scholarly journals Risk factors, early presentations, and clinical markers of Parkinson's disease in Primary Care in a diverse UK population

2021 ◽  
Author(s):  
Cristina Simonet ◽  
Jonathan P Bestwick ◽  
Mark Jitlal ◽  
Aaron Ben-Joseph ◽  
Charles R Marshall ◽  
...  
Keyword(s):  
Risk Factors ◽  
Primary Care ◽  
Hearing Loss ◽  
Access To Health Care ◽  
Universal Access ◽  
Surrogate Marker ◽  
Final Diagnosis ◽  
Population Based ◽  
Clinical Markers ◽  
Health Care Design

Importance: Predictors of future Parkinson′s disease (PD) have been suggested through population-based studies, but these studies over–represent white, affluent groups and may not be generalisable. Objective: To investigate the association between risk factors and pre–diagnostic presentations of PD in a uniquely diverse UK population, with universal access to health care. Design, Setting, and Participants: A case–control study was conducted in East London, using primary care health records. Main outcomes and Measures: Logistic regression was used to determine associations between risk factors and pre–diagnostic presentations of PD with final diagnosis. Three periods (recorded <2 years, 2–5 years, and 5–10 years prior to diagnosis) were analysed. Results: Primary care records were available for 1,055 patients with PD and 1,009,523 controls. The strongest associations were found for tremor (OR, 181.69; 95% CI, 151.91–217.31) and ′memory complaints′ (OR, 9.84; 95% CI, 7.39–13.11), <2 years before PD diagnosis. However, associations for both complaints persisted up to 10 years prior to PD diagnosis. Shoulder pain was more common in those who developed PD, emerging 5 to 10 years prior to diagnosis (OR, 2.54; 95% CI, 1.77–3.65), and may be a surrogate marker for rigidity. Epilepsy showed a strongest association with subsequent PD (OR, 5.14; 95% CI, 1.26–21.0), and associations were also found for hypertension (OR, 1.71; 95% CI, 1.34–2.17) and type 2 diabetes (OR, 1.57; 95% CI, 1.31–1.87) 5 to 10 years before diagnosis. We replicated several known associations with early non motor features including hypotension, constipation, and depression. A weak but novel association was observed with prodromal hearing loss and subsequent PD, which appeared up to 10 years prior to diagnosis. No associations with future PD diagnosis were found for ethnicity or deprivation index. Conclusions and relevance: This study provides further evidence that a range of comorbidities and pre-diagnostic presentations are encountered in primary care prior to PD diagnosis, but for the first time in such a diverse and deprived population. Convincing temporal associations were observed for epilepsy and hearing loss with subsequent PD. The predominance of ′memory symptoms′ hints at an excess of cognitive dysfunction in early PD in this population or difficulty in correctly ascertaining symptoms in traditionally under–represented groups.

scholarly journals Access to cancer care in northwestern Ontario—a population-based study using administrative data

2020 ◽  
Vol 27 (3) ◽  
Author(s):  
M. Febbraro ◽  
M. Conlon ◽  
J. Caswell ◽  
N. Laferriere
Keyword(s):  
Administrative Data ◽  
Urban Areas ◽  
Access To Health Care ◽  
Universal Access ◽  
Population Based ◽  
Ontario Health Insurance Plan ◽  
Cancer Data ◽  
Factors Associated ◽  
Specialist Consultation ◽  
Northwestern Ontario

Background: Despite universal access to health care in Canada, disparities exist relating to social determinants of health, which contribute to discrepancies in cancer incidence and outcomes between rural and urban areas. Given that Canada has one of the highest-quality national population-based cancer registry systems in the world and there is little information regarding cancer statistics specific to northwestern Ontario, the purpose of this study was to estimate the percentage of cancer patients without documentation of a specialist consultation (medical or radiation oncology consultation) and to determine factors that affect access to specialist consultation in northwestern Ontario. Methods: This was a population-based retrospective study using administrative data. Administration data was obtained through the Ontario Cancer Data Linkage Project. For each index case, a timeline was constructed of all Ontario Health Insurance Plan billing codes and associated service dates starting with primary cancer diagnosis and ending with death. Specific factors affecting access to specialist consultation were assessed. Results: Within the 6 year study period (2010-2016), 2583 index cases were identified. Most (n=2007, 78%) received a specialist consultation. Factors associated with not receiving a specialist consultation included older age (p<0.0001, OR 0.29; 95% CI 0.19-0.44) and rural residence (p<0.0001, OR 0.48; 95% CI 0.48-0.72). Factors associated with receiving a specialist consultation included increased duration of disease (p< 0.0001, OR 1.32; 95% CI 1.19-1.46), a diagnosis of breast cancer (p < 0.0001, OR 2.51; 95% CI 1.43-4.42), and a diagnosis of lung cancer (p< 0.0001, OR 1.77; 95% CI 1.38-2.26).   Conclusions: These findings are consistent with the other studies assessing access to care barriers, but is the first to look at care access in northwestern Ontario. Further research is needed to examine gaps in care relating to access to primary referral services, symptom recognition, cancer screening, and travel associated burdens specific to northwestern Ontario.

