Biomedical subjects

Peter R Croft

Publications and source records attributed to Peter R Croft.

30 records · Page 2Linked to original sources

PubMed2004

An epidemiological survey of symptoms of menstrual loss in the community.

BACKGROUND: For the early detection of gynaecological malignancy, guidance based on presenting symptoms exists to aid a general practitioner (GP) in determining who to investigate or refer. The evidence for this advice is based on the prevalence of symptoms in women with gynaecological malignancy or within specialist clinics. There are no studies on the incidence of symptoms within the community. AIM: To provide an estimate of the incidence of self-reported symptoms of menstrual loss in the community population of a single general practice. DESIGN OF STUDY: A prospective population-based cohort study of women identified through a baseline postal survey and followed 6 and 12 months later. SETTING: An urban general practice with four partners and 10,000 registered patients. METHOD: A postal baseline survey was undertaken on all women aged 18-54 years on the practice age-sex register. Responders who consented to follow-up were sent further questionnaires at 6 and 12 months. All questionnaires enquired about the presence or absence of symptoms related to vaginal bleeding. Twelve-month cumulative incidence rates were calculated using responders to the baseline, 6-month and 12-month questionnaires. RESULTS: A total of 2435 questionnaires were initially sent out at baseline and 1513 (62%) women replied to all three questionnaires. The 12-month cumulative incidence of symptoms in menstruating women was: menorrhagia 25% (95% confidence interval [CI] = 22 to 29); periods heavier than usual, 21% (95% CI = 18 to 23); change in pattern of cycle, 29% (95% CI = 26 to 32); short cycle 21% (95% CI = 19 to 24); long cycle 15% (95% CI = 13 to 18); intermenstrual bleeding 17% (95% CI = 14 to 19); postcoital bleeding 6% (95% CI = 5 to 8); prolonged period 9% (95% CI = 7 to 11). CONCLUSION: The development of symptoms of menstrual loss among women in the community is common, in contrast to the rarity of gynaecological malignancy. This raises concern about the usefulness of current guidelines, based on symptoms, advising women when to consult, and for the early detection of gynaecological malignancy in the community and primary care.

Adolescent↗

PubMed2003

Does questionnaire structure influence response in postal surveys?

This study tested the effect of questionnaire structure on response, speed of return, and content of answers in a postal survey. All 259 patients aged 30-59 years who consulted with back pain at four UK general practices from March to June 2001 were randomly allocated to receive either a traditionally or chronologically structured self-completion questionnaire. The response was higher and the returns quicker (P =.05) for the chronologic questionnaire. There were no statistically significant differences in completion rates or scores on the SF-36, Chronic Pain Grade, Hospital Anxiety and Depression Scale, or Roland-Morris Disability Questionnaire between the two types of questionnaire, and test-retest reliability was high for all scales. Changing questionnaire structure to make questions chronologic does not substantially affect the answers given, but may make a questionnaire more acceptable and easier to complete and speed up returns.

Adult↗

PubMed2003

Predictors of hip joint replacement in new attenders in primary care with hip pain.

BACKGROUND: Studies investigating the factors associated with need for total hip replacement should ideally be based on prospective investigation of new attenders in primary care. AIM: To determine the incidence of listing for total hip replacement, and its predictors, among attenders in primary care with a new episode of hip pain. DESIGN OF STUDY: Prospective multicentre cohort study. SETTING: One hundred and ninety-five patients (mean age = 63 years, 68% female) with new episode of hip pain, attending primary care between November 1994 and October 1997. At the first visit, patients were evaluated for indices of pain and disability, range of hip movement, and radiographic changes of osteoarthritis. METHOD: General practitioner participants were recruited from the membership of the Primary Care Rheumatology Society to recruit all consecutive attenders with a new episode of hip pain. Annual follow-up was carried out to determine which patients were being 'put on a waiting list' for total hip replacement. RESULTS: Seven per cent of patients were put on a waiting list for total hip replacement within 12 months and 23% of patients within four years. At presentation, pain duration, pain severity, (including the need to use a stick) and restriction of internal rotation were the major clinical predictors of being put on a waiting list. Radiographic predictors of osteoarthritis performed similarly to the clinical measures. A simple scoring system based on both radiographic severity and two of the clinical measures was derived that identified groups at high likelihood of being put on a waiting list (sensitivity = 76%) with a low false-positive rate (specificity = 95%). CONCLUSION: New primary care attenders with pain are frequently accepted for total hip replacement soon after their first attendance--a decision that can be predicted by simple clinical measures.

