Prediction of depression in European general practice attendees: the PREDICT study

Background Prevention of depression must address multiple risk factors. Estimating overall risk across a range of putative risk factors is fundamental to prevention of depression. However, we lack reliable and valid methods of risk estimation. This protocol paper introduces PREDICT, an international research study to address this risk estimation. Methods/design This is a prospective study in which consecutive general practice attendees in six European countries are recruited and followed up after six and 12 months. Prevalence of depression is assessed at baseline and each follow-up point. Consecutive attendees between April 2003 and September 2004 who were aged 18 to 75 were asked to take part. The possibility of a depressive episode was assessed using the Depression Section of the Composite International Diagnostic Interview. A selection of presumed risk factors was based on our previous work and a systematic review of the literature. It was necessary to evaluate the test-retest reliability of a number of risk factor questions that were developed specifically, or adapted, for the PREDICT study. In a separate reliability study conducted between January and November 2003, consecutive general practice attendees in the six participating European countries completed the risk factor items on two occasions, two weeks apart. The overall response rate at entry to the study was 69%. We exceeded our expected recruitment rate, achieving a total of 10,048 people in all. Reliability coefficients were generally good to excellent. Discussion Response rate to follow-up in all countries was uniformly high, which suggests that prediction will be based on almost a full cohort. The results of our reliability analysis are encouraging and suggest that data collected during the course of PREDICT will have a satisfactory level of stability. The development of a multi-factor risk score for depression will lay the foundation for future research on risk reduction in primary care. Our data will also provide the necessary evidence base on which to develop and evaluate interventions to reduce the prevalence of depression

Prevalence of abdominal obesity in Slovene primary health care attendees - the IDEA study

Namen dela: Debelost velja za enega glavnih dejavnikov tveganja za koronarno srčno bolezen, sladkorno bolezen, žilne bolezni in metabolni sindrom. Vedno več je dokazov, da je abdominalna debelost močnejši napovedni dejavnik kot splošna debelost, ki se opredeljuje s povišanim indeksom telesne mase. Za kvantifikacijo zdravstvenega tveganja, povezanega z abdominalno debelostjo, sopotrebne zanesljive globalne ocene prevalence abdominalne debelosti. Metode:Raziskava IDEA oziroma mednarodni dan za oceno abdominalne debelosti jevelikanska mednarodna epidemiološka presečna raziskava, ki je prinesla zanesljive podatke o porazdeljenosti obsega pasu glede na regijo, spol, starost in socialno ekonomske sloje po vsem svetu. Vsi bolniki, ki so bili stari med 18 in 80 leti, ženske pa niso bile noseče, ter so se oglasili pri naključno izbranem zdravniku na primarni ravni zdravstvene oskrbe v vnaprej določenih dveh polovicah dveh dnevov, so se lahko priključili raziskavi. Rezultati: V Sloveniji je v raziskavi sodelovalo 1536 ljudi. Prevalenca abdominalne debelosti med slovenskimi bolniki na primarni ravni zdravstvene oskrbe je bila 33,5 % pri moških in 50 % pri ženskah. Prevalenca abdominalne debelosti narašča s starostjo bolnikov in se zmanjšuje z višanjem njihove dosežene izobrazbe. Abdominalna debelost ima visoko prevalenco med nezaposlenimi ženskami in bivšimi kadilci. Abdominalna debelost je pogostejša med bolniki s srčno-žilnimi boleznimi, sladkorno boleznijo in z visokim tlakom. Prevalenca abdominalne debelosti je višja med ženskami po menopavzi, še posebej med tistimi, ki ne prejemajo nadomestnega hormonskega zdravljenja. Zaključek: Merjenje obsega pasu je enostavna metoda, ki bi lahko pomagala pri oceni nujnosti zmanjšanja telesne teže.Background: Obesity is well recognized as a major risk factor for coronary heart disease, vascular mortality, diabetes and metabolic syndrome. However, evidence is accumulating that abdominal obesity is a stronger predictor for these disorders than generalized obesity, defined by elevated body mass index.Reliable estimates of the worldwide prevalence of abdominal obesity are needed to quantify the associated health risk. Methods: The International Day for the Evaluation of Abdominal Obesity (IDEA) study is a large, international, epidemiological cross-sectional study designed to provide reliable data on the distribution of waist circumference according to region, gender, age and socio-economic background. Any non-pregnant patient aged 18-80years who consulted one of the randomly selected primary care physicians on two pre-defined half days was eligible to participate in the study. Results: In Slovenia, 1536 patients were enrolled in the study. The prevalenceof abdominal obesity in Slovene primary health care (PHC) attendees was 33.5% for men and 50.0% for women. The prevalence of abdominal obesity is increasing with age and declining with higher level of education. Abdominal obesity is highly prevalent among unemployed women and former smokers. The prevalence of abdominal obesity is higher among patients with cardiovascular risk factors, including hypertension and type 2 diabetes, and among post-menopausal women, especially among those receiving no hormone replacementtherapy. Conclusion: Waist circumference is easy to measure and mayserve as a single measure to assess the need for weight loss

