Cross-sectional Study In Primary Care Research Articles

The Effect of Sleep Impairment, as Assessed by the CASIS Questionnaire, in Patients with Chronic Obstructive Pulmonary Disease on Disease Severity and Physical and Mental Health: A Cross-Sectional Study in Primary Care

The aim of our study was to assess the prevalence of sleep impairment among primary care patients with COPD and explore its impact on disease severity and overall health status. This cross-sectional study included 251 participants > 40 years old from the prospective COCARE COPD study. Data on sociodemographic characteristics, medical history, disease-specific quality of life [COPD Assessment Test (CAT)], COPD severity [Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2023 categorization based on CAT score and exacerbations], fatigue [Fatigue Severity Scale (FSS)], psychological parameters [Patient Health Questionnaire-9 (PHQ-9) and General Anxiety Disorder-7 (GAD-7)], and sleep complaints [COPD and Asthma Sleep Impact Scale (CASIS) and Epworth Sleepiness Scale (ESS)] were collected. Multiple logistic regression analysis was conducted to test for associations of sleep impairment with COPD and overall health status, adjusting for confounders. Sleep impairment, indicated by a CASIS score ≥ 30, increased the risk of worse COPD health status (CAT ≥ 10 OR: 9.7, 95% CI: 5–19, p < 0.001), COPD severity (GOLD B OR: 8.9, 95% CI: 4.5–17.6, p < 0.001 and GOLD E OR: 17.4, 95% CI: 5.1–59.4, p < 0.001), excessive daytime sleepiness (ESS > 10, OR: 3.2, 95% CI: 1.3–8.1, p = 0.012), depressive symptoms (PHQ-9 ≥ 10, OR: 6.4, 95% CI: 2.1–19.1, p = 0.001), anxiety symptoms (GAD-7 ≥ 10, OR: 3.9, 95% CI: 1.6–9.2, p = 0.002), and fatigue (FSS ≥ 36, OR: 5.3, 95% CI: 2.8–9.8, p < 0.001). In conclusion, our findings suggest that sleep impairment, based on the CASIS questionnaire, is associated with worse physical and mental health in patients with COPD. Therefore, through consistent evaluation of sleep and targeted management strategies, healthcare providers could improve the quality of life for these patients.

Dutch Translation and Psychometric Evaluation of the Person-Centered Primary Care Measure.

Person-centered care is foundational to good quality primary care and has positive effects on health outcomes and patient satisfaction. The Person-Centered Primary Care Measure (PCPCM) is a recently developed, patient-reported survey able to assess person-centeredness and has demonstrated strong validity and reliability. Little is known, however, about the feasibility of the PCPCM in non-English-speaking settings. We aimed to translate the questionnaire into Dutch, psychometrically evaluate the translated version, and ensure its feasibility for patients in Dutch primary care. We translated the PCPCM into Dutch using forward-backward translations. We conducted psychometric evaluations to ensure its feasibility among Dutch-speaking primary care patients, with special attention to low literacy populations. Next, we assessed structural validity, convergent validity using the Quality of Care Through the Patient's Eyes (QUOTE) questionnaire, and internal consistency in a cross-sectional study in primary care. Translation and adaptation for low literacy populations required 4 iterations. In 4 general practices, 205 patients completed the survey. Confirmatory factor analyses could not confirm the 1-factor solution. The 3-factor solution was found to be a more optimal fit: comprehensiveness of care, personal relation, and contextual care. Internal reliability was high (Cronbach's α were 0.82, 0.73, and 0.86, respectively). We found a strong correlation between the total PCPCM and QUOTE scores (Spearman's ρ = 0.65, P <.001), indicating good convergent validity. The Dutch version of the PCPCM has acceptable validity and reliability for measuring person-centeredness in primary care among Dutch-speaking populations including those with low literacy.

Exploring the Link between Social Support and Patient-Reported Outcomes in Chronic Obstructive Pulmonary Disease Patients: A Cross-Sectional Study in Primary Care.

