Search

People with severe mental illnesses are at increased risk for physical illness, including cardiovascular disease. (1) (2) Guidance from the National Institute for Clinical Excellence recommends monitoring of cardiovascular risk [...]

Background:: Primary care is the 'first port of call' for weight control advice, creating a need for simple, effective interventions that can be delivered without specialist skills. Ten Top Tips (10TT) is a leaflet based on habit-formation theory that could fill this gap. The aim of the current study was to test the hypothesis that 10TT can achieve significantly greater weight loss over 3 months than ‘usual care’. Methods:: A two-arm, individually randomised, controlled trial in primary care. Adults with obesity were identified from 14 primary care providers across England. Patients were randomised to either 10TT or 'usual care' and followed up at 3, 6, 12, 18 and 24 months. The primary outcome was weight loss at 3 months, assessed by a health professional blinded to group allocation. Difference between arms was assessed using a mixed-effect linear model taking into account the health professionals delivering 10TT, and adjusted for baseline weight. Secondary outcomes included body mass index, waist circumference, the number achieving a 5% weight reduction, clinical markers for potential comorbidities, weight loss over 24 months and basic costs. Results:: Five-hundred and thirty-seven participants were randomised to 10TT (n=267) or to ‘usual care' (n=270). Data were available for 389 (72%) participants at 3 months and for 312 (58%) at 24 months. Participants receiving 10TT lost significantly more weight over 3 months than those receiving usual care (mean difference =−0.87kg; 95% confidence interval: −1.47 to −0.27; P=0.004). At 24 months, the 10TT group had maintained their weight loss, but the ‘usual care’ group had lost a similar amount. The basic cost of 10TT was low, that is, around £23 ($32) per participant. Conclusions:: The 10TT leaflet delivered through primary care is effective in the short-term and a low-cost option over the longer term. It is the first habit-based intervention to be used in a health service setting and offers a low-intensity alternative to ‘usual care’.

Much research has been done on patients’ attitudes towards the use of computers in general practice consultations, but the attitudes of health professionals require further investigation. Ten out of 21 general practitioners (GPs) and eight out of 11 practice nurses were interviewed or given a written questionnaire to determine their views on the advantages and the potential uses of computers, and their impact on consultations. Professionals had expectations of improved electronic links with the local health authority and hospitals, and access to laboratory results. However, they expressed mixed views on paperless records, and concerns about patient data confidentiality and the effect of the computer on professionals’ interactions with patients. All GPs and three out of 11 nurses approached were strongly opposed to the idea that computers ‘dehumanize’ the consultation. Primary care health professionals would benefit from computer training to have a clearer concept of the full potential of general practice computer systems, and to gain a better understanding of the issues around patient confidentiality.

Objectives To determine neuro-otological and psychiatric abnormalities associated with complaints of dizziness in an epidemiological community sample of people of working age, and the extent of comorbidity between neuro-otological and psychiatric dysfunction. MethodA survey of 3884 people randomly selected from six general practice lists identified 262 people with significant dizziness, from which a subsample of 15 men and 22 women were recruited for testing. Dizzy subjects were evaluated by blind neuro-otological testing, computerised dynamic posturography, a computerised psychiatric assessment, neuro-otological and general medical examination, and diagnosis. An age matched control group of 18 men and 22 women underwent the same evaluation. ResultsTests of auditory, vestibular, and oculo-motor function did not discriminate between dizzy subjects and controls, but dizzy subjects had significantly worse balance on posturographic testing, more diagnoses of medical disorder, and a higher prevalence of psychiatric morbidity. Conclusions The findings suggest that dizziness in the community is typically characterised by mild physical disorder accompanied by some psychiatric disturbance. As the combination of minor physical and psychiatric disorder is known to be unusually persistent and handicapping, treatment programmes must be provided for this prevalent syndrome, perhaps by a partnership between primary care and neuro-otological and psychiatric hospital outpatient clinics with experience and expertise in the diagnosis and management of dizziness and psychiatric disturbance.

Sexual dysfunction is an important aspect of sexual heath that is prevalent in the population but frequently goes undetected.

Dizziness is commonly experienced in the community, but little is known about the long-term progression of the condition.

AimsOur aim was to assess the numbers of obese children and young people(CYP) eligible for assessment and management at each stage of the NICE (National Institute for Health and Clinical Excellence) childhood obesity pathway in England. Current surveillance estimates of obesity are not useful for assessing potential clinical burden on primary/secondary care.Abstract P02 Table 1Obesity pathwayPathway stageEligibility% of population eligible% eligible in most deprived quintilePopulation of CYP eligible in England (95% CI)1A: Management in primary/ community careObese>98thBMI centile(%)11.2%15.8%1,220,0001B. Eligible for community lifestyle modificationObese:BMI>98%11.2%15.8%1,220,0001C. Likely to seek evaluation by general practiceObese BMI>98% +(distress or positive family history)2.6%4.1%283,400 (2 18 000 to 3 70 600)2: Eligible for assessment in secondary care(Obese BMI>98% +primary care measurable comorbidity) OR extreme obesity (BMI>99.86%)5.1%7.5%555,900 (4 90 500 to 6 32 200)For age 12+ years3: Eligible for anti-obesity drug treatmentObese BMI>98% +any co-morbidity8.2%15.4%309,300 (2 03 700 to 4 30 000)4. Eligible for bariatric surgery(Obese: BMI>35kg/ m2+ any comorbidity) OR morbidly obese BMI>40kg/m22.4%3.1%90,500 (71 700 to 1 13 100)MethodsWe created a model of the UK population using data on CYP 2–18 years from Health Surveys for England from 2006– 2013. Data: height, weight, lipids, HbA1c, blood pressure, deprivation, ethnicity, family history, musculoskeletal problems and psychological distress (General Health Questionnaire (GHQ)). We combined data across years to maximise the sample. We used guidance from NICE (2006) and UK expert consensus (OSCA guidelines: ADC 2012) to identify the potential burden on services if all eligible children were assessed and treated. England population data were obtained from ONS(2014).ResultsThe table shows the proportions eligible for each stage of the obesity pathway and the corresponding population estimate (95% confidence intervals) for England.ConclusionsLarge proportions of CYP are eligible for secondary referral, anti-obesity drugs and bariatric surgery, likely far in excess of treatment availability. This mismatch is particularly marked in deprived CYP. Current guidance is flawed, with higher proportions eligible for higher stages in the pathway. Needs-based and evidence-based planning of CYP obesity services is required to reduce inequalities.

À chaque instant, environ 1 % de la population générale reçoit une corticothérapie systémique. Si les infections sont des complications reconnues comme « classiques » des corticothérapies systémiques, très peu d’études sont en fait disponibles concernant le risque relatif d’infections communes chez les patients recevant une corticothérapie systémique en population générale. Par ailleurs, l’impact de la durée d’exposition sur ces risques relatifs et les facteurs de risque d’infection sont mal connus.