Search PubMed⌕ Search

Biomedical subjects

P Croft

Publications and source records attributed to P Croft.

At least 37 records · Page 2Linked to original sources
PubMed2001

Postal surveys in primary care: the hidden burden.

OBJECTIVE: To investigate and analyse concerns raised by unsolicited mailing of a health survey to a community sample of older people. DESIGN: Observation and monitoring of all telephone calls received throughout a 6-week survey mailing period. SETTING AND PARTICIPANTS: A total sample of all those aged over 50 years registered with three general practices in North Staffordshire (n=8995). MAIN VARIABLE STUDIED: The frequency of telephone contact following the receipt of a postal questionnaire, and the nature of any associated distress. RESULTS AND CONCLUSIONS: Individuals who receive unsolicited postal surveys may experience anxiety because of the actual receipt of the questionnaire, concerns about taking part or not taking part, personal issues, anger, worthiness or frustration with NHS services. Anxiety may also be triggered because of administrative issues, for example lost mail or overlap between mailing periods. Researchers can adopt measures both to reduce the potential anxiety and often hidden burden of postal surveys, and to facilitate individuals' positive participation in research.

Aged↗
PubMed2001

Clinical assessment of the osteoarthritis patient.

It is becoming apparent that the disease process of osteoarthritis should be regarded separately from the clinical syndrome of joint pain, use-related stiffness and disability. The latter may best be approached as a chronic regional pain disorder that requires attention to physical, psychological and social factors as well as those related to the disease process. This chapter sets out to look at some of the practical implications of taking this view for the clinical assessment. Starting with the syndrome of hip, knee or hand pain in older adults in the community, we consider what leads people to consult, what the important features to assess might be, the role of imaging in the clinical assessment of osteoarthritis, and finally how a management plan could be formulated. The usefulness of assessing clinical osteoarthritis as a regional pain disorder is uncertain. Even if this were demonstrated, the concept of osteoarthritis as a structural disease should be retained as an integral part.

Adult↗
PubMed2001

Predicting radiographic hip osteoarthritis from range of movement.

OBJECTIVES: The primary objective was to test the hypothesis that new attenders in primary care with hip pain and radiographic osteoarthritis (OA) have a decreased range of movement compared with those without OA. The secondary objective was to define the planes of movement and thresholds that were the most discriminatory for OA. METHODS: Men and women aged 40 yr and over presenting with a new episode of hip pain were recruited from 36 general practices across the UK. A standardized radiographic and clinical examination was performed. The discriminating ability of the range of movement for each plane to identify those with radiographic OA was assessed using receiver operating characteristic curves. RESULTS: New hip pain attenders with radiographic OA had restricted movement at the hip compared with those without radiographic change. Restriction in internal rotation was the most predictive and flexion the least predictive of radiographic OA. At this cut-off, restriction in any single plane had a sensitivity of 86% for moderate and 100% for severe OA (specificity was 54 and 42% respectively). Restriction in all three planes had greater discrimination (sensitivity was 33% for mild to moderate OA and 54% for severe OA; specificity was 93 and 88% respectively). CONCLUSIONS: Restriction in range of movement was predictive of the presence of OA in these new presenters to primary care with hip pain, and the results of this examination could be used to inform decisions regarding radiography.

Adult↗
PubMed2001

A brief screening tool for knee pain in primary care. 1. Validity and reliability.

OBJECTIVES: To design and test the performance of a new knee pain screening tool (KNEST), both separately and together with a combination of existing questionnaires, which will be used to assess the general health status of knee pain sufferers in primary care. METHODS: A postal survey of knee pain and disability was sent to a random sample of 240 individuals aged over 55 yr registered with two general practices in North STAFFORDSHIRE: The survey questionnaire consisted of the KNEST; a pain manikin; the Short Form 36 (SF-36); the Hospital Anxiety and Depression Scale (HADS); demographic questions; and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) for those who reported knee pain. A second, identical questionnaire was sent 2 weeks later to a random subsample of responders (n=80) to test repeatability. RESULTS: An 85% baseline response rate was achieved for the first questionnaire. The 12-month prevalence of knee pain identified from baseline responders to the survey was 45%. A response rate of 74% was achieved for the repeatability questionnaire. Each section of the questionnaire was well completed and repeatability was good for nearly all measures (most reliability scores exceeded 0.6). A new core question about knee pain showed good internal reliability, with an agreement score of 91% between baseline and retest assessment, and good construct validity in relation to knee pain identified on the pain manikin (agreement 95%). Good agreement was found between recalled consultation for knee pain in the questionnaire and evidence of consultation for knee pain in general practice records. CONCLUSIONS: The KNEST appears to be a reliable and valid composite tool for the study of population needs and outcomes of care for people aged over 55 yr with knee pain.