We aimed to explore the link between social support and various patient-reported outcome measures (PROMs) in primary care patients with COPD. This was a cross-sectional study with 168 patients with COPD from six primary care centers in Crete, Greece. We collected data on sociodemographic characteristics, medical history, disease-specific quality of life, the COPD Assessment Test (CAT), fatigue, the Fatigue Severity Scale (FSS), phycological parameters, Patient Health Questionnaire-9, General Anxiety Disorder-7, sleep complaints, the Pittsburg Sleep Quality Index, the Athens Insomnia scale (AIS), and the Epworth Sleepiness Scale. Social support was measured using the Multidimensional Scale of Perceived Social Support (MSPSS). Out of 168 patients with COPD, 114 (68.9%) exhibited low levels of social support. Low social support (MSPSS total ≤ 5) was positively associated with COPD symptoms (CAT score ≥ 10) (OR = 3.97, 95%CI:1.86-8.44; p < 0.01), fatigue (FSS ≥ 36) (OR = 2.74, 95%CI:1.31-5.74; p = 0.01), and insomnia symptoms (AIS ≥ 6) (OR = 5.17 95%CI:2.23-12.01; p < 0.01), while the association with depressive symptoms (PHQ-9 ≥ 10) was marginally significant (OR = 3.1, 95%CI:0.93-10.36; p = 0.07). Our results suggest that lower levels of social support are positively associated with PROMs in patients with COPD. Therefore, our findings show an additional way to improve the overall health of patients with COPD in primary care by putting social support at the epicenter of actions.

Statins use for primary prevention of cardiovascular disease: A population-based digitally enabled real-world evidence cross-sectional study in primary care in Brazil

BACKGROUNDStatins are the main strategy to reduce dyslipidemia-related cardiovascular risk. Nevertheless, there is scarce evidence on the real-world statins use in primary care settings in low-middle-income countries. OBJECTIVEWe conducted a cross-sectional retrospective study using anonymized data routinely collected by community health workers in Brazil aimed to evaluate statin use and associated factors in a primary prevention population with cardiovascular risk enhancers. METHODSStudy population consisted of adults with hypertension, diabetes, and/or dyslipidemia. The primary and secondary outcomes were the proportion of individuals self-reporting statins use on any dose and high-dose statins/high-intensity lipid-lowering therapy (LLT), respectively. RESULTSOf the 2,133,900 adult individuals in the database, 415,766 (19.5%) were included in the study cohort. From this cohort, 89.1% had hypertension, 28.9% diabetes, and 5.5% dyslipidemia. The mean age was 61.5 (standard deviation 14.5) years, 63.4% were female, and 61.0% were of mixed-race. Only 2.6% and 0.1% of individuals self-reported the use of statins and high-dose statins/high-intensity LLT, respectively. Older age (odds ratio [OR] 1.96; 95% confidence interval [CI] 1.88, 2.05, p < 0.001), living in the South region of Brazil (OR 4.39; 95% CI 3.97, 4.85, p < 0.001), heart failure (OR 2.60; 95% CI 2.33, 2.89, p < 0.001), chronic kidney disease (OR 1.49; 95% CI 1.35, 1.64, p < 0.001), and anti-hypertensive medications use (OR 4.38; 95% CI 4.07, 4.71, p < 0.001) were independently associated with statin use. CONCLUSIONIn a real-world evidence study analyzing data routinely collected in a digitized primary care setting, we observed a very low use of statins in a primary prevention population with cardiovascular risk enhancers in Brazil. Socio-demographic factors and co-morbidities were associated with higher statins use rates.

Patient enablement and health-related quality of life for patients with chronic back and knee pain: a cross-sectional study in primary care.

