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1.
Br J Dermatol ; 178(4): 917-924, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-29094346

RESUMO

BACKGROUND: Epidemiology data regarding hidradenitis suppurativa (HS) are conflicting and prevalence estimates vary 80-fold, from 0·05% in a population-based study to 4%. OBJECTIVES: To assess the hypothesis that previous population-based studies underestimated true HS prevalence by missing undiagnosed cases. METHODS: We performed a population-based observational and case-control study using the U.K. Clinical Practice Research Datalink (CPRD) linked to hospital episode statistics data. Physician-diagnosed cases in the CPRD were identified from specific Read codes. Algorithms identified unrecognized 'proxy' cases, with at least five Read code records for boils in flexural skin sites. Validation of proxy cases was undertaken with general practitioner (GP) questionnaires to confirm criteria-diagnosed cases. A case-control study assessed disease associations. RESULTS: On 30 June 2013, 23 353 physician-diagnosed HS cases were documented in 4 364 308 research-standard records. In total, 68 890 proxy cases were identified, reduced to 10 146 criteria-diagnosed cases after validation, extrapolated from 107 completed questionnaires (61% return rate). Overall point prevalence was 0·77% [95% confidence interval (CI) 0·76-0·78%]. An additional 18 417 cases had a history of one to four flexural skin boils. In physician-diagnosed cases, odds ratios (ORs) for current smoker and obesity (body mass index > 30 kg m-2 ) were 3·61 (95% CI 3·44-3·79) and 3·29 (95% CI 3·14-3·45). HS was associated with type 2 diabetes, Crohn disease, hyperlipidaemia, acne and depression, and not associated with ulcerative colitis or polycystic ovary syndrome. CONCLUSIONS: Contrary to results of previous population-based studies, HS is relatively common, with a U.K. prevalence of 0·77%, one-third being unrecognized, criteria-diagnosed cases using the most stringent disease definition. If individuals with probable cases are included, HS prevalence rises to 1·19%.


Assuntos
Efeitos Psicossociais da Doença , Hidradenite Supurativa/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Algoritmos , Estudos de Casos e Controles , Criança , Pré-Escolar , Feminino , Humanos , Incidência , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Prevalência , Reino Unido/epidemiologia , Adulto Jovem
2.
J Clin Pharm Ther ; 41(2): 224-8, 2016 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-26936206

RESUMO

WHAT IS KNOWN AND OBJECTIVE: The tricyclic antidepressant dosulepin has been associated with an increased risk of toxicity in overdose compared with other antidepressants. In the UK, the MHRA and NICE have issued advice on the prescribing of dosulepin, and a National Prescribing Indicator (NPI) to monitor usage was introduced in Wales in 2011. The aim of this study was to assess whether trends in dosulepin usage in Wales and NE England changed following the two pieces of safety guidance and the introduction of the National Prescribing Indicator in Wales. METHODS: Primary care dosulepin usage in the 12 months prior to and following MHRA safety advice (in 2007), NICE guideline CG90 (in 2009) and the introduction of the NPI (in 2011) was obtained. Usage was measured using defined daily doses (DDDs) per 1000 prescribing units (PUs). The trends in the 12 months prior to and following the introduction of prescribing advice and the NPI were compared using an autoregressive integrated moving average (ARIMA) model. RESULTS AND DISCUSSION: In Wales, the trend in dosulepin usage did not change significantly prior to and following the MHRA advice: -0·18 and -0·43 DDDs/1000PUs per month, respectively (P = 0·07), or prior to and following NICE CG90: -0·30 and -0·49 DDDs/1000PUs per month, respectively (P = 0·35). In the 12 months prior to and following the introduction of the NPI, the trend was -0·45 and -0·98 DDDs/1000PUs per month, respectively (P = 0·001). In NE England, the trend did not alter significantly following the NICE advice or the introduction of the NPI in Wales. WHAT IS NEW AND CONCLUSION: The trend in dosulepin usage in Wales altered significantly following the introduction of the NPI, but not after the other prescribing advice. This association, coupled with the absence of a significant change in NE England over the same period, provided some evidence of the effectiveness of the NPI in prompting a change in prescribing behaviour in Wales.


