scholarly journals Symptoms associated with inflammatory arthritis are common in the primary care population: results from the joint symptoms survey

Rheumatology ◽  
2019 ◽  
Vol 58 (11) ◽  
pp. 2009-2014 ◽  
Author(s):  
Samantha L Hider ◽  
Sara Muller ◽  
Toby Helliwell ◽  
James A Prior ◽  
Ian Scott ◽  
...  
Keyword(s):  
Primary Care ◽  
Joint Pain ◽  
Inflammatory Arthritis ◽  
Joint Stiffness ◽  
Treat To Target ◽  
Primary Care Population ◽  
Large Numbers ◽  
Joint Symptoms ◽  
Primary Care Patients ◽  
The Mean

Abstract Objectives To describe the prevalence of self-reported inflammatory joint symptoms, such as joint pain, stiffness and swelling, in UK primary care patients consulting for both musculoskeletal (MSK) and non-musculoskeletal (non-MSK) complaints. Methods A joint symptoms questionnaire survey was sent to 10 161 individuals, of whom 5050 had consulted for MSK problems. These were matched by age, gender and general practice to non-MSK consulters. Participants provided data on relevant symptoms such as joint pain, stiffness and swelling. The prevalence of these symptoms, their severity and impact were compared between MSK and non-MSK consulters. Results A total of 4549 adults responded to the survey (adjusted response 45.8%) of whom 52.3% consulted for a MSK problem. The mean (s.d.) age was 61.6 (14.8) years and 58.9% were female. Persistent (on at least half of the days in the last month) inflammatory symptoms were common even in non-MSK consulters, with 42% reporting joint pain, 36% reporting joint stiffness and 18% reporting joint swelling. This is in comparison with 62% reporting joint pain, 50% stiffness and 24% swelling among MSK consulters. Conclusions Although symptoms such as persistent joint pain, swelling and stiffness are predictive of inflammatory arthritis, large numbers of people consulting primary care for non-MSK reasons report these symptoms when asked by questionnaire. This compounds the challenges of diagnosing inflammatory arthritis in a non-specialist setting where new approaches are needed to ensure accurate, early diagnosis, facilitating a treat-to-target approach.

scholarly journals Prevalence and factors associated with multimorbidity among primary care patients with decreased renal function

PLoS ONE ◽  
2021 ◽  
Vol 16 (1) ◽  
pp. e0245131
Author(s):  
Jennifer A. Hirst ◽  
José M. Ordóñez Mena ◽  
Chris A. O’Callaghan ◽  
Emma Ogburn ◽  
Clare J. Taylor ◽  
...  
Keyword(s):  
Primary Care ◽  
Logistic Regression ◽  
Renal Function ◽  
Accurate Estimate ◽  
Secondary Outcome ◽  
Factors Associated ◽  
Primary Care Population ◽  
Primary Care Patients ◽  
The Mean ◽  
Common Combination

Objectives To establish the prevalence of multimorbidity in people with chronic kidney disease (CKD) stages 1–5 and transiently impaired renal function and identify factors associated with multimorbidity. Design and setting Prospective cohort study in UK primary care. Participants 861 participants aged 60 and older with decreased renal function of whom, 584 (65.8%) had CKD and 277 (32.2%) did not have CKD. Interventions Participants underwent medical history and clinical assessment, and blood and urine sampling. Primary and secondary outcome measures Multimorbidity was defined as presence of ≥2 chronic conditions including CKD. Prevalence of each condition, co-existing conditions and multimorbidity were described and logistic regression was used to identify predictors of multimorbidity. Results The mean (±SD) age of participants was 74±7 years, 54% were women and 98% were white. After CKD, the next most prevalent condition was hypertension (n = 511, 59.3%), followed by obesity (n = 265, 30.8%) ischemic heart disease (n = 145, 16.8%) and diabetes (n = 133, 15.4%). Having two co-existing conditions was most common (27%), the most common combination of which was hypertension and obesity (29%). One or three conditions was the next most prevalent combination (20% and 21% respectively). The prevalence of multimorbidity was 73.9% (95%CI 70.9–76.8) in all participants and 86.6% (95%CI 83.9–89.3) in those with any-stage CKD. Logistic regression found a significant association between increasing age (OR 1.07, 95%CI 1.04–0.10), increasing BMI (OR 1.15, 95%CI 1.10–1.20) and decreasing eGFR (OR 0.99, 95%CI 0.98–1.00) with multimorbidity. Conclusions This analysis is the first to provide an accurate estimate of the prevalence of multimorbidity in a screened older primary care population living with or at risk of CKD across all stages. Hypertension and obesity were the most common combination of conditions other than CKD that people were living with, suggesting that there may be multiple reasons for closely monitoring health status in individuals with CKD.