Arthroplasty, Replacement, Hip↗

PubMed2003

Increased vaginal bleeding and psychological distress: a longitudinal study of their relationship in the community.

OBJECTIVE: To explore the temporal relationship between the development of self-reported symptoms of vaginal bleeding and the development of psychological distress among women in the community. DESIGN: Prospective cohort study using postal surveys at baseline and at 6 and 12 months. SETTING: An urban four-partner general practice with 10000 registered patients. POPULATION: All women aged 18-54 years on the practice age-sex register. METHODS: Baseline postal questionnaire with follow up questionnaires sent at 6 and 12 months. MAIN OUTCOME MEASURES: The associations between the development of heavy periods and psychological distress. RESULTS: Two thousand and four hundred and thirty-five baseline questionnaires were sent out with an initial response rate of 76%. One thousand and five hundred and thirteen women (62%) responded to all three questionnaires. Women with psychological distress at baseline were more likely to develop heavy periods 6 months later than women without distress (adjusted odds ratio 1.87, 95% CI 1.15, 3.02). Women with heavy periods at baseline were no more likely to develop psychological distress 6 months later than women with non-heavy periods (adjusted odds ratio 1.09, 95% CI 0.73, 1.63). Similar findings existed with respect to intermenstrual bleeding and postcoital bleeding. Results of the 12-month analysis were similar. CONCLUSION: In the community, psychological distress appears to influence the future self-reporting of heavy periods and other symptoms of vaginal bleeding.

Adolescent↗

PubMed2003

Consultation and the outcome of shoulder-neck pain: a cohort study in the population.

OBJECTIVE: Despite the high prevalence of shoulder-neck pain in the community, and the fact that it is commonly a persistent and disabling condition, only a minority of sufferers seek medical help. We investigated the association between primary care consultation and subsequent outcome in a cohort of shoulder-neck pain sufferers. METHODS: A population with unilateral shoulder-neck pain was identified by a questionnaire mailed to 4002 adults randomly selected from the register of one family practice. Subjects were asked to shade areas of pain on a blank manikin, and give demographic details and scales of pain, anxiety, and depression. For the following 2 years, general practitioner (GP) consultations for shoulder and neck problems were determined using the practice database. The persistence of pain and degree of shoulder-specific disability, as well as general health status using the Medical Outcome Study Short Form-36 (SF-36), were assessed by means of a second postal survey at 2 years' followup. RESULTS: Three hundred four subjects (11.7% of questionnaire responders) had unilateral shoulder-neck pain at baseline, and 224 were included in the study analyses. Of these, 47 (21%) consulted their GP for shoulder-neck problems over the 2 years. Of the 47 consulters, 36 (77%) reported shoulder-neck pain at followup; this was a higher percentage than that for nonconsulters (RRadjusted = 1.3). Among all subjects with persistent shoulder-neck pain, consulters were more likely than nonconsulters to have shoulder related disability at followup (RRadjusted = 1.6). On average, consulters had more pain and lower levels of physical functioning at followup than nonconsulters as measured by the SF-36. CONCLUSION: The minority of shoulder-neck pain sufferers who consult a primary care practitioner do not have better subsequent pain and disability outcomes than those who do not consult. Our findings raise questions about the current influence of medical care on the natural history of this condition.

Adolescent↗

PubMed2002

Episodes of low back pain: a proposal for uniform definitions to be used in research.

STUDY DESIGN: Literature review and group discussions. OBJECTIVE: To propose uniform definitions for low back pain episodes to be used in research. BACKGROUND: Different definitions of episodes have been used in low back pain studies. This hampers comparison of study results. Definitions are proposed for episodes of low back pain, care for low back pain, and work absence because of low back pain. METHODS: In a Medline search, we identified about 1200 papers, of which 81 possibly contained a definition of episodes. In group discussions, we decided which definitions to propose and discussed their applicability. RESULTS: We found few definitions in the literature. In the group discussions we decided to define an episode of LBP as a period of pain in the lower back lasting for more than 24 hours, preceded and followed by a period of at least 1 month without low back pain. An episode of care for low back pain was defined as a consultation or a series of consultations for low back pain, preceded and followed by at least 3 months without consultation for low back pain. An episode of work absence due to low back pain was defined as a period of work absence due to low back pain, preceded and followed by a period of at least 1 day at work. CONCLUSIONS: In many studies, episodes of low back pain are mentioned without a clear definition. We consider our proposed definitions of episodes to be arbitrary but well considered. We advise that they be tested for use in future research.