Assuntos
Antidepressivos Tricíclicos/administração & dosagem , Antidepressivos Tricíclicos/efeitos adversos , Dotiepina/administração & dosagem , Dotiepina/efeitos adversos , Padrões de Prática Médica/tendências , Idoso , Monitoramento de Medicamentos/métodos , Prescrições de Medicamentos , Humanos , Atenção Primária à Saúde/métodos , Reino Unido
3.
Diabet Med ; 33(2): 169-83, 2016 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-26202820

RESUMO

AIMS: To give an updated perspective of interventions from additional data collected since our first review, conducted in 2008. BACKGROUND: This updated Cochrane Review incorporates new information from recent randomized controlled trials on culturally appropriate diabetes health education interventions. METHODS: An electronic literature search of six databases was repeated, with databases of ongoing trials checked and three journals hand-searched. Meta-analysis was carried out for sufficiently homogeneous outcomes, and common themes among trials were highlighted. RESULTS: A total of 22 new trials were added to the original 11. Meta-analysis of 28 trials containing suitable data showed significant improvements in glycaemic control (HbA1c ) and diabetes knowledge over a period of 24 months, after the delivery of culturally appropriate education to participants, compared with those receiving 'conventional' care. There were no consistent benefits over the control group in other selected outcome measures, and lack of data continued to make analysis of several outcome measures difficult. CONCLUSIONS: Research activity in this field has increased considerably over the past 6 years, with culturally appropriate diabetes education showing consistent benefits over conventional care in terms of glycaemic control and diabetes knowledge, sustained in the short- to mid-term. Further research is needed to determine the clinical significance of these improvements and their cost-effectiveness.


Assuntos
Assistência à Saúde Culturalmente Competente , Diabetes Mellitus Tipo 2/terapia , Medicina Baseada em Evidências , Disparidades nos Níveis de Saúde , Saúde das Minorias , Educação de Pacientes como Assunto , Terapia Combinada/tendências , Assistência à Saúde Culturalmente Competente/tendências , Países Desenvolvidos , Complicações do Diabetes/etnologia , Complicações do Diabetes/prevenção & controle , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/epidemiologia , Diabetes Mellitus Tipo 2/etnologia , Conhecimentos, Atitudes e Prática em Saúde/etnologia , Política de Saúde/tendências , Transição Epidemiológica , Humanos , Hipoglicemia/prevenção & controle , Saúde das Minorias/educação , Saúde das Minorias/tendências , Cooperação do Paciente/etnologia , Educação de Pacientes como Assunto/tendências , Prevalência , Ensaios Clínicos Controlados Aleatórios como Assunto , Reprodutibilidade dos Testes
4.
Psychooncology ; 20(9): 984-91, 2011 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-20677331

RESUMO

OBJECTIVES: There is little evidence regarding the long-term psychological implications of breast cancer risk assessment for women at moderate genetic risk. A follow-up study of a trial cohort was conducted to evaluate psychological outcomes and their predictors at 6-year follow-up. A further aim was to examine threshold scores for high cancer worry. METHODS: Questionnaires were sent to 384 women assessed as moderate risk during a UK trial of genetic assessment (TRACE). Measures included cancer worry, perceived risk, health behaviours, general anxiety, psychological morbidity, optimism, and background variables assessed during TRACE and at 6-year follow-up. RESULTS: Reductions from baseline cancer worry and breast self-examination (BrSE) frequency were maintained 6 years after risk assessment, with relatively consistent levels over short- and long-term follow-up. Provision of risk information led to short-term reductions in perceived risk. During the 6-year period, 43% of women reported having made lifestyle changes and 27% had requested a mammogram. Baseline and post-risk cancer worry were the only significant predictors of long-term cancer worry. Greater worry at baseline predicted more frequent BrSE and higher perceived risk, but not lifestyle change or mammogram requests, at 6 years. Eighteen percent of women reported cancer worry above a threshold of 12.5 at long-term follow-up, compared with 30% at baseline. CONCLUSIONS: Overall reductions in cancer worry following moderate risk assessment were maintained in the long term. However, women at risk of sustained high cancer worry should be identified at an early stage in the risk assessment process for more intensive psycho-educational intervention. Copyright © 2010 John Wiley & Sons, Ltd.