Disease activity assessment in rheumatoid arthritis

2020 ◽  
pp. 161-168
Author(s):  
Josef Smolen
Keyword(s):  
Rheumatoid Arthritis ◽  
Disease Activity ◽  
Joint Pain ◽  
Joint Stiffness ◽  
Treat To Target ◽  
Therapeutic Decision ◽  
Activity Assessment ◽  
Disease Modifying ◽  
Therapeutic Decision Making ◽  
Disease Activity Assessment

The major clinical hallmarks of rheumatoid arthritis (RA) are articular swelling, joint pain, and morning joint stiffness. Disease activity assessment is pivotal when following patients with RA throughout the course of their disease, and especially when assessing improvement or deterioration upon institution of the necessary therapies. To prevent an adverse outcome, it is essential to diagnose the disease early and to start treatment with disease-modifying antirheumatic drugs (DMARDs) immediately after diagnosis. Adhering to the treat-to-target approach, which is a central strategy irrespective of the type of treatment available and the therapy applied, requires consistency in using validated composite measures of disease activity. Rather than a mere matter of using specific therapies, it is also a matter of using tools for disease activity assessment to guide therapeutic decision-making. This enables offering and achieving the best possible outcomes for RA patients.

scholarly journals Cross-sectional associations between inflammation, sickness behaviour, health anxiety and self-rated health in a Swedish primary care population

2019 ◽  
Vol 17 ◽  
pp. 205873921984435 ◽  
Author(s):  
Karin Lodin ◽  
Mats Lekander ◽  
Predrag Petrovic ◽  
Gustav Nilsonne ◽  
Erik Hedman-Lagerlöf ◽  
...  
Keyword(s):  
Primary Care ◽  
Interleukin 6 ◽  
Health Anxiety ◽  
Health State ◽  
Sickness Behaviour ◽  
Cross Sectional ◽  
Primary Care Population ◽  
Self Rated Health ◽  
Primary Care Patients ◽  
Low Levels

This study investigated associations between inflammatory markers, sickness behaviour, health anxiety and self-rated health in 311 consecutive primary care patients. Poor self-rated health was associated with high sickness behaviour ( ρ = 0.28, P < 0.001; ρ = 0.42, P = 0.003) and high health anxiety ( ρ = 0.31, P < 0.001; ρ = –0.32, P = 0.003). High levels of interleukin 6 were associated with poor self-rated health in men ( ρ = 0.26, P = 0.009). Low levels of interleukin-6 were associated with poor self-rated health in women ( ρ = –0.15, P = 0.04), but this association was non-significant when adjusted for health anxiety ( ρ = –0.08, P = 0.31). These results are consistent with the theory that interoceptive processes draw on both inflammatory mediators and the state of sickness behaviour in inferring health state.

scholarly journals Development of a diagnostic decision tree for obstructive pulmonary diseases based on real-life data

2016 ◽  
Vol 2 (1) ◽  
pp. 00077-2015 ◽  
Author(s):  
Esther I. Metting ◽  
Johannes C.C.M. in ’t Veen ◽  
P.N. Richard Dekhuijzen ◽  
Ellen van Heijst ◽  
Janwillem W.H. Kocks ◽  
...  
Keyword(s):  
Primary Care ◽  
Decision Tree ◽  
Pulmonary Disease ◽  
External Validation ◽  
Real Life ◽  
Computer Assisted ◽  
Obstructive Pulmonary Disease ◽  
Primary Care Population ◽  
Interaction Detection ◽  
Primary Care Patients