Chronic back and knee pain impairs health- related quality of life (HRQoL) and patient enablement can improve HRQoL. To determine whether enablement was a moderator of the effect of chronic back and knee pain on HRQoL. A cross-sectional study of Chinese patients with chronic back and knee problems in public primary care clinics in Hong Kong. Each participant completed the Chinese Patient Enablement Instrument-2 (PEI-2), the Chinese Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and the Pain Rating Scale (PRS). Multivariable regression examined the effects of PRS score and PEI-2 score on WOMAC total score. A moderation regression model and simple slope analysis were used to evaluate whether the interaction between enablement (PEI-2) and pain (PRS) had a significant effect on HRQoL (WOMAC). Valid patient-reported outcome data from 1306 participants were analysed. PRS score was associated with WOMAC total score (β = 0.326, P<0.001), whereas PEI-2 score was associated inversely with WOMAC total score (β = -0.260, P<0.001) and PRS score. The effect of the interaction between PRS and PEI-2 (PRS × PEI-2) scores on WOMAC total score was significant (β = -0.191, P<0.001) suggesting PEI-2 was a moderator. Simple slope analyses showed that the relationship between PRS and WOMAC was stronger for participants with a low level of PEI-2 (gradient 3.056) than for those with a high level of PEI-2 (gradient 1.746). Patient enablement moderated the impact of pain on HRQoL. A higher level of enablement can lessen impairment in HRQoL associated with chronic back and knee pain.

Knowledge, attitudes and practice of female genital mutilation and cutting: An observational cross-sectional study in primary care (FGM/C Study).

Female genital mutilation and cutting (FGM/C) describes procedures involving partial or total removal of the external female genitalia or other injury to the female genital organs for non-medical reasons. Increasing migration means many communities living in the UK originate from countries where FGM/C is practiced. Consequently, clinicians in the UK are increasingly exposed to women and children who have experienced FGM/C. To explore the knowledge, attitudes and practice of primary care general practitioners and practice nurses about FGM/C. An observational cross-sectional study with general practitioners (GPs) and practice nurses (PNs) working in primary care in the West Midlands, United Kingdom. An online survey was circulated to GPs and PNs between September 2019 and December 2019. 137 survey responses were received. Study participants were predominantly female (81.8%) and general practitioners (59.9%) with a mean age of 47.3 (SD =9.1). 19.7% of responders reported seeing more than one patient with FGM/C in the last 12 months. 91% of responders had received some form of FGM/C training; however the format and frequency of training varied and 34.3% felt they had received inadequate training to manage treatment of FGM/C. Results suggest varying degrees of competence and confidence associated with recognising and managing patients with FGM/C in primary care in the West Midlands. Given that FGM/C patients typically present in primary care it is important that clinicians can provide appropriate support underpinned by up-to-date training.

Ability of Anthropometric Measurements to Predict Metabolic Health among Patients in Alberta: A Cross-sectional Study in Primary Care.

Purpose: This study compared anthropometric and body fat percent (BF%) equations in relation to measures of metabolic health.Methods: BF% calculations (Bergman, Fels, and Woolcott) and anthropometric measurements were used to determine obesity among a sample of patients attending primary care in Alberta, Canada. Anthropometric variables included body mass index (BMI), waist circumference, waist:hip ratio, waist:height ratio, and calculated BF%. Metabolic Z-score was computed as the average of the individual Z-scores of triglycerides, total cholesterol, and fasting glucose and the number of standard deviations from the sample mean.Results: Five hundred and fourteen individuals were included (41.2% male, age: 53 ± 16y, BMI: 27.4 ± 5.7kg/m2). BMI ≥ 30kg/m2 detected the smallest number of participants (n = 137) as having obesity, while Woolcott BF% equation categorized the largest number of participants as having obesity (n = 369). No anthropometric or BF% calculation predicted metabolic Z-score in males (all p ≥ 0.05). In females, age-adjusted waist:height ratio had the highest prediction power (R2 = 0.204, p < 0.001), followed by age-adjusted waist circumference (R2 = 0.200, p < 0.001) and age-adjusted BMI (R2 = 0.178, p < 0.001).Conclusions: This study did not find evidence that BF% equations more strongly predicted metabolic Z-scores than other anthropometric values. In fact, all anthropometric and BF% variables were weakly related to metabolic health parameters, with apparent sex differences.

