Elevated HbA1c is Associated with Increased Risk of Incident Dementia in Primary Care Patients

2015 ◽  
Vol 44 (4) ◽  
pp. 1203-1212 ◽  
Author(s):  
Alfredo Ramirez ◽  
Steffen Wolfsgruber ◽  
Carolin Lange ◽  
Hanna Kaduszkiewicz ◽  
Siegfried Weyerer ◽  
...  
Keyword(s):  
Primary Care ◽  
Incident Dementia ◽  
Increased Risk ◽  
Primary Care Patients

scholarly journals Quit Experiences among Primary Care Patients Enrolled in a Smoking Cessation Pilot RCT Early in the COVID-19 Pandemic

2021 ◽  
Vol 18 (3) ◽  
pp. 1011
Author(s):  
Andrea A. Joyce ◽  
Grace M. Styklunas ◽  
Nancy A. Rigotti ◽  
Jordan M. Neil ◽  
Elyse R. Park ◽  
...  
Keyword(s):  
Primary Care ◽  
Text Messaging ◽  
Risk Perceptions ◽  
Environmental Changes ◽  
Age Groups ◽  
Text Messages ◽  
Increased Risk ◽  
Primary Care Patients ◽  
The Impact ◽  
At Home

The impact of the COVID-19 pandemic on US adults’ smoking and quitting behaviors is unclear. We explored the impact of COVID-19 on smoking behaviors, risk perceptions, and reactions to text messages during a statewide stay-at-home advisory among primary care patients who were trying to quit. From May–June 2020, we interviewed smokers enrolled in a 12-week, pilot cessation trial providing text messaging and mailed nicotine replacement medication (NCT04020718). Twenty-two individuals (82% white, mean age 55 years), representing 88% of trial participants during the stay-at-home advisory, completed exit interviews; four (18%) of them reported abstinence. Interviews were thematically analyzed by two coders. COVID-19-induced environmental changes had mixed effects, facilitating quitting for some and impeding quitting for others. While stress increased for many, those who quit found ways to cope with stress. Generally, participants felt at risk for COVID-19 complications but not at increased risk of becoming infected. Reactions to COVID-19 and quitting behaviors differed across age groups, older participants reported difficulties coping with isolation (e.g., feeling disappointed when a text message came from the study and not a live person). Findings suggest that cessation interventions addressing stress and boredom are needed during COVID-19, while smokers experiencing isolation may benefit from live-person supports.

Mortality in incident dementia - results from the German Study on Aging, Cognition, and Dementia in Primary Care Patients

2015 ◽  
Vol 132 (4) ◽  
pp. 257-269 ◽  
Author(s):  
S. Roehr ◽  
T. Luck ◽  
H. Bickel ◽  
C. Brettschneider ◽  
A. Ernst ◽  
...  
Keyword(s):  
Primary Care ◽  
German Study ◽  
Incident Dementia ◽  
Primary Care Patients

scholarly journals Suicide risk linked with clinical consultation frequency, psychiatric diagnoses and psychotropic medication prescribing in a national study of primary-care patients

2016 ◽  
Vol 46 (16) ◽  
pp. 3407-3417 ◽  
Author(s):  
K. Windfuhr ◽  
D. While ◽  
N. Kapur ◽  
D. M. Ashcroft ◽  
E. Kontopantelis ◽  
...  
Keyword(s):  
Primary Care ◽  
Psychotropic Drug ◽  
Psychotropic Medication ◽  
Suicide Risk ◽  
National Study ◽  
Clinical Practice Research Datalink ◽  
Psychiatric Diagnoses ◽  
Clinical Consultation ◽  
Increased Risk ◽  
Primary Care Patients