The aim of this study was to develop and explore the diagnostic accuracy of a decision tree derived from a large real-life primary care population.Data from 9297 primary care patients (45% male, mean age 53±17 years) with suspicion of an obstructive pulmonary disease was derived from an asthma/chronic obstructive pulmonary disease (COPD) service where patients were assessed using spirometry, the Asthma Control Questionnaire, the Clinical COPD Questionnaire, history data and medication use. All patients were diagnosed through the Internet by a pulmonologist. The Chi-squared Automatic Interaction Detection method was used to build the decision tree. The tree was externally validated in another real-life primary care population (n=3215).Our tree correctly diagnosed 79% of the asthma patients, 85% of the COPD patients and 32% of the asthma–COPD overlap syndrome (ACOS) patients. External validation showed a comparable pattern (correct: asthma 78%, COPD 83%, ACOS 24%).Our decision tree is considered to be promising because it was based on real-life primary care patients with a specialist's diagnosis. In most patients the diagnosis could be correctly predicted. Predicting ACOS, however, remained a challenge. The total decision tree can be implemented in computer-assisted diagnostic systems for individual patients. A simplified version of this tree can be used in daily clinical practice as a desk tool.

scholarly journals Evaluation of the 13-item Hypomania Checklist and a brief 3-item manic features questionnaire in primary care

2017 ◽  
Vol 41 (4) ◽  
pp. 187-191 ◽  
Author(s):  
Sukhmeet Singh ◽  
Paul Scouller ◽  
Daniel J. Smith
Keyword(s):  
Primary Care ◽  
Bipolar Disorder ◽  
Clinical Implications ◽  
Predictive Values ◽  
Mean Delay ◽  
Item Questionnaire ◽  
Primary Care Patients ◽  
The Mean ◽  
Recorded Diagnosis

Aims and methodThe mean delay for bipolar disorder diagnosis is 10 years. Identification of patients with previous hypomania is challenging, sometimes resulting in misdiagnosis. The aims of this study were: (a) to estimate the proportion of primary care patients with depression currently taking antidepressants who have undiagnosed bipolar disorder and (b) to compare a brief 3-item manic features questionnaire with the Hypomania Checklist (HCL-13). The sample comprised patients with a recorded diagnosis of depression, either on long-term antidepressant therapy or with previous multiple courses of antidepressants.ResultsOf 149 participants assessed, 24 (16.1%) satisfied criteria for bipolar disorder. Areas under the curve (AUC) for the 3-item questionnaire and the HCL-13 were similar (0.79 and 0.72, respectively) but positive predictive values (PPV) were low.Clinical implicationsBipolar disorder may be underdiagnosed in primary care. A 3-item questionnaire could be used by general practitioners to screen for bipolar disorder in their patients with depression.

Trauma and Posttraumatic Stress Disorder in a Rural Primary Care Population in South Africa

2007 ◽  
Vol 100 (3_suppl) ◽  
pp. 1115-1120 ◽  
Author(s):  
K. Peltzer ◽  
M. J. Seakamela ◽  
L. Manganye ◽  
K. G. Mamiane ◽  
M. S. Motsei ◽  
...  
Keyword(s):  
South Africa ◽  
Primary Care ◽  
Unexpected Death ◽  
Rural Primary Care ◽  
Primary Care Population ◽  
Life Threatening Illness ◽  
Life Threatening ◽  
Primary Care Patients ◽  
Serious Injury ◽  
A Current