Factors associated with diabetes-related distress among Asian patients with poorly controlled type-2 diabetes mellitus: a cross-sectional study in primary care

BackgroundDiabetes-related distress (DRD) is a negative emotional state related to the burden of living with diabetes mellitus. It has been associated with poor self-care and glycaemic control. This cross-sectional study aimed to examine the factors associated with DRD among urban Asian patients with poorly controlled type-2 diabetes mellitus (T2DM) in primary care in Singapore. The factors included demographics, diabetes history, medical co-morbidities, mood disorders and social history.MethodsPatients with T2DM and HbA1c of 8% or more were recruited from 2 public primary care centres in Singapore. They were administered a questionnaire survey to identify DRD based on the Problem Area In Diabetes (PAID) scale. Their anxiety and depression were screened using GAD-7 and PHQ-9, and quality of life (QOL) measured using the EQ-5D-5L. Their clinical data, including HbA1c, comorbidities and medications, were extracted from the electronic medical records.ResultsAmong the 356 subjects, the prevalence of DRD was 17.4%. DRD was significantly associated with younger age (AOR (95% CI) = 0.93 (0.89–0.97), p = 0.001), ex-smoker status (AOR (95% CI) = 22.30 (2.43–204.71), p = 0.006) and history of kidney disease (AOR (95% CI) = 3.41 (1.39–8.35), p = 0.007). Those who screened positive for depression (AOR (95% CI) = 4.98 (1.19–20.86), p = 0.028) were almost five times more likely to have DRD. Quality of life was lower among those with DRD (EQ5D index score AOR (95% CI) = 0.11 (0.01–0.97), p = 0.047), who also tended to feel that diabetes pharmacotherapy interfered with their normal life (AOR (95% CI) = 2.89 (1.38–6.08), p = 0.005).ConclusionAbout 1 in 6 patients with poorly controlled T2DM had DRD. Younger age, ex-smoker status, history of kidney disease, and those with depressive symptoms were most at risk.

Frailty Profile of Geriatric Patients According to the Multidimensional Prognostic Index: A Cross-Sectional Study in Primary Care in the Sultanate of Oman

Frailty Profile of Geriatric Patients According to the Multidimensional Prognostic Index: A Cross-Sectional Study in Primary Care in the Sultanate of Oman

Frequency of Follow-Up Attendance and Blood Glucose Monitoring in Type 2 Diabetic Patients at Moderate to High Cardiovascular Risk: A Cross-Sectional Study in Primary Care.

Regular follow-up attendance in primary care and routine blood glucose monitoring are essential in diabetes management, particularly for patients at higher cardiovascular (CV) risk. We sought to examine the regularity of follow-up attendance and blood glucose monitoring in a primary care sample of type 2 diabetic patients at moderate-to-high CV risk, and to explore factors associated with poor engagement. Cross-sectional data were collected from 2130 patients enrolled in a diabetic retinopathy screening programme in Guangdong province, China. Approximately one-third of patients (35.9%) attended clinical follow-up <4 times in the past year. Over half of patients (56.9%) failed to have blood glucose monitored at least once per month. Multivariable logistic regression analysis showed that rural residents (adjusted odds ratio [aOR] = 0.420, 95% confidence interval [CI] = 0.338-0.522, p < 0.001, for follow-up attendance; aOR = 0.580, 95%CI: 0.472-0.712, p < 0.001, for blood glucose monitoring) and subjects with poor awareness of adverse consequences of diabetes complications (aOR = 0.648, 95%CI = 0.527-0.796, p < 0.001, for follow-up attendance; aOR = 0.770, 95%CI = 0.633-0.937, p = 0.009, for blood glucose monitoring) were both less likely to achieve active engagement. Our results revealed an urban-rural divide in patients' engagement in follow-up attendance and blood glucose monitoring, which suggested the need for different educational approaches tailored to the local context to enhance diabetes care.

