2012; selected and critically appraised published randomised controlled trials (RCTs) that compared nurse-led care with care by primary care physicians on patient satisfaction, Quality of Life (QoL), hospital admission, mortality and costs of healthcare. We assessed the individual study risk of bias, calculated the study-specific and pooled relative risks (RR) or standardised mean differences (SMD); and performed fixed-effects meta-analyses.Results24 RCTs (38,974 participants) and 2 economic studies met the inclusion criteria. Pooled analyses showed higher overall scores of patient satisfaction with nurse-led care (SMD 0.18, 95% CI 0.13 to 0.23), in RCTs of single contact or urgent care, short (less than 6 months) follow-up episodes and in small trials (N ≤ 200). Nurse-led care was effective at reducing the overall risk of hospital admission (RR 0.76, 95% CI 0.64 to 0.91), mortality (RR 0.89, 95% CI 0.84 to 0.96), in RCTs of on-going or non-urgent care, longer (at least 12 months) follow-up episodes and in larger (N > 200) RCTs. Higher quality RCTs (with better allocation concealment and less attrition) showed higher rates of hospital admissions and mortality with nurse-led care albeit less or not significant. The results seemed more consistent across nurse practitioners than with registered or licensed nurses. The effects of nurse-led care on QoL and costs were difficult to interpret due to heterogeneous outcome reporting, valuation of resources and the small number of studies.ConclusionsThe available evidence continues to be limited by the quality of the research considered. Nurse-led care seems to have a positive effect on patient satisfaction, hospital admission and mortality. This important finding should be confirmed and the determinants of this effect should be assessed in further, larger and more methodically rigorous research.

The aims of this study were (1) to investigate the participation and performance trends at the '100 km Lauf Biel' in Switzerland from 1998 to 2010, and (2) to compare the age-related changes in 100-km running performance between males and females. For both sexes, the percent of finishers significantly (P<0.01) decreased for the 18-29 and the 30-39-year age groups, while it significantly (P<0.01) increased for the 40-49 and the 50-59-year age groups over the studied period. From 1998 to 2010, the mean age of the top ten finishers increased by 0.4 years per annum for both females (P=0.02) and males (P=0.003). The running time for the top ten finishers remained stable for females, while it significantly (P=0.001) increased by 2.4 min per annum for males. There was a significant (P<0.001) age effect on running times for both sexes. The best 100-km running times was observed for the age comprised between 30 and 49 years for males, and between 30 and 54 years for females, respectively. The age-related decline in running performance was similar until 60-64 years between males and females, but was greater for females compared to males after 65 years. Future studies should investigate the lifespan from 65 to 75 years to better understand the performance difference between male and female master ultra-marathoners.

Background The coronavirus disease 2019 (COVID-19) pandemic has resulted in a strong negative impact on economic and social life worldwide. It has also negatively influenced people’s general health and quality of life. The aim of the present study was to study the impact of social distancing on physical activity level, and the association between mood state (depression and anxiety level) or sex with actual physical activity levels, the change in physical activity caused by social distancing period, the adhesion level to social distancing, the adoption time of social distancing, family income and age. Methods A self-administered questionnaire with personal, quarantine, physical activity, and mood state disorders information’s was answered by 2140 Brazilians of both sex who were recruited through online advertising. Results The physical activity level adopted during the period of social distancing (2.9 ± 1.1) was lower than that adopted prior to the pandemic period (3.5 ± 0.8, p < 0.001). Thirty percent of the participants presented symptoms of moderate/severe depression and 23.3% displayed moderate/severe anxiety symptoms. A greater presence of symptoms related to anxiety and depression were associated with low physical activity levels, low family monthly income, and younger age. A higher percentage of men who had no mood disorders was observed among those who were very active than among those less active. Conclusion The COVID-19 pandemic has a negative impact on physical activity. Those who reduced their level of physical activity had the highest levels of mood disorders. Therefore, physical activity programs should be encouraged, while respecting the necessary social distancing to prevent the spread of Severe Acute Respiratory Syndrome Coronavirus 2.

Background: Osteoarthritis (OA) is highly prevalent and has substantial impact on quality of life as well as on healthcare costs. The general practitioner (GP) often is the first care provider for patients with this chronic disease. The aim of this study was to identify health care needs of patients with OA and to reveal possible obstacles for improvements in primary care management of OA patients.

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