Prevalence and 5-Year Incidence of Tinnitus among Older Adults: The Epidemiology of Hearing Loss Study

2002 ◽  
Vol 13 (06) ◽  
pp. 323-331 ◽  
Author(s):  
David M. Nondahl ◽  
Karen J. Cruickshanks ◽  
Terry L. Wiley ◽  
Ronald Klein ◽  
Barbara E. K. Klein ◽  
...  
Keyword(s):  
Risk Factors ◽  
Older Adults ◽  
Hearing Loss ◽  
Population Based ◽  
Modifiable Risk Factors ◽  
Population Based Study ◽  
Beaver Dam ◽  
Falling Asleep ◽  
Reported Data ◽  
Baseline Examination

Tinnitus (ringing or buzzing in the ear or head) can range from barely noticeable to debilitating. Although a few studies have estimated the prevalence of this condition in adult populations, we know of no population-based estimates of incidence. As part of a population-based study of hearing loss in adults aged 48 to 92 years at baseline in Beaver Dam, Wisconsin, self-reported data on tinnitus were obtained at the baseline examination (1993–1995; N = 3753) and again 5 years later (1998–2000; N = 2800). A person was classified as having tinnitus if their tinnitus was at least moderate in severity or caused difficulty in falling asleep. The prevalence of tinnitus at baseline was 8.2 percent. The 5-year incidence of tinnitus among the 2513 participants at risk was 5.7 percent. Risk factors for prevalent and incident tinnitus were evaluated. The results suggest that tinnitus is a common problem for older adults and is associated with some modifiable risk factors.

scholarly journals 296. The Hepatitis C Cascade of Care across Four Safety Net Settings in the Southeast

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S160-S161
Author(s):  
Asher J Schranz ◽  
Michael Kovasala ◽  
Candice Givens ◽  
Alison Hilton ◽  
Courtney Maierhofer ◽  
...  
Keyword(s):  
Risk Factors ◽  
Primary Care ◽  
Hepatitis C ◽  
Sustained Viral Response ◽  
Community Outreach ◽  
Linkage To Care ◽  
Health Department ◽  
Safety Net ◽  
Population Based ◽  
Lower Odds

Abstract Background Despite advances in antivirals, disparities in hepatitis C (HCV) treatment remain. We evaluated persons diagnosed with HCV in 4 safety net sites in a large Southeastern county, using care cascades to conceptualize milestones in treatment. Methods Persons diagnosed with HCV in 4 screening sites across Durham County, North Carolina, from December 2015 to May 2018 were included, allowing for 9 months of follow-up. Sites included the county health department (CHD), a federally qualified health center (FQHC) where providers trained in HCV care, jail and community outreach. Persons with HCV were eligible for a bridge counselor intervention to enhance linkage to care with an HCV-treating provider (either primary care or specialist). Outcomes were monitored by chart review. Persons linked to care in the prison (n = 36) were censored from subsequent cascade steps due to inability to obtain records. Cascades were compared by the site of diagnosis. Multivariable logistic regression was used to evaluate predictors of being prescribed antivirals. Results 505 persons were diagnosed with HCV: 216 in the FQHC, 158 in the jail, 72 in the CHD, and 59 in community outreach. Overall, 89% were counseled on their diagnosis, 65% were linked to care, 41% prescribed antivirals, 38% started medications, 34% completed medications and 24% achieved sustained viral response at 12 weeks (SVR-12). Progression through the cascade was highest for those diagnosed at the FQHC (figure). In analyses adjusted for demographics and risk factors, diagnosis in a community outreach setting had lower odds of antiviral prescription, compared with diagnosis in the FQHC (OR 0.33, 95% CI 0.12–0.89). Linkage to care at a specialist clinic (vs. primary care) was associated with antiviral prescription (OR 3.82, CI 1.95–7.46). Sex, race/ethnicity, insurance status and HCV risk factors were not associated with antiviral prescription. Conclusion Among persons diagnosed with HCV across four safety net sites, a quarter achieved SVR-12. Those diagnosed in community outreach had lower odds of antiviral prescription, and those who were linked to a specialist were more likely to receive antiviral prescription. Improving progression through cascade milestones across safety-net settings is integral to improving population-based HCV outcomes. Disclosures All authors: No reported disclosures.