Evaluating the relationship between family role performance levels and health perceptions of individuals: a cross-sectional study in primary care

The aim of this study is to examine the relationship between family role performance levels and health perceptions of individuals. This cross-sectional study was conducted with 438 participants who applied to four Family Health Centers between 18 July 2020 and 18 November 2020. The data were collected using Personal Information Form, Family Role Performance Scale, and Perception of Health Scale. ANOVA, independent samples t test and regression test were used for statistics calculations. Ethics Committee approval and institutional permissions were obtained to conduct the study. Scale mean scores of the participants were 30.92 ± 6.41 for Family Role Performance Scale and 48.35 ± 7.73 for Perception of Health Scale. As a result of simple linear regression analysis, a significant correlation was found between Family Role Performance and Perception of Health Scale. According to regression analysis, it was determined that family role performance affected health perception at the rate of 15.1%. In this study, it was determined that as family role performance increased, the level of health perception also increased, and there was a correlation between family role performance and health perception. Family role performances and health perception for all participants were at a moderate level

Is the Association between Herbal Use and Blood-Pressure Control Mediated by Medication Adherence? A Cross-Sectional Study in Primary Care.

Herbs have been used worldwide for many health conditions as an alternative treatment, including hypertension. Their use might affect the use of conventional medications, as well as blood-pressure control. This study aims to determine whether the potential associations between herb use and high blood pressure in hypertensive patients was mediated by medication adherence. A cross-sectional study was conducted using questionnaires and available medical databases at a primary care clinic of a tertiary hospital in Chiang Mai, Thailand. The data were collected from 450 patients with essential hypertension. Drug adherence was assessed by the Morisky Green Levine Medication Adherence Scale. The history of herbs used in the past three months was obtained. The goal of controlled blood pressure was defined in accordance with the Thai guidelines on the treatment of hypertension. Of the total 450 patients, 42% had high adherence. Nearly 18% reported herb use in the past three months. High medication adherence was strongly associated with blood-pressure control when adjusted for age, gender, education, the presence of comorbidities, and herb use (aOR 26.73; 95% CI 8.58–83.23; p < 0.001). The association between herb use and blood-pressure control did not achieve statistical significance (p = 0.143). However, the adjusted odds ratio of the association between herb use and blood-pressure control was diluted from 0.67 to 0.83 when adding the factor of medication adherence to the model. In conclusion, herb use was associated with poor medication adherence, which was in turn associated with poor blood-pressure control. Assessing this information contributes to appropriate exploration and counseling.

Association Between the Health Locus of Control and Medication Adherence: An Observational, Cross-Sectional Study in Primary Care.

Background: Medication non-adherence is an important healthcare issue and a common problem. Many predictors of non-adherence have been found in different settings and cohorts.Objective: Evaluate the impact of the health locus of control (HLC) on unintentional/intentional non-adherence in primary care.Methods: In this observational, cross-sectional study, 188 patients (mean age 63.3 ± 14.9 years) were recruited from three primary care practices in Jena, Germany, over 4 months. The study assessed demographic data, self-reported adherence (German Stendal adherence to medication score, SAMS), HLC, and depression.Results: According to the SAMS total score, 44 (27.5%) were fully adherent, 93 (58.1%) were moderately non-adherent, and 23 (14.4%) were clinically significantly non-adherent. The most common reasons for non-adherence were forgetting to take the medication or lacking knowledge about the prescribed medication. Multiple linear regression revealed that adherence was good in people with external HLC and poor in internal HLC. In particular, intentional non-adherence was positively associated with internal HLC and negatively with fatalistic external HLC. Depression had a negative influence on both intentional and unintentional non-adherence.Conclusion: HLC is an independent predictor of medication non-adherence and is a promising target for interventions that enhance adherence.

Insulin Therapy in Type 2 Diabetes Is Associated With Barriers to Activity and Worse Health Status: A Cross-Sectional Study in Primary Care.