The aim of this study was to assess trauma events experienced and PTSD among 250 consecutive rural primary clinic patients (all Black Africans, 24% male and 76% female; M age 31.1 yr., SD = 11.8; range 18–65 years) in South Africa using the Trauma History Questionnaire and the PTSD Checklist-Civilian Version, interview administered. Results indicated that the mean number of traumatic events reported was 3.5 ( SD = 2.9, range = 0–19) and was significantly higher among men ( M = 4.9, SD = 3.5) than women ( M = 3.0, SD = 2.6). Among the most frequently endorsed traumas among men were seeing someone seriously injured or killed (60%), serious accident (43.3%), and seeing dead bodies (43.3%), and among women natural disaster (mostly floods) (51.6%), news of a serious injury, life-threatening illness or unexpected death of someone close (31.1%), and seeing someone seriously injured or killed (30%). A current diagnosis of PTSD was found in 12.4%) of the sample. Trauma incidence figures were high ( M = 3.5) and were comparable with an urban Xhosa primary care population in South Africa ( M = 3.8). A current indicative diagnosis of PTSD of 12.4%) also compares with other studies; 19.9% among urban Xhosa primary care patients and 11.8% among American primary care patients.

scholarly journals Promoting Collaborative Goal Setting for Cancer Prevention Among Primary Care Patients: Pilot Testing a New Application (Preprint)

2020 ◽  
Author(s):  
Daniel Resnick ◽  
Marilyn M. Schapira ◽  
Jazmine M. Smith ◽  
Allison Bautista ◽  
Chang Xu ◽  
...  
Keyword(s):  
Primary Care ◽  
Cancer Prevention ◽  
Goal Setting ◽  
Behavioral Change ◽  
Mobile Application ◽  
Primary Care Providers ◽  
Care Providers ◽  
System Usability Scale ◽  
Primary Care Patients ◽  
The Mean

BACKGROUND Many newly diagnosed cancers are associated with modifiable lifestyle behaviors, such as diet, exercise, smoking cessation, and maintaining a healthy weight. Despite this, primary care providers rarely discuss cancer prevention behaviors with their patients. OBJECTIVE To assess the usability, acceptability and engagement of the Healthier Together mobile application, which is designed to promote cancer prevention behaviors among Non-Hispanic Black primary care patients, utilizing social network and goal setting theories of behavior change. METHODS In an eight-week pilot study, we enrolled primary care patients (n=41) and provided these participants with a cancer prevention mobile application that allowed them to select, track, and share progress on cancer prevention goals with other users. We assessed application usability with the System Usability Scale (SUS). We assessed app acceptability by qualitatively analyzing open-ended responses about participants’ overall experience with the app. We assessed participant engagement by analyzing the built-in data capture, including how many times participants checked in (out of a maximum of eight) during the study. RESULTS Of 41 participants, the mean age was 51 (SD: 12) and 31 (76%) were women. App use data was captured for all participants and 34 (83%) completed the exit survey and interview. The mean SUS score was 87 (SD ±12; median 90; IQR 78-95). Analysis of open-ended responses revealed several key themes, with participants complementing the application’s ease of use and health behavior promoting features, while also commenting on the need for more feedback and social interactions through the application. On average, participants checked in 5.7 times (SD: 2.7) out of eight possible opportunities. Thirty-one participants (76%) checked in during at least 4 of the 8 weeks. Secondary analyses revealed that participants often accomplished their set goal (mean: 5.1, SD: 2.7) for each week. Qualitative analysis of comments participants left within the app after each weekly check-in revealed several themes on how the app assisted participants in behavioral change, highlighting that some participants built up exercise programs, ate healthier foods, lost a significant amount of weight, and stopped smoking during the study. CONCLUSIONS The implementation of a mobile cancer prevention goal setting application in a primary care setting was feasible with high usability, acceptability, and engagement from participants. User feedback revealed an influence on health behaviors. These findings suggest the promise of the HT application to facilitate behavioral change to reduce cancer risk among Non-Hispanic Black primary care patients.