BackgroundLittle is known about the precursors of suicide risk among primary-care patients. This study aimed to examine suicide risk in relation to patterns of clinical consultation, psychotropic drug prescribing, and psychiatric diagnoses.MethodNested case-control study in the Clinical Practice Research Datalink (CPRD), England. Patients aged ⩾16 years who died by suicide during 2002–2011 (N = 2384) were matched on gender, age and practice with up to 20 living control patients (N = 46 899).ResultsRisk was raised among non-consulting patients, and increased sharply with rising number of consultations in the preceding year [⩾12 consultations v. 1: unadjusted odds ratio (OR) 6.0, 95% confidence interval (CI) 4.9–7.3]. Markedly elevated risk was also associated with the prescribing of multiple psychotropic medication types (⩾5 types v. 0: OR 62.6, CI 44.3–88.4) and with having several psychiatric diagnoses (⩾4 diagnoses v. 0: OR 31.1, CI 19.3–50.1). Risk was also raised among patients living in more socially deprived localities. The confounding effect of multiple psychotropic drug types largely accounted for the rising risk gradient observed with increasing consultation frequency.ConclusionsA greater proportion of patients with several psychiatric diagnoses, those prescribed multiple psychotropic medication types, and those who consult at very high frequency might be considered for referral to mental health services by their general practitioners. Non-consulters are also at increased risk, which suggests that conventional models of primary care may not be effective in meeting the needs of all people in the community experiencing major psychosocial difficulties.

Improving the Recognition of Anxiety Disorders in Depressed Patients

CNS Spectrums ◽  
2006 ◽  
Vol 11 (S1) ◽  
pp. 2-4
Author(s):  
Iwona Chelminski
Keyword(s):  
Primary Care ◽  
Anxiety Disorder ◽  
Panic Disorder ◽  
Anxiety Disorders ◽  
Panic Attacks ◽  
Depressed Patients ◽  
Increased Risk ◽  
History Of ◽  
Primary Care Patients

There is considerable symptom overlap and high levels of comorbidity between anxiety disorders and depression. The recognition of this comorbidity has both academic interest and clinical significance. Epidemiological studies have demonstrated that depressed individuals with a history of anxiety disorders are at increased risk for hospitalization, suicide attempt, and greater impairment from the depression. These individuals also tend to have a more chronic course of depression, as observed in psychiatric patients, primary care patients, and epidemiological samples. Van Valkenberg and colleagues reported that depressed patients with anxiety had poorer outcome and greater psychosocial impairment than those without an anxiety disorder. In the National Institute of Mental Health Collaborative Depression Study, the presence of panic attacks predicted a lower rate of recovery during the first 2 years of the follow-up interval. Similarly, Grunhaus found poorer outcome in depressed patients with comorbid panic disorder than in depressed patients without panic. In an 8-month follow-up study, depressed primary care patients with a history of generalized anxiety disorder (GAD) or panic disorder were less likely to have recovered from their depressive episode.Gaynes and colleagues prospectively followed primary care patients with major depressive disorder (MDD) every 3 months for 1 year after their initial diagnostic evaluation. At baseline, half of the original 85 patients had a coexisting anxiety disorder, the most frequent being social phobia (n=38). Twelve months after intake, 68 of the patients were available for the final interview. Those with a comorbid anxiety disorder were significantly more likely to still be in an episode of depression (82% vs 57%; risk ratio=1.44; 95% CI 1.02-2.04), and they experienced more disability days during the course of the 12 months than the depressed patients without an anxiety disorder (67.1 days vs 27.5 days).

scholarly journals Risk factors for dementia diagnosis in German primary care practices

2016 ◽  
Vol 28 (7) ◽  
pp. 1059-1065 ◽  
Author(s):  
Anke Booker ◽  
Louis EC Jacob ◽  
Michael Rapp ◽  
Jens Bohlken ◽  
Karel Kostev
Keyword(s):  
Risk Factors ◽  
Primary Care ◽  
Health Insurance ◽  
Antihypertensive Drugs ◽  
Logistic Regression Models ◽  
Dementia Risk ◽  
Increased Risk ◽  
Diagnosis Of Dementia ◽  
Primary Care Patients ◽  
Primary Care Practices