IntroductionMany individuals with type 2 diabetes mellitus (T2DM) experience “psychological insulin resistance”. Consequently, it could be expected that insulin therapy may have negative effects on psychological outcomes and well-being. Therefore, this study compared health status and psychosocial functioning of individuals with T2DM using only oral antihyperglycemic agents (OHA) and on insulin therapy (with or without OHA).Materials and MethodsIn this cross-sectional study, we used baseline data of a cluster randomized controlled trial conducted in 55 Dutch general practices in 2005. Health status was measured with the Short Form (SF)-36 (scale 0–100) and psychosocial functioning with the Diabetes Health Profile (DHP, scale 0-100). To handle missing data, we performed multiple imputation. We used linear mixed models with random intercepts per general practice to correct for clustering at practice level and to control for confounding.ResultsIn total, 2,794 participants were included in the analysis, their mean age was 65.8 years and 50.8% were women. Insulin-users (n = 212) had a longer duration of T2DM (11.0 versus 5.6 years) and more complications. After correcting for confounders and multiple comparisons, insulin-users reported significantly worse outcomes on vitality (SF-36, adjusted difference -5.7, p=0.033), general health (SF-36, adjusted difference -4.8, p=0.043), barriers to activity (DHP, adjusted difference -7.2, p<0.001), and psychological distress (DHP, adjusted difference -3.7, p=0.004), all on a 0-100 scale.DiscussionWhile previous studies showed similar or better health status in people with type 2 diabetes receiving insulin therapy, we found that vitality, general health and barriers to activity were worse in those on insulin therapy. Although the causality of this association cannot be established, our findings add to the discussion on the effects of insulin treatment on patient-reported outcomes in daily practice.

Inferior control of low-density lipoprotein cholesterol in women is the primary sex difference in modifiable cardiovascular risk: A large-scale, cross-sectional study in primary care

Background and aimsSex differences in cardiovascular prevention have been reported, yet the role of sex with regard to different modifiable risk factors such as low-density lipoprotein cholesterol (LDL-C), systolic blood pressure (BP), and glycated hemoglobin (HbA1c) in primary care settings is unclear. Therefore, we studied sex differences in assessment and measured values of LDL-C, BP, and HbA1c in primary and secondary cardiovascular prevention delivered by general practitioners. MethodsThis cross-sectional study was based on electronic medical records of 59,092 primary care patients (51.9% women) aged 40–79 years in Switzerland. Multilevel regression was used to model associations of sex with assessment and measured values of LDL-C, BP, and HbA1c in 2018. ResultsIn both primary and secondary prevention, women had lower LDL-C assessment rates (age-adjusted odds ratio (aOR) 0.71 [95% confidence interval (CI) 0.67 to 0.75] and 0.70 [CI 0.51 to 0.95]), and higher measured LDL-C values than men (age-adjusted difference 0.30 mmol/L [CI 0.25 to 0.35] and 0.28 mmol/L [CI 0.07 to 0.48]). Compared with men, women in primary prevention displayed lower BP and HbA1c assessment frequencies (aOR 0.77 [CI 0.73 to 0.81] and 0.76 [CI 0.71 to 0.80]) and measured values (age-adjusted difference -2.49 mmHg [CI -2.99 to -1.79] and -0.19% [CI -0.24 to -0.14]), while there was no sex difference in secondary prevention. Age-dependent increases in measured values of LDL-C, BP, and HbA1c were greater in women than men. ConclusionsControl of LDL-C in women in primary care should be improved to reduce sex-based inequalities in prevention of cardiovascular disease.

Pregnancy protection and pregnancies in women prescribed ACE inhibitors or ARBs: a cross-sectional study in primary care.

The teratogenic risks of angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) are well documented, but prescribing these in younger women in primary care is becoming increasingly frequent. To record how frequently women of childbearing age, who are prescribed an ACE inhibitor or ARB, receive preconception advice and/or are prescribed contraception, and how many pregnancies, terminations, and miscarriages occur in this population. Additionally, to ascertain whether patterns in the above differ across age groups. Cross-sectional study conducted among patients from 141 general practices in East London. Women aged 15-45 years who were issued a prescription for an ACE inhibitor or ARB between 1 October 2018 and 1 January 2019 inclusive were included. An electronic search strategy was designed to extract pseudonymised data concerning preconception and contraception advice, contraception, and pregnancies from the electronic clinical system; this was applied to the selected cohort on 1 January 2019. Data were analysed in 5-year age groups. Of 302 939 women aged 15-45 years, 2651 (0.9%) were prescribed an ACE inhibitor or an ARB in a 3-month period. Of these, 2159 (81.4%) had no advice and no contraception prescription recorded, 35 (1.3%) had preconception advice recorded, and 230 (8.7%) had contraception advice recorded. A total of 100 pregnancies and 21 terminations/miscarriages were recorded in the 12 months preceding the index date (1 January 2019). This study found that the recording of pre-pregnancy advice and contraception in women of childbearing age who were prescribed an ACE inhibitor or an ARB was suboptimal; this may place women and their babies at risk of exposure to teratogens during pregnancy. The findings indicate that there is a need for improved safety strategies based in primary care.

