O08: The epidemiology of alopecia areata: a population‐based cohort study in UK primary care

Background: Up to 70% of patients report ongoing symptoms four weeks after hospitalisation for pneumonia, and the impact on primary care is poorly understood. Aim: To investigate the frequency of primary care consultations after hospitalisation for pneumonia, and the reasons for consultation. Design: Population-based cohort study. Setting: UK primary care database of anonymised medical records (Clinical Practice Research Datalink, CPRD) linked to Hospital Episode Statistics (HES), England. Methods: Adults with the first ICD-10 code for pneumonia (J12-J18) recorded in HES between July 2002-June 2017 were included. Primary care consultation within 30 days of discharge was identified as the recording of any medical Read code (excluding administration-related codes) in CPRD. Competing-risks regression analyses were conducted to determine the predictors of consultation and antibiotic use at consultation; death and readmission were competing events. Reasons for consultation were examined. Results: Of 56,396 adults, 55.9% (n=31,542) consulted primary care within 30 days of discharge. The rate of consultation was highest within 7 days (4.7 per 100 person-days). The strongest predictor for consultation was a higher number of primary care consultations in the year prior to index admission (adjusted sHR 8.98, 95% CI 6.42-12.55). The commonest reason for consultation was for a respiratory disorder (40.7%, n=12,840), 12% for pneumonia specifically. At consultation, 31.1% (n=9,823) received further antibiotics. Penicillins (41.6%, n=5,753) and macrolides (21.9%, n=3,029) were the commonest antibiotics prescribed. Conclusion: Following hospitalisation for pneumonia, a significant proportion of patients consulted primary care within 30 days, highlighting the morbidity experienced by patients during recovery from pneumonia.

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Attendance of routine childcare visits in primary care for children of mothers with depression: a nationwide population-based cohort study

British Journal of General Practice ◽

10.3399/bjgp18x694565 ◽

2018 ◽

Vol 68 (667) ◽

pp. e97-e104 ◽

Cited By ~ 6

Author(s):

Bente Kjær Lyngsøe ◽

Claus Høstrup Vestergaard ◽

Dorte Rytter ◽

Mogens Vestergaard ◽

Trine Munk-Olsen ◽

...

Keyword(s):

Primary Care ◽

Cohort Study ◽

Relative Risk ◽

Confidence Interval ◽

Maternal Depression ◽

Vaccination Programme ◽

Population Based ◽

Point Of Interest ◽

Vulnerable Families

BackgroundDepression is a common and potentially debilitating illness worldwide. Attendance to routine childcare appointments is a key point of interest in the effort to improve the health and care for families facing depression.AimTo evaluate the association between maternal depression and offspring non-attendance to the Danish childcare and vaccination programme (CCP) for children from 0–5 years of age. The CCP consists of seven separate visits and several vaccinations. To investigate if exposure to recent and previous depression may affect attendance differently.Design and settingPopulation-based cohort study using Danish nationwide registers.MethodParticipants were all live-born children (n = 853 315) in Denmark in the period from 1 January 2000 until 31 August 2013, and their mothers. The outcome of interest was non-attendance of each one of the seven scheduled childcare visits and two vaccination entities in the CCP. Exposure was maternal (both previous and recent) depression. All information was obtained from Danish national registries.ResultsThe risk of not attending CCP was higher for children of mothers with depression. For children of mothers with previous depression, the relative risk (RR) was 1.01 (95% confidence interval [CI] = 0.98 to 1.03) at the 5-week childcare visit, and 1.12 (95% CI = 1.09 to 1.14) at the 5-year childcare visit. For children of mothers with recent depression, the RR was 1.07 (95% CI = 1.03 to 1.13) at the 5-week visit, and 1.15 (95% CI = 1.13 to 1.17) at the 5-year visit. Furthermore, the risk of missing at least four of the seven childcare visits was higher for children of females with maternal depression (RR = 1.16, 95% CI = 1.13 to 1.19).ConclusionMaternal depression seems to compromise CCP attendance. These findings suggest a need for careful clinical attention to these vulnerable families, even years after a diagnosis of depression.

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Association between alopecia areata and retinal diseases: A nationwide population-based cohort study

Journal of the American Academy of Dermatology ◽

10.1016/j.jaad.2021.10.045 ◽

2021 ◽

Author(s):

Hui-Chu Ting ◽

Sheng-Hsiang Ma ◽

Ying-Hsuan Tai ◽

Ying-Xiu Dai ◽

Yun-Ting Chang ◽

...

Keyword(s):

Cohort Study ◽

Alopecia Areata ◽

Population Based ◽

Retinal Diseases

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Increased risk of alopecia areata among patients with polycystic ovary syndrome: A population‐based cohort study

The Journal of Dermatology ◽

10.1111/1346-8138.15659 ◽

2020 ◽

Author(s):

Tsung‐Hsien Chang ◽

Ying‐Hsuan Tai ◽

Ying‐Xiu Dai ◽

Yun‐Ting Chang ◽

Mu‐Hong Chen

Keyword(s):

Cohort Study ◽

Polycystic Ovary Syndrome ◽

Alopecia Areata ◽

Polycystic Ovary ◽

Population Based ◽

Ovary Syndrome ◽

Increased Risk

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Vitamin D prescribing in children in UK primary care practices: a population-based cohort study

BMJ Open ◽

10.1136/bmjopen-2019-031870 ◽

2019 ◽

Vol 9 (12) ◽

pp. e031870 ◽

Cited By ~ 1

Author(s):

Mandy Wan ◽

Laura J Horsfall ◽

Emre Basatemur ◽

Jignesh Prakash Patel ◽

Rukshana Shroff ◽

...