Absenteeism↗

PubMed2002

Disseminating and implementing the results of back pain research in primary care.

STUDY DESIGN: Description of a workshop entitled "Implementation and Dissemination: Getting Research into Practice," that was held at the Fourth International Forum on Low Back Pain Research in Primary Care, in Israel in March 2000. SUMMARY OF BACKGROUND DATA: A gap exists between research endeavors and the dissemination and implementation of new research findings. OBJECTIVES: To describe the outcomes of a workshop on implementation and dissemination of research findings. METHODS: The Fourth International Forum on Low Back Pain Research in Primary Care aimed to encourage open discussion and consensus building among leading experts in the field, and to develop a research agenda. The workshop on implementation and dissemination focused on issues surrounding the gap between research results and actual practice. These issues were introduced by several presentations. The broad conclusions of the subsequent debate are summarized in this paper as a series of responses to key questions: 1) who should do the implementation?, 2) what should researchers do to help implementation?, 3) what are the key outcomes?, and 4) what are important ingredients for successful implementation? RESULTS: There was consensus about the importance of implementation of research findings, about the ineffectiveness of merely publishing or disseminating research findings, and about the need for prospective randomized trials evaluating the cost-effectiveness of different implementation strategies. The majority view is that the health provider professions and the professional bodies are the central organizations to implement guidelines, rather than the researchers themselves. Success in getting guidelines or research results into practice is dependent on involving local health service groups, experts, and opinion leaders (both local and national). Patient-centered outcomes and cost-effectiveness of guideline implementation were considered important. It was acknowledged that there are many potentially effective ingredients for successful implementation, but a clear indication of the contents of an effective implementation strategy is still lacking. CONCLUSIONS: The plenary and workshops focused on closing the gap between research results and actual practice. As long as we do not fully understand how best to influence and change physician behavior, the choice of implementation strategies should be based on the present knowledge of potentially effective interventions and should include considerations of available resources for, and potential barriers to, implementation.

Back Pain↗

PubMed2002

Why women consult with increased vaginal bleeding: a case-control study.

BACKGROUND: Many women with heavy periods and irregular bleeding do not consult about them. It has been suggested that some of these symptoms are associated with psychological distress and that this influences consultation behaviour which may account for why some women present with a menstrual disturbance and others with apparently the same problem do not. AIM: To explore the relationship between symptom severity, psychological distress, and the seeking of medical help in primary care among women aged 54 years or less with increased vaginal bleeding. DESIGN OF STUDY: Case control. SETTING: An urban four-partner general practice of 10,000 patients. METHOD: Questionnaires were sent to women who were consulting with new episodes of 'increased vaginal bleeding' and two groups of controls: consulting controls with 'acute respiratory tract infection' (RTI) or 'other illness' as identified by weekly computerised searches, and community controls, selected from the practice age-sex register. RESULTS: Nine hundred and forty-three questionnaires were sent out to 108 cases and 835 controls with an 80% response rate. Of these, 60.9% of the cases, 47.0% of the consulting controls, and 39.7% of the community controls were subjects with probable psychological distress on the General Health Questionnaire (chi2 test, P = 0.002). Cases were more likely than community controls to have heavy periods (odds ratio [OR] = 2.86, 95% confidence interval [CI] = 1.53-5.35) and heavy periods interfering with life (OR = 3.69, 95% CI = 2.02-6.75). After controlling for heaviness of periods, cases were still more likely to have psychological distress (OR = 1.80, 95% CI = 1.00-3.24). The same relationships prevailed when comparing cases and consulting controls. CONCLUSION: Interference in life caused by heaviness of periods appears to be a powerful initiator of consultation with increased vaginal bleeding. Perceived heavy periods and psychological disturbance are weaker predictors. Women presenting to primary care with increased vaginal bleeding are more likey to have a psychological disturbance than women from the community or those consulting with another illness.

Adult↗

PubMed2002

The effect of diabetic control on the incidence of, and changes in, retinopathy in type 2 non-insulin dependent diabetic patients.