ABSTRACTBackground:Dementia is a psychiatric condition the development of which is associated with numerous aspects of life. Our aim was to estimate dementia risk factors in German primary care patients.Methods:The case-control study included primary care patients (70–90 years) with first diagnosis of dementia (all-cause) during the index period (01/2010-12/2014) (Disease Analyzer, Germany), and controls without dementia matched (1:1) to cases on the basis of age, sex, type of health insurance, and physician.Practice visit records were used to verify that there had been 10 years of continuous follow-up prior to the index date. Multivariate logistic regression models were fitted with dementia as a dependent variable and the potential predictors.Results:The mean age for the 11,956 cases and the 11,956 controls was 80.4 (SD: 5.3) years. 39.0% of them were male and 1.9% had private health insurance. In the multivariate regression model, the following variables were linked to a significant extent with an increased risk of dementia: diabetes (OR: 1.17; 95% CI: 1.10–1.24), lipid metabolism (1.07; 1.00–1.14), stroke incl. TIA (1.68; 1.57–1.80), Parkinson's disease (PD) (1.89; 1.64–2.19), intracranial injury (1.30; 1.00–1.70), coronary heart disease (1.06; 1.00–1.13), mild cognitive impairment (MCI) (2.12; 1.82–2.48), mental and behavioral disorders due to alcohol use (1.96; 1.50–2.57). The use of statins (OR: 0.94; 0.90–0.99), proton-pump inhibitors (PPI) (0.93; 0.90–0.97), and antihypertensive drugs (0.96, 0.94–0.99) were associated with a decreased risk of developing dementia.Conclusions:Risk factors for dementia found in this study are consistent with the literature. Nevertheless, the associations between statin, PPI and antihypertensive drug use, and decreased risk of dementia need further investigations.

scholarly journals Role of persistent and worsening sleep disturbance in depression remission and suicidal ideation among older primary care patients: the PROSPECT study

SLEEP ◽  
2020 ◽  
Vol 43 (10) ◽  
Author(s):  
Joseph J Gallo ◽  
Seungyoung Hwang ◽  
Christine Truong ◽  
Charles F Reynolds ◽  
Adam P Spira
Keyword(s):  
Older Adults ◽  
Primary Care ◽  
Suicidal Ideation ◽  
Major Depression ◽  
Sleep Disturbance ◽  
Primary Care Physicians ◽  
Minor Depression ◽  
Increased Risk ◽  
Primary Care Patients ◽  
Clinically Significant

Abstract Study Objectives We analyzed data from a practice-based randomized controlled trial within 20 primary care practices located in greater New York City, Philadelphia, and Pittsburgh to determine whether persistent or worsening sleep disturbance plays a role in the outcomes of depression and suicidal ideation at 1 year in older adults with depression. Methods The study sample consisted of 599 adults aged 60 years and older meeting criteria for major depression or clinically significant minor depression. Longitudinal analysis via growth curve mixture modeling was carried out to classify patients as having worsening, persistent, or improving sleep over 1 year. Results At 1-year follow-up, compared with patients with improving sleep, those with worsening sleep were more likely to have a diagnosis of major depression (adjusted odds ratio (aOR) = 28.60, 95% confidence interval (CI) 12.15 to 67.34), a diagnosis of clinically significant minor depression (aOR = 11.88, 95% CI 5.67 to 24.89), and suicidal ideation (aOR = 1.10, 1.005 to 1.199), and were half as likely to achieve remission (aOR = 0.52, 95% CI 0.46 to 0.57). Patients with persistent sleep disturbance showed similar but attenuated results. Conclusions Older primary care patients with depression who exhibit worsening or persistent sleep disturbance were at increased risk for persistent depression and suicidal ideation 1 year later. The pattern of sleep disturbance over time may be an important signal for exploration by primary care physicians of depression and suicidal ideation among older adults with depression. Clinical Trial Registration NCT00279682.

High frequency of anti-parietal cell antibody (APCA) and intrinsic factor blocking antibody (IFBA) in individuals with severe vitamin B12 deficiency – an observational study in primary care patients

2020 ◽  
Vol 58 (3) ◽  
pp. 424-429 ◽  
Author(s):  
Maria Salinas ◽  
Emilio Flores ◽  
Maite López-Garrigós ◽  
Carlos Leiva-Salinas
Keyword(s):  
Primary Care ◽  
Observational Study ◽  
Vitamin B12 ◽  
Parietal Cell ◽  
Intrinsic Factor ◽  
Vitamin B12 Deficiency ◽  
Severe Vitamin ◽  
Increased Risk ◽  
Primary Care Patients ◽  
B12 Deficiency