Keyword(s):

Primary Care ◽

Vitamin D ◽

Cohort Study ◽

Clinical Symptoms ◽

Population Based ◽

Vitamin D Supplementation ◽

Annual Incidence ◽

Health Improvement ◽

Laboratory Test Results ◽

General Practices

ObjectiveTo examine temporal changes in the incidence and patterns of vitamin D supplementation prescribing by general practitioners (GPs) between 2008 and 2016.DesignPopulation-based cohort study.SettingUK general practice health records from The Health Improvement Network.ParticipantsChildren aged 0 to 17 years who were registered with their general practices for at least 3 months.Outcome measuresAnnual incidence rates of vitamin D prescriptions were calculated, and rate ratios were estimated using multivariable Poisson regression to explore differences by sociodemographic factors. Data on the type of supplementation, dose, dosing schedule, linked 25-hydroxyvitamin D (25(OH)D) laboratory test results and clinical symptoms suggestive of vitamin D deficiency were analysed.ResultsAmong 2 million children, the crude annual incidence of vitamin D prescribing increased by 26-fold between 2008 and 2016 rising from 10.8 (95% CI: 8.9 to 13.1) to 276.8 (95% CI: 264.3 to 289.9) per 100 000 person-years. Older children, non-white ethnicity and general practices in England (compared with Wales/Scotland/Northern Ireland) were independently associated with higher rates of prescribing. Analyses of incident prescriptions showed inconsistent supplementation regimens with an absence of pre-supplementation 25(OH)D concentrations in 28.7% to 56.4% of prescriptions annually. There was an increasing trend in prescribing at pharmacological doses irrespective of 25(OH)D concentrations, deviating in part from UK recommendations. Prescribing at pharmacological doses for children with deficient status increased from 3.8% to 79.4%, but the rise was also observed in children for whom guidelines recommended prevention doses (0% to 53%). Vitamin D supplementation at pharmacological doses was also prescribed in at least 40% of children with no pre-supplementation 25(OH)D concentrations annually.ConclusionsThere has been a marked and sustained increase in vitamin D supplementation prescribing in children in UK primary care. Our data suggests that national guidelines on vitamin D supplementation for children are not consistently followed by GPs.

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Bidirectional association between alopecia areata and sleep disorders: a population-based cohort study in Taiwan

Sleep Medicine ◽

10.1016/j.sleep.2020.06.015 ◽

2020 ◽

Vol 75 ◽

pp. 112-116 ◽

Cited By ~ 3

Author(s):

Ying-Xiu Dai ◽

Ying-Hsuan Tai ◽

Chih-Chiang Chen ◽

Yun-Ting Chang ◽

Tzeng-Ji Chen ◽

...

Keyword(s):

Cohort Study ◽

Sleep Disorders ◽

Alopecia Areata ◽

Population Based ◽

Bidirectional Association

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Associations between attainment of incentivized primary care indicators and incident lower limb amputation among those with type 2 diabetes: a population-based historical cohort study

BMJ Open Diabetes Research & Care ◽

10.1136/bmjdrc-2020-002069 ◽

2021 ◽

Vol 9 (1) ◽

pp. e002069

Author(s):

Laura H Gunn ◽

Eszter P Vamos ◽

Azeem Majeed ◽

Pasha Normahani ◽

Usman Jaffer ◽

...

Keyword(s):

Blood Pressure ◽

Type 2 Diabetes ◽

Primary Care ◽

Cohort Study ◽

Lower Limb ◽

Population Based ◽

Lower Limb Amputation ◽

Medical Decision ◽

Limb Amputation

IntroductionEngland has invested considerably in diabetes care through such programs as the Quality and Outcomes Framework (QOF) and National Diabetes Audit (NDA). Associations between program indicators and clinical endpoints, such as amputation, remain unclear. We examined associations between primary care indicators and incident lower limb amputation.Research design and methodsThis population-based retrospective cohort study, spanning 2010–2017, was comprised of adults in England with type 2 diabetes and no history of lower limb amputation. Exposures at baseline (2010–2011) were attainment of QOF glycated hemoglobin (HbA1c), blood pressure and total cholesterol indicators, and number of NDA processes completed. Propensity score matching was performed and multivariable Cox proportional hazards models, adjusting for disease-related, comorbidity, lifestyle, and sociodemographic factors, were fitted using matched samples for each exposure.Results83 688 individuals from 330 English primary care practices were included. Mean follow-up was 3.9 (SD 2.0) years, and 521 (0.6%) minor or major amputations were observed (1.62 per 1000 person-years). HbA1c and cholesterol indicator attainment were associated with considerably lower risks of minor or major amputation (adjusted HRs; 95% CIs) 0.61 (0.49 to 0.74; p<0.0001) and 0.67 (0.53 to 0.86; p=0.0017), respectively). No evidence of association between blood pressure indicator attainment and amputation was observed (adjusted HR 0.88 (0.73 to 1.06; p=0.1891)). Substantially lower amputation rates were observed among those completing a greater number of NDA care processes (adjusted HRs 0.45 (0.24 to 0.83; p=0.0106), 0.67 (0.47 to 0.97; p=0.0319), and 0.38 (0.20 to 0.70; p=0.0022) for comparisons of 4–6 vs 0–3, 7–9 vs 0–3, and 7–9 vs 4–6 processes, respectively). Results for major-only amputations were similar for HbA1c and blood pressure, though cholesterol indicator attainment was non-significant.ConclusionsComprehensive primary care-based secondary prevention may offer considerable protection against diabetes-related amputation. This has important implications for diabetes management and medical decision-making for patients, as well as type 2 diabetes quality improvement programs.

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