Symptoms in long-term breast cancer survivors: A cross-sectional study in primary care

PurposeVarious long-term symptoms can manifest after breast cancer treatment, but we wanted to clarify whether these are more frequent among long-term breast cancer survivors than matched controls and if they are associated with certain diagnoses. MethodsThis was a cross-sectional, population-based study of 350 breast cancer survivors treated with chemo- and/or radiotherapy ≥5 years (median 10) after diagnosis and 350 women without cancer matched by age and primary care physician. All women completed a questionnaire enquiring about symptoms, underwent echocardiography to assess the left ventricle ejection fraction, and completed the Hospital Anxiety and Depression Scale. Cardiovascular diseases were diagnosed from primary care records. In a multivariable logistic regression analysis, symptoms were adjusted for the long-term effects and compared between cohorts and within the survivor group. ResultsConcentration difficulties, forgetfulness, dizziness, and nocturia were more frequent among breast cancer survivors compared with controls, but differences could not be explained by cardiac dysfunction, cardiovascular diseases, depression, or anxiety. Intermittent claudication and appetite loss were more frequent among breast cancer survivors than controls and associated with cardiac dysfunction, depression, and anxiety. Breast cancer survivors treated with chemotherapy with/without radiotherapy were at significantly higher odds of forgetfulness and nocturia, but significantly lower odds of dizziness, compared with breast cancer survivors treated with radiotherapy alone. ConclusionsIntermittent claudication and appetite loss are common among breast cancer survivors and are associated with cardiac dysfunction and mood disorders. Other symptoms varied by whether the patient underwent chemotherapy with/without radiotherapy (forgetfulness and nocturia) radiotherapy alone (dizziness).

Adherence to inhalers and comorbidities in COPD patients. A cross-sectional primary care study from Greece

BackgroundComorbidities and adherence to inhaled therapy appears to have a major impact on treatment goals, health status and disease control in chronic obstructive pulmonary disease (COPD). Aim of the study was to assess levels of adherence to inhalers, comorbidities and associations with COPD outcomes in patients residing in rural and semi-urban areas of Greece.MethodsTwo hundred fifty-seven COPD patients were enrolled from primary health care in 2015–2016. Physicians used structured interviews and questionnaires to assess quality of life and disease status. Patients were classified into groups according to GOLD 2019 guidelines (based on CAT and mMRC). Adherence to inhalers was measured with the Test of Adherence to Inhalers (TAI). Multivariate linear and logistics regression models were used to assess associations between comorbidities and adherence to inhalers with COPD outcomes, including CAT and mMRC scores, exacerbations and GOLD A-D status.Results74.1% of COPD patients reported poor adherence, while most of them were characterized as deliberate non-compliers (69.5%). 77.1% had ≥2 comorbidities, with overweight/obese (82.2%), hypertension (72.9%) and diabetes mellitus (58%) being the most prevalent. In multivariate analysis, COPD outcomes having significant associations with poor adherence included worse health status [OR (95% CI) 4.86 (1.61–14.69) and 2.93 (1.51–5.71) based on CAT and mMRC, respectively], having ≥2 exacerbations in the past year [4.68 (1.51–4.44)], and disease status e.g., be in groups C or D [3.13 (1.49–8.53) and 3.35 (1.24–9.09) based on CAT and mMRC, respectively). Subjects with gastroesophageal reflux showed better inhaler adherence [OR (95% CI) 0.17 (0.6–0.45)], but none of the comorbid conditions was associated with COPD outcomes after adjustments.ConclusionsPoor adherence to inhalers and comorbidities are both prevalent in COPD patients of primary care residing in rural/semi-urban areas of Greece, with adherence influencing COPD outcomes. Raising awareness of patients and physicians on the importance of comorbidities control and inhaler adherence may lead to interventions and improve outcomes.