The purpose of this study was to investigate the association between retinopathy and the levels of diabetic control found in type 2 non-insulin dependent diabetic patients. The study covered a four-year period and used retrospective, routinely recorded general practice and optometry records from 260 patients; those with retinopathy (n = 38) and those without retinopathy (n = 222). The study demonstrated a strong relationship between the presence of retinopathy and long-term diabetic control as measured by glycosylated HbA1c, disease duration and, to a lesser extent, the level of urine microalbumin. Blood pressure, cholesterol, body-mass index, and smoking status showed little association with the presence of retinopathy. We conclude that retinopathy, assessed by community optometrists, is a significant correlate of poor diabetic control.

Adult↗

PubMed2001

Risk factors for neck pain: a longitudinal study in the general population.

The objective of the study was to examine the 1-year cumulative incidence of episodic neck pain and to explore its associations with individual risk factors, including a history of previous neck injury. A baseline cross-sectional survey of an adult general population sample made up of all 7669 adults aged 18-75 years, registered with two family practices in South Manchester, United Kingdom, identified the study population of adults with no current neck pain. This study population was surveyed again 12 months later to identify all those who had experienced neck pain during the follow-up period. At follow-up, cumulative 1-year episode incidence of neck pain was estimated at 17.9% (95% confidence interval 16.0-19.7%). Incidence was independent of age, but was more common in women. A history of previous neck injury at baseline was a significant risk factor for subsequent neck pain in the follow-up year (risk ratio 1.7, 95% confidence interval 1.2-2.5), independent of gender and psychological status. Other independent baseline risk factors for subsequent neck pain included number of children, poor self-assessed health, poor psychological status and a past history of low back pain. We have carried out a prospective study in a general population sample and demonstrated that established risk factors for chronic pain predict future episodes of neck pain, and shown that in addition a history of neck injury is an independent and distinct risk factor. This finding may have major public health and medicolegal implications.

Adolescent↗

PubMedDate not supplied

Systematic review of sexual problems: epidemiology and methodology.

We conducted a comprehensive systematic literature review of five sexual problems in order to estimate their population prevalence and to investigate issues arising from the reviewing of epidemiological literature. Two independent reviewers scrutinized abstracts, extracted data, and assessed methodological quality. Twenty-eight relevant studies were identified. Prevalence figures varied considerably, and meta-analysis was not possible because of heterogeneity in study quality and design. Prevalence depends on case definition, characteristics of the study population, and time frame of the prevalence estimates, therefore, design, implementation, and reporting of epidemiological studies needs standardization before systematic reviews and meta-analyses can be carried out.

Dyspareunia↗

PubMedDate not supplied

Why do older people report fewer headaches?

BACKGROUND: We have previously confirmed a clear decline in headache prevalence with increasing age. This parallels the pattern in other painful conditions but the age-related decline in prevalence is greater for headache. OBJECTIVE: To investigate whether the decline in headache prevalence with age was associated with the elimination of work-related factors, increases in other health problems or concomitant use of pain-relieving medicines. We discuss these and other possible explanations from the literature. METHODS: Cross-sectional postal survey to a random sample of 5,000 adults with follow-up by (i) consultations with general practitioners and prescriptions issued during the 12 months subsequent to the survey and (ii) a follow-up postal survey at 12 months. RESULTS: Headache prevalence was similar in working and retired respondents within age strata. Headache sufferers were more likely to consult their general practitioner for any reason (excluding headache) compared with non-sufferers and this was true for each age group. Headache sufferers were also more likely to be frequent consulters compared with non-sufferers in all except the oldest age group (age 66 years and over) where there was no difference. There was a clear increase in prescriptions for analgesics and non-steroidal anti-inflammatory drugs issued with increasing age. There was no difference in the percentage of daily medication users among headache sufferers compared with non-sufferers. CONCLUSION: Neither retirement from work nor the presence of other health problems account for the decline in headache prevalence with age. Whilst the data on concomitant use of pain-relieving medicines suggest this is also not a major factor in the age-related decline, the high use of such medicines in older age groups means we cannot rule out a link. Evidence from the literature suggests that there may be a number of age-related factors involved including changes in reporting of headache, biochemical changes, and the development of strategies to prevent and manage headaches.

Adolescent↗