Anticholinergic burden and most common anticholinergic-acting medicines in older general practice patients

Anticholinergic burden in older adults has been correlated with cognitive decline, delirium, dizziness and confusion, falls and hospitalisations. Nevertheless, anticholinergic-acting medications remain commonly prescribed in up to a third of older adults in primary care population. Our aim was to study the anticholinergic burden in older adults in Slovenian ambulatory setting and explore the most commonly involved medications which could be avoided by the physicians

Nasopharyngeal carriage of Streptococcus pneumoniae and serotypes indentified among nursing home residents in comparison to the elderly and patients younger than 65 years living in domestic environment

In Slovenia, there is little data available on pneumococcal vaccination rates and no data on asymptomatic NPCR and serotypes in the population of nursing home residents in comparison to the elderly living in domestic environment, therefore the goal was to gain these data

Association of common mental disorders and quality of life with the frequency of attendance in Slovenian family medicine practices: longitudinal study.

BACKGROUND: Most research on frequent attendance has been cross-sectional and restricted to one year attendance rates. A few longitudinal studies suggest that frequent attendance is self-limiting. Frequent attenders are more likely to have social and psychiatric problems, medically unexplained physical symptoms, chronic somatic diseases (especially diabetes) and are prescribed more psychotropic medication and analgesics. RESEARCH QUESTION: To describe the attendance rates in a longitudinal study and to test if depression, panic syndrome, other anxiety syndrome, alcohol misuse and general quality of life are associated with frequent attendance in next two consecutive years. METHODS: 1118 consecutive family practice attendees, aged 18 to 75 years from randomly selected family medicine practices were recruited at baseline and followed up at 12 and 24 months. We identified frequent attenders in the top 10 centile within one year. Using a multivariate model, we ascertained if presence of common mental disorders and quality of life assessed at baseline in 2003 predict frequent attendance in 2004 and 2005. RESULTS: 40% of frequent attenders continue to be frequent attenders in the following year and 20% of the frequent attenders were so for the 24 month period. Lower physical scores on the SF-12 questionnaire were strongly associated with future frequent attendance at 12 and 24 months. There was a trend for people with greater than elementary school education to be less likely to become frequent attenders at both 12 and 24 months. For other variables these effects were less consistent. Presence of major depression, panic syndrome, other anxiety syndrome and alcohol misuse were not predictive of frequent attendance in the following two years. CONCLUSION: Low physical quality of life is strongly predictive of higher frequent attendance and similar finding was observed for people with lower educational level but further confirmatory research is required to establish this association

Demographic data for the year 2005 (n = 542).

<p>Demographic data for the year 2005 (n = 542).</p

Multivariate model showing effects of risk factors for frequent attendance in the two following years after assessment of risk factors (df = degrees of freedom, OR = odds ratio, CI = confidence intervals).

<p>Nagelkerke R² = 0.234 Nagelkerke R² = 0.221.</p

Flow diagram of frequent attenders (FA) from 2003 to 2005.

<p>Flow diagram of frequent attenders (FA) from 2003 to 2005.</p

Number and percentage of frequent attenders in years 2003–2005.

<p>Number and percentage of frequent attenders in years 2003–2005.</p