Prevalence of suspected COVID-19 infection in patients from ethnic minority populations: a cross-sectional study in primary care.

BackgroundThe first wave of the London COVID-19 epidemic peaked in April 2020. Attention initially focused on severe presentations, intensive care capacity, and the timely supply of equipment. While general practice has seen a rapid uptake of technology to allow for virtual consultations, little is known about the pattern of suspected COVID-19 presentations in primary care.AimTo quantify the prevalence and time course of clinically suspected COVID-19 presenting to general practices, to report the risk of suspected COVID-19 by ethnic group, and to identify whether differences by ethnicity can be explained by clinical data in the GP record.Design and settingCross-sectional study using anonymised data from the primary care records of approximately 1.2 million adults registered with 157 practices in four adjacent east London clinical commissioning groups. The study population includes 55% of people from ethnic minorities and is in the top decile of social deprivation in England.MethodSuspected COVID-19 cases were identified clinically and recorded using SNOMED codes. Explanatory variables included age, sex, self-reported ethnicity, and measures of social deprivation. Clinical factors included data on 16 long-term conditions, body mass index, and smoking status.ResultsGPs recorded 8985 suspected COVID-19 cases between 10 February and 30 April 2020.Univariate analysis showed a two-fold increase in the odds of suspected COVID-19 for South Asian and black adults compared with white adults. In a fully adjusted analysis that included clinical factors, South Asian patients had nearly twice the odds of suspected infection (odds ratio [OR] = 1.93, 95% confidence interval [CI] = 1.83 to 2.04). The OR for black patients was 1.47 (95% CI = 1.38 to 1.57).ConclusionUsing data from GP records, black and South Asian ethnicity remain as predictors of suspected COVID-19, with levels of risk similar to hospital admission reports. Further understanding of these differences requires social and occupational data.

The Association Between Beliefs and Adherence to Inhaled Controller Medication Among Older Adults with Asthma: A Cross-Sectional Study in Primary Care.

BackgroundWhile illness perceptions and medication beliefs have been shown to be associated with inhaled corticosteroid (ICS) adherence in younger adults with asthma, their impact on older adults is less understood. This study aimed to determine the prevalence of ICS adherence among older Asian adults and to assess the association between ICS adherence, illness perceptions and medication beliefs.MethodsA questionnaire survey on older multi-ethnic Asian patients, aged ≥60 years, with physician-diagnosed asthma, was conducted in two Singapore public primary care clinics. The scores of the Medication Adherence Report Scale for asthma (MARS) were computed to determine the adherence to ICS alone or in combination with LABA. Illness perceptions and medication beliefs were assessed by the scores from the Brief-Illness Perception Questionnaire (B-IPQ) and Beliefs about Medications Questionnaire (BMQ), respectively. Logistic regression analyses were used to identify factors associated with ICS adherence.ResultsAnalyses of 323 participants (57% males; Chinese 73.7%, Malay 12.7%, Indian 12.4%; mean age 71.5 years) showed that 40.9% of them had good adherence to ICS (mean MARS score≥4.5). Good adherence to ICS was associated with perception of asthma as a chronic illness (OR=1.22; 95% CI=1.10–1.35; p<0.001), belief of ICS as an essential medication (2.67; 1.76–4.06; p<0.001) and fewer concerns about its use (0.39; 0.26–0.60; p<0.001). Patients on combined ICS-LABA therapy had higher adherence (2.50; 1.41–4.44; p=0.02) than those on ICS monotherapy.ConclusionFour in ten older patients with asthma were adherent to ICS. Perception of medication necessity, chronicity of illness, concerns and use of ICS-LABA medication were associated with adherence.