Assuntos
Ansiedade , Neoplasias da Mama/psicologia , Predisposição Genética para Doença/psicologia , Comportamentos Relacionados com a Saúde , Mamografia/psicologia , Adulto , Neoplasias da Mama/genética , Feminino , Seguimentos , Humanos , Pessoa de Meia-Idade , Medição de Risco , Fatores de Risco , Inquéritos e Questionários
5.
Health Technol Assess ; 13(20): 1-224, iii, 2009 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-19393135

RESUMO

OBJECTIVES: To assess the effectiveness and cost-effectiveness of breaks in care in improving the well-being of informal carers of frail and disabled older people living in the community and to identify carer needs and barriers to uptake of respite services. DATA SOURCES: Major electronic databases were searched from the earliest possible date to April 2008. REVIEW METHODS: Selected studies were assessed and subjected to extraction of numerical data for meta-analysis of quantitative studies and extraction of text for thematic analysis of qualitative studies. Quality of the studies was assessed using checklists specifically designed for the current review. RESULTS: In total, 104 papers were identified for inclusion in the quantitative synthesis, 16 of which were appropriate for meta-analysis. Carer burden was reduced at 2-6 months' follow-up in single-sample studies but not in randomised controlled trials (RCTs) and quasi-experimental studies. Depression was reduced in RCTs in the short term and for home care but not for day care. These effects, however, were not significant in random-effects models. There was a trend for longer interventions to have more positive effects than shorter interventions. There was no effect of respite on anxiety, but it had positive effects on morale and anger and hostility. Single-group studies suggested that quality of life was worse after respite use. There were increased rates of institutionalisation after respite use; however, this does not establish a causal relationship as it may be a result of respite being provided late in the caregiving career. A total of 70 papers were identified for inclusion in the qualitative synthesis. Uptake of respite care was influenced by: carer attitudes to caring and respite provision; the caregiving relationship; knowledge of, and availability of, services; the acceptability to, and impact of respite care on, care recipients; hassles resulting from the use of respite care; quality of respite care; and the appropriateness and flexibility of service provision. Carers expressed needs for active information provision about services, support offered early in the caregiving career, access to a variety of services with flexible provision, reliable transport services, continuity of care, good-quality care, appropriate environments, care that provides benefits for care recipients (socialisation and stimulation), and appropriate activities for care recipients' levels of abilities and interests. CONCLUSIONS: There was some evidence to support respite having a positive effect on carers but the evidence was limited and weak. It is difficult, therefore, to make recommendations as to the most appropriate form of delivery of respite, apart from the suggestion that a range of services is probably most appropriate, to provide flexibility of respite provision and responsiveness to carer and care recipient characteristics and needs and also changes in those needs over time. There is a need for further high-quality larger trials that include economic evaluations.


Assuntos
Idoso Fragilizado , Pesquisa sobre Serviços de Saúde/organização & administração , Serviços de Saúde para Idosos/organização & administração , Cuidados Intermitentes/organização & administração , Idoso , Cuidadores/psicologia , Análise Custo-Benefício , Estudos Transversais , Pessoas com Deficiência/psicologia , Pessoas com Deficiência/estatística & dados numéricos , Prática Clínica Baseada em Evidências , Família/psicologia , Idoso Fragilizado/psicologia , Idoso Fragilizado/estatística & dados numéricos , Necessidades e Demandas de Serviços de Saúde , Humanos , Estudos Longitudinais , Modelos Organizacionais , Avaliação de Resultados em Cuidados de Saúde , Pesquisa Qualitativa , Qualidade da Assistência à Saúde , Qualidade de Vida/psicologia , Projetos de Pesquisa , Avaliação da Tecnologia Biomédica
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