AbstractBackgroundVitamin B12 deficiency is common worldwide and is also linked to several diseases including autoimmune atrophic gastritis (AAG). The presence of anti-parietal cell antibodies (APCA) and/or intrinsic factor blocking antibodies (IFBA) is indicative of AAG that may develop into pernicious anemia. Both conditions are known to be associated with an increased risk of gastric carcinoma. The aim of this study was to estimate the frequency of individuals positive for APCA and IFBA antibodies in primary care patients with severe vitamin B12 deficiency.MethodsAn observational study was designed and 5468 consecutive patients from primary care with a request for vitamin B12 status were included and add-on testing for APCA and IFBA that were automatically registered if severe vitamin B12 deficiency was identified (<73.8 pmol/L). For patients included in the intervention, study demographic data, mean corpuscular volume (MCV) and hemoglobin values were collected.ResultsSeventy-seven patients with severe vitamin B12 deficiency were identified and out of these 44 (57%) presented with antibodies to APCA and 11 (14%) to IFBA, 25 (32.5%) had anemia, and 25 (32.5%) had macrocytosis. The majority of APCA and/or IFBA positive patients were found in the age group >70 years. Both anemia and macrocytosis were more common among APCA positive patients but the association was not statistically significant, neither was the correlation between IFBA status and anemia and/or macrocytosis. Among the patients with anemia, 10 (39%) had macrocytosis, although the rate of macrocytosis among patients with or without anemia did not differ significantly.ConclusionsThe automated analysis strategy of measuring antibodies to APCA and IFBA in patients with severe vitamin B12 deficiency, efficiently detected positivity in more than 60% the patients. The result point to the presence of a high rate of otherwise undetected AAG and the potential clinical utility of APCA and IFBA as markers in primary care.

Predictors of Institutionalisation in Incident Dementia – Results of the German Study on Ageing, Cognition and Dementia in Primary Care Patients (AgeCoDe Study)

2012 ◽  
Vol 33 (4) ◽  
pp. 282-288 ◽  
Author(s):  
Melanie Luppa ◽  
Steffi G. Riedel-Heller ◽  
Janine Stein ◽  
Hanna Leicht ◽  
Hans-Helmut König ◽  
...  
Keyword(s):  
Primary Care ◽  
German Study ◽  
Incident Dementia ◽  
Primary Care Patients

Test of an online tool to facilitate NCCN guideline-compliant access to cancer genetics care.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. 1542-1542
Author(s):  
Kara J. Milliron ◽  
Amanda Cook ◽  
David Keren ◽  
Lynn A. McCain ◽  
Lee Schroeder ◽  
...  
Keyword(s):  
Primary Care ◽  
Family History ◽  
User Experience ◽  
Cancer Genetics ◽  
Healthcare Providers ◽  
Cancer Genetic Counseling ◽  
Health History ◽  
Increased Risk ◽  
Primary Care Patients ◽  
The Impact

1542 Background: Minority populations experience inequities of access to cancer genetics. We developed and tested an online family history collection and interpretation tool, InheRET, to determine acceptability, validity and utility.Patients are mostly unable to recall accurate family history in clinic and providers have little time to collect the 3-generation pedigree. Thus, ~90% of high risk patients remain unidentified. We evaluated the impact InheRET has on facilitating National Comprehensive Cancer Network (NCCN) Guideline-compliant referrals for cancer genetic counseling. Methods: Patients from 3 clinics were consented online to participate. A user experience survey for patients and providers followed the health history questionnaire. Results: 628 patients were consented over a year, 555 (>88%) completed the tool. 439 (79%) completed the post-questionnaire user experience. Review of Inheret's recommendations by a genetic counselor found 100% accuracy. Ease of Use: 84-87% of patients reported tool was easy to use. Understandability: 92-97% of patients reported tool was easy to understand. No significant differences were reported between those with high school (n=28, avg age 50.1 yrs) compared to those with advanced degrees (n=139, avg age 45.4 yrs); patients age 70+ experienced increased difficulties. Among primary care patients (n=135), 43 established patients were newly identified as meeting NCCN referral criteria. Healthcare providers found InheRET useful, did not require extra clinical time, and all wish to continue to use it. The patient provided data were more complete and encompassed more family members than with paper forms. Turn-around-times to receive the patient’s information were decreased from 4-6 weeks to ~ 72 hours. A patient scheduling backlog of 400 patients was cleared using InheRET. Previously, 40% of cancer genetics patients were lost to follow up, due to not completing their intake forms. This number was reduced to 6.5%. Conclusions: Patients find InheRET to be easy to use and understand and they complete this health history tool more frequently and in greater detail than by paper forms. InheRET provides accurate results, verified by in person interviews, in a timely fashion, saving clinical time, possibly enabling increase in earned clinical revenues (under analysis), and improving patient care overall. Importantly, the 43 primary care patients identified to be at increased risk were already established patients, who had not been previously identified as such by their healthcare providers as being at increased risk.

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