Disability Evaluation↗
PubMed2001

Knee pain and osteoarthritis in older adults: a review of community burden and current use of primary health care.

BACKGROUND: Osteoarthritis is the single most common cause of disability in older adults, and most patients with the condition will be managed in the community and primary care. AIM: To discuss case definition of knee osteoarthritis for primary care and to summarise the burden of the condition in the community and related use of primary health care in the United Kingdom. DESIGN: Narrative review. METHOD: A literature search identified studies of incidence and prevalence of knee pain, disability, and radiographic osteoarthritis in the general population, and data related to primary care consultations. Findings from UK studies were summarised with reference to European and international studies. RESULTS: During a one year period 25% of people over 55 years have a persistent episode of knee pain, of whom about one in six in the UK and the Netherlands consult their general practitioner about it in the same time period. The prevalence of painful disabling knee osteoarthritis in people over 55 years is 10%, of whom one quarter are severely disabled. CONCLUSION: Knee osteoarthritis sufficiently severe to consider joint replacement represents a minority of all knee pain and disability suffered by older people. Healthcare provision in primary care needs to focus on this broader group to impact on community levels of pain and disability.

Activities of Daily Living↗
PubMed2001

A case-control study of differences between regular and causal adult attenders in general dental practice.

OBJECTIVES: To assess whether adults attending a dental practice for regular dental care have better oral health than adults attending casually in response to a dental problem, and to explore the barriers to asymptomatic attendance. METHODS: An observational case-control study comparing the characteristics of 100 regular attenders with 100 causal attenders in one general dental practice in North Staffordshire. All study subjects were aged 18 years or over. Sociodemographic characteristics of the two groups were collated, including age, gender, social class, marital status, employment status and smoking status. The primary outcome measure was the observed number of teeth with dentinal caries diagnosed using bitewing radiographs. RESULTS: Regular attenders were observed to have better oral health with respect to dental caries and tooth mobility (p < 0.05). This was not explained by the observation that causal attenders were more likely than regular attenders to be male, aged 18-44 years, in social class III or IV. Secondary outcomes, including number of subjects with mobile teeth and teeth with > 30% bone-loss, were also significantly worse in the casual attenders. However, the median number of teeth present in both groups was 27. In regular attenders, the most common reason for attending was to 'keep the teeth' (96%). In casual attenders, 'fear/dislike of dental treatment' was the most frequent indicator of non-attendance (56%). CONCLUSIONS: In our study, adults who regularly attended general dental practice were shown to have better oral health, including less overall tooth decay, mobility and bone-loss, compared with adults who did not attend on a regular basis. Assuming this result to be externally valid, a challenge for the dental profession in the future will be to develop effective oral health promotion initiatives.

Adolescent↗
PubMed2001

A qualitative study of patients' views on anxiety and depression.

BACKGROUND: In the management of patients with anxiety and depression in general practice, the emphasis has been on improving detection and appropriate use of drug therapies by health professionals. Patients' own perceptions of their problems and what services they would prefer have not often been sought. AIM: To explore patient perspectives in relation to their healthcare needs in anxiety and depression. DESIGN OF STUDY: Semi-structured individual and focus group interviews. SETTING: A total of 27 patients from an urban four-partner group general practice who were identified as having anxiety and depression by a practice population questionnaire survey. METHOD: All interviews were transcribed and the major themes were summarised using grounded theory analysis. RESULTS: Patients seek many different ways of coping with their problems but view their general practice as a focal point for help. Their experiences are dominated by the struggle to control unwelcome and intrusive thoughts and to live in a hostile and threatening world. They also have distinct preferences regarding their health needs and there is universal scepticism about drug therapies. CONCLUSION: Patients describe personal and professional barriers to seeking help and have particular views on the treatment options. This perspective contrasts with the current professional emphasis on detection and drug use. This view is therefore central to informing the debate on management of neurotic disorders in primary care and on improving the care of these patients.

Adolescent↗
PubMed2001

Factors affecting over-the-counter use of aspirin in the secondary prophylaxis of cardiovascular disease.