scholarly journals Fracture prevention: a population-based intervention delivered in primary care

QJM ◽  
2019 ◽  
Vol 113 (5) ◽  
pp. 313-319
Author(s):  
K Hoggard ◽  
S Hart ◽  
J Birchall ◽  
S Kirk ◽  
I Goff ◽  
...  
Keyword(s):  
Risk Factors ◽  
Primary Care ◽  
Treatment Options ◽  
Clinical Excellence ◽  
Fracture Prevention ◽  
Population Based ◽  
Osteoporosis Diagnosis ◽  
Nice Guidance ◽  
Risk Patients ◽  
History Of

Abstract Background Osteoporosis is common, increasing as the population ages and has significant consequences including fracture. Effective treatments are available. Aim To support proactive fracture risk assessment (FRAX) and optimizing treatment for high-risk patients in primary care. Design Clinical cohort Setting November 2017 to November 2018, support was provided to 71 practices comprising 69 of 90 practices within two National Health Service Clinical Commissioning Groups areas. Total population 579 508 (207 263 aged over 50 years). Participants FRAX (National Institute for Care and Clinical Excellence, NICE CG146) in (i) males aged 75 years and over, (ii) females aged 65 years and over, (iii) females aged under 65 years and males aged under 75 years with risk factors and (iv) under 50 years with major risk factors. Results A total of 158 946 met NICE CG146, 11 961 were coded with an osteoporosis diagnosis (7.5%), of those, 42% were prescribed treatment with a bone sparing agent (BSA). In total, 6942 were assessed to initiate BSA. Thirty percent of untreated osteoporosis diagnosis patients had never been prescribed BSA. Even when prescribed, 1700 people (35%) were for less than minimum recommended duration. Of the total 9784 patients within the FRAX recommended to treat threshold, 3197 (33%) were currently treated with BSA and 3684 (37%) had no history of ever receiving BSA. From untreated patients, expected incidence of 875 fractures over a 3-year period (approximately £3.4 million). Treatment would prevent 274 fractures (cost reduction: £1 274 045, with prescribing costs: saving £805 145 after 3 years of treatment). Conclusion Underdiagnosis and suboptimal treatment of osteoporosis was identified. Results suggest that implementing NICE guidance and optimizing treatment options in practice is possible and could prevent significant fractures.

scholarly journals Long-term systemic glucocorticoid therapy and weight gain: a population-based cohort study

Rheumatology ◽  
2020 ◽  
Author(s):  
Laurence Fardet ◽  
Irwin Nazareth ◽  
Irene Petersen
Keyword(s):  
Risk Factors ◽  
Primary Care ◽  
Weight Gain ◽  
Population Based ◽  
Health Improvement ◽  
Control Group ◽  
Chronic Obstructive ◽  
Clinical Trial Registration ◽  
Weight Variation ◽  
Systemic Glucocorticoids

Abstract Objectives To describe the variation in weight gain in people chronically exposed to systemic glucocorticoids in primary care and to identify the risk factors for weight gain. Methods Data were analysed from the British database, The Health Improvement Network. Body weight variations of individuals prescribed systemic glucocorticoids for at least 3 months at a mean dose ≥10 mg/day were described. The risk factors associated with weight gain ≥10% of the usual weight were assessed. Results A total of 31 516 adults prescribed glucocorticoids and 26 967 controls were included in the study. During glucocorticoid exposure, only 12 475 (39.6%) individuals gained &gt;2 kg compared with their usual weight. Younger women were more likely to gain weight (mean weight gain in 18–39-year-old glucocorticoid-exposed women: 3.6 kg (s.d. 8.6) compared with 2 kg (s.d. 7.3) in the control group; the absolute mean difference was 1.6 kg (95% CI 0.9, 2.2; P &lt; 0.001). Weight gain ≥10% of the usual weight was observed in 10.2% (n = 3208) of those chronically exposed to glucocorticoids. Women, younger people, those living in areas of higher deprivation, smokers, those on higher doses of the drug and those previously exposed to glucocorticoids were at higher risk. The risk was lower in people prescribed glucocorticoids for an inflammatory condition when compared with asthma or chronic obstructive pulmonary disease. Conclusion After taking into account usual weight rather than weight just before glucocorticoid initiation and the natural history of weight variation, the amount of weight gain induced by systemic glucocorticoids as prescribed in primary care is less than usually thought. Clinical trial registration 18THIN081.

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