Abstract P131: Associations Between Joint Symptoms and Prospective Changes in Physical Activity in First-degree Relatives of Rheumatoid Arthritis (RA) Patients

Circulation ◽  
2016 ◽  
Vol 133 (suppl_1) ◽  
Author(s):  
Jan M Hughes-Austin ◽  
Joachim H Ix ◽  
Samuel R Ward ◽  
Michael H Weisman ◽  
James R O’Dell ◽  
...  
Keyword(s):  
Physical Activity ◽  
Joint Pain ◽  
Joint Stiffness ◽  
Cvd Risk ◽  
First Degree Relatives ◽  
Increased Risk ◽  
Joint Symptoms ◽  
Metabolic Expenditure ◽  
Mtp Joints ◽  
Over Time

Background: CVD is accelerated in RA, and risk of CVD death is 50% higher in RA patients. Physical activity (PA) mitigates increased CVD risk, but RA patients typically have less PA. It is not known whether PA declines prior to RA onset, or whether joint symptoms (sxs) contribute to PA decline. We sought to determine whether RA-related joint sxs were associated with PA over time in first-degree relatives (FDRs) of RA patients, a population at increased risk for future RA. Methods: In the Studies of the Etiology of RA (SERA), we evaluated associations between presence of joint sxs and hours of PA in 878 FDRs; of whom, 376 had ≥2 visits. A physician confirmed joint swelling; participants self-reported stiffness and pain in the wrist, elbow, or any MCP, PIP, or MTP joints. Hours sleeping, sitting, and performing slight, moderate, or heavy activity during a typical 24-hour day were obtained through questionnaire, weighted to reflect metabolic expenditure, and calculated as follows: PA = (1.0*h sleep + 1.1*h sedentary + 1.5*h slight + 2.4*h moderate + 5.0*h heavy ). Linear mixed models were used to evaluate associations between joint sxs and change in PA over time, adjusting for age, sex, race, BMI, smoking, and positivity for RA-related autoantibodies Results: Mean baseline age was 50±16 years. 74% were female, 78% were White, 7% had joint swelling, 15% had joint stiffness, and 24% had joint pain. Average PA was 37±7. At baseline, PA was higher in FDRs with joint stiffness (B=1.27±0.64, p=0.05) and joint pain (B=1.43±0.54, p=0.01), and lower in FDRs with joint swelling (B=-1.50±0.91, p=0.10). Adjusting for baseline PA, baseline joint swelling, stiffness, and pain were not significantly associated with changes in PA. However, change in joint swelling was associated with increased PA; and changes in joint stiffness and pain were associated with decreased PA. (Table) Conclusion: Joint sxs may not predict future PA, but PA may be lower at the time joint sxs occur. Clinicians should address joint sxs as part of their PA intervention in CVD prevention.

The effect of different analytical platforms and methods on the performance of population-specific adjusted calcium equation

2020 ◽  
Vol 57 (4) ◽  
pp. 300-311 ◽  
Author(s):  
N Jassam ◽  
D Narayanan ◽  
D Turnock ◽  
G Lee ◽  
K Earp ◽  
...  
Keyword(s):  
Primary Care ◽  
Diagnostic Value ◽  
Recent Attempt ◽  
Data Sets ◽  
Primary Care Population ◽  
Primary Care Patients ◽  
Specific Equation ◽  
New Equation ◽  
Analytical Platforms ◽  
Adjustment Equation

Background A recent attempt to improve the diagnostic value of adjusted calcium addressed a primary care-specific adjusted calcium equation, but validated the new equation for Roche Cobas, BCG and NM-BAPTA methods only. In this study, we aim to validate a population-specific equation for other methods and platforms. Method We collected retrospective patient data-sets from 15 hospital laboratories using a range of commercially available analytical platforms and methods for calcium and albumin measurements. Raw data-sets were collected and filtered according to Payne’s criteria, and separate adjusted calcium equations were derived for hospitalized and primary care patients. Results Mean albumin and calcium results were significantly higher in primary care populations ( P <  0.0001). The prevalence of hypocalcaemia using adjusted calcium ranged between 6% and 44% for inpatient data-sets and was higher in users of BCG methods. The application of community-specific adjustment equation to primary care data-sets reduced the prevalence of hypocalcaemia (mean 1.7%, range 0.8–3.7%). Conclusion We demonstrated that the use of a community-specific calcium adjustment equation to a primary care population reduces both the percentage and the variation of hypocalcaemia between different laboratories.

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