Little is known about the contribution of over-the-counter (OTC) aspirin to cardiovascular prophylaxis. To investigate this, a two-phase cross-sectional study was carried out in nine general practices in North Staffordshire. In the first phase, all patients with cardiovascular disease (CVD) were identified from computer searches using morbidity registers and drug searches. The search also identfied the subgroup receiving prescribed prophylactic aspirin. In the second phase, a questionnaire was posted to all patients with CVD who were not on prescribed aspirin to establish their current use of OTC aspirin. Overall, 69% of the CVD group used aspirin, with 26% of aspirin being OTC. OTC aspirin use was more common in those aged under 65 years, men, and the more affluent. Also, there were significant differences in OTC aspirin use between the various practices. This study shows that a considerable amount of aspirin is used OTC in those with CVD. Its use is influenced by several factors that could be addressed when considering attempts to improve the overall uptake of aspirin.

Age Factors↗
PubMed2000

Carpal tunnel syndrome: a nested case-control study of risk factors in women.

Risk factors for the development of carpal tunnel syndrome in women were studied by means of a nested case-control analysis of a prospective cohort study of the health effects of oral contraception in British women. A total of 1,264 women who had a diagnosis of carpal tunnel syndrome reported by their general practitioner between 1968 and 1993 were compared with 1,264 age-matched control women who did not have this diagnosis. The syndrome was associated in older women with some hormonal factors, notably past use of oral contraception (adjusted odds ratio in women aged 40 years and over = 1.38, 95 percent confidence interval: 1.08, 1.76) and more generally with obesity (adjusted odds ratio = 1.68, 95 percent confidence interval: 1.29, 2.18). However, the strongest link was with a previous history of another musculoskeletal complaint for which consultation had been sought (adjusted odds ratio = 1.98, 95 percent confidence interval: 1.61, 2.42). Previous findings of a higher risk in women with diabetes and myxoedema were confirmed, but these contribute only a small proportion of all cases in women. There was no link with psychologic problems or nonmusculoskeletal pain complaints. The previously described increased incidence of carpal tunnel syndrome in women may be partly due to hormonal factors, but is also related to an underlying propensity to musculoskeletal problems and their higher overall frequency in women.

Adult↗
PubMed2000

Occupational physical activities and osteoarthritis of the knee.

OBJECTIVE: To assess the risk of knee osteoarthritis (OA) associated with kneeling, squatting, and other occupational activities. METHODS: We compared 518 patients who were listed for surgical treatment of knee OA and an equal number of control subjects from the same communities who were matched for sex and age. Histories of knee injury and occupational activities were ascertained at interview, height and weight were measured, and the hands were examined for Heberden's nodes. Data were analyzed by conditional logistic regression. RESULTS: After adjustment for body mass index (BMI), history of knee injury, and the presence of Heberden's nodes, risk was elevated in subjects who reported prolonged kneeling or squatting (odds ratio [OR] 1.9; 95% confidence interval [95% CI] 1.3-2.8), walking >2 miles/day (OR 1.9; 95% CI 1.4-2.8), and regularly lifting weights of at least 25 kg (OR 1.7; 95% CI 1.2-2.6) in the course of their work. The risks associated with kneeling and squatting were higher in subjects who also reported occupational lifting, and appeared to interact multiplicatively with the risk conferred by obesity. People with a BMI of > or =30 kg/m2 whose work had entailed prolonged kneeling or squatting had an OR of 14.7 (95% CI 7.2-30.2), compared with subjects with a BMI <25 kg/m2 who were not exposed to occupational kneeling or squatting. CONCLUSION: There is now strong evidence for an occupational hazard of knee OA resulting from prolonged kneeling and squatting. One approach to reducing this risk may lie in the avoidance of obesity in people who perform this sort of work.

Aged↗
PubMed2000

Researching limiting long-term illness.

Needs assessment has become one of the cornerstones for commissioning health care in the UK but, as yet, no agreed methodological framework exists. This study attempts to build on a number of different approaches used in needs assessment in order to formulate a more complex and integrated model. We have taken limiting long-term illness (LLI) as a starting point and examined its prevalence within the primary care setting in an area of North Staffordshire. This was followed by the application of a health status measure on two sub-samples (those reporting LLI and those not reporting LLI). The diagnostic assessments of the GP was placed alongside the results of the health status measure in order to compare self-assessment with the professional perspective. Finally, in-depth interviews with people with LLI were carried out examining their own experience of ill-health. We argue that this detailed and complex needs assessment allows for a more targeted approach to commissioning and service development.

Chronic Disease↗
PubMed2000

Is the quality of asthma prescribing, as measured by the general practice ratio of corticosteroid to bronchodilator, associated with asthma morbidity?

The objective of this study was to determine whether the quality of asthma prescribing in general practice is associated with the severity of asthma patients' symptoms. Cross-sectional survey of asthma-like symptoms in patients prescribed antiasthma therapy was used. The setting was two general practices with contrasting ratios of corticosteroid to bronchodilator (high vs. low). The main outcome measures were: patient symptoms score and patient characteristics (age, gender, diagnosis, smoking, social class, and deprivation status). Patients on antiasthma therapy from the practice with the low corticosteroid to bronchodilator ratio had a higher mean symptom score (20.1, 95% CI 18.6, 21.7) than patients on antiasthma therapy from the practice with the high corticosteroid to bronchodilator ratio (13.2, 95% CI 11.8, 14.5). The mean difference in patient symptom score between the two practices was 7.0 (95% CI 4.9, 9.0); this changed little after adjustment for potential confounders. The quality of prescribing, as measured by the practice ratio of corticosteroid to bronchodilator, appears to be an important factor in the outcome of asthma care. The ratio of corticosteroid to bronchodilator in a general practice is one indicator of the quality of prescribing for asthma.

Adolescent↗
PubMed2000

The introduction of a routine monitoring system in primary care for patients with a first episode of cardiovascular disease.

A study at a group general practice in the English midlands found that health promotion advice had not been routinely provided to some patients with cardiovascular disease and stroke. The purpose of this project therefore was to introduce a monitoring system to ensure that health promotion issues were covered systematically with patients following a first episode of cardiovascular disease. Patients with a first episode of a relevant condition would be identified by an automated search on the practice database, and contacted by the health visitor. A checklist would ensure that all appropriate issues were covered. The system was easily introduced at the practice and no difficulties were experienced with its administration. A total of 62 patients were seen during the year. A substantial number of secondary prevention issues were addressed through advice and information leaflets. The project was felt to be a useful addition to care by the workers involved. Although some of the issues may have been addressed in routine care, early organized nurse contact ensures systematic coverage and early referrals where necessary, as well as potential psychological benefit to patients.

Adult↗
PubMed2000

Radiographic change is common in new presenters in primary care with hip pain. PCR Hip Study Group.

OBJECTIVE: To determine the prevalence of radiographic osteoarthritis in subjects with hip pain newly presenting to primary care. METHODS: The study was cross-sectional in design, set in 35 general practices across the UK. It included 195 men and women aged 40 yr and over (median 63 yr) presenting with a new episode of hip pain. Hip radiographs were scored for minimum joint space (MJS) and overall-Croft's modification of the Kellgren and Lawrence (Croft)-grade of osteoarthritis. RESULTS: In all, definite evidence of radiographic change in the painful joint was common: Croft grade > or =2 in 44%, > or =3 in 34%. MJS of 2.5 mm or less was seen in 30% of whom half were below 1.5 mm. There were no significant gender differences in radiographic severity. CONCLUSIONS: Radiographic change is common in patients newly presenting with hip pain and many already have advanced disease.

Adult↗
PubMed2000

Are triptans with enhanced lipophilicity used for the acute treatment of migraine associated with an increased consulting rate for depressive illness?

1997, sumatriptan-treated migraineurs had significantly higher depression PCRs (22.3%) compared with non-triptan users (19.3%), a difference of 6.4% (95% confidence interval (CI) 4.6-8.4%, P < 0.001). In the year (April 1997 to March 1998) following the launch of the TELs, depression PCRs were significantly higher among patients using these compounds compared with sumatriptan-treated patients (5.1%, CI 1.8-12.0%, P < 0.05). However, after taking account of prior depression (odds ratio (OR) 6.45, 95% CI 3.63-11.43), TELs were not significantly associated with depression (OR 0.27, 95% CI 0.03-2.13). Furthermore, rates of newly diagnosed depression after treatment were similar in the two triptan groups (sumatriptan 4.2%; TELs 3.9%). Although, the TELs are being prescribed to patients with higher pre-existing rates of depression, they are not associated with subsequently increased consulting for depressive illness compared with patients taking sumatriptan. This study highlights the potential to use GPRD to test targeted hypotheses exploring pharmacovigilance issues for patients using new medicines.

Cohort Studies↗