Transitions in Parkinson's disease in primary care: Protocol of a longitudinal mixed methods study

Introduction: Parkinson's disease affects many aspects of the lives of patients and their relatives. Patients must adapt continuously to disabilities that necessitate changes in (medical) support, such as domestic adjustments, involvement of (non) professional caregivers or admission to hospital. Such changes mark a transition: a transfer of a patient between levels or locations of care. Transitions are likely to be multifold and complex, given that Parkinson's disease care extends across all echelons of healthcare. Patients and relatives are vulnerable during a transition, which imposes risks for their safety and quality of life. Guidance by the general practitioner, who knows the preferences of the patient, can help to overcome challenges associated with a transition. However, patient-centred primary care requires insight into the transitions patients with Parkinson's disease encounter. We aim to examine these transitions and the way patients, relatives and general practitioners experience them and cope with them. Moreover, we will study the patients' expectations of their general practitioner during a transition and the general practitioners' views on their role. Methods and analysis: A longitudinal mixed methods study will be conducted, using qualitative research methods combined with quantitative data as a validated questionnaire on quality of life. Patients will be asked to make a video diary every 2 weeks for a period of 1 year. Once they encounter a transition, patients and their general practitioners will be interviewed to identify causes and consequences of the transition. The verbatim transcripts of the videos and interviews will be analysed according to the principles of constant comparative analysis. Ethics and dissemination: Ethical approval was not needed according to Dutch legislation. Informed consent of patients, relatives and general practitioners will be obtained. We will disseminate the results in peer-reviewed journals, at research conferences and on the website of the Dutch Parkinson's Disease Association

The diagnostic pathway of Parkinson's disease: A cross-sectional survey study of factors influencing patient dissatisfaction

Background: The diagnostic pathway of Parkinson’s disease (PD) is often complicated. Experiences during this pathway can affect patients’ satisfaction and their confidence and trust in healthcare providers. Although healthcare providers cannot influence the impact of the diagnosis, they can influence how patients experience the pathway. This study, therefore, aims to provide insight into PD patients’ dissatisfaction with the diagnostic pathway and to describe the factors that influence it. Methods: We carried out a cross-sectional survey study among 902 patient members of the Dutch Parkinson’s Disease Association, who were each asked to write an essay about their diagnostic pathway. A coding format was developed to examine the content of these essays. Inter-observer agreement on coding patient dissatisfaction was calculated using Cohen’s kappa. The χ2 test and a multivariable logistic regression analysis were performed to assess the relation between dissatisfaction and sex, level of education, duration of the pathway, communication with the general practitioner (GP) and the neurologist, the number of healthcare providers involved, whether or not a second opinion had taken place (including the person who initiated it) and diagnostic delay (taking into consideration who caused the delay according to the patient). A subgroup analysis was performed to gain insight into sex-related differences. Results: Of all patients, 16.4% explicitly described they were dissatisfied with the diagnostic pathway, whereas 4.8% were very satisfied. The inter-observer agreement on coding dissatisfaction was κ = 0.82. The chance of dissatisfaction increased with a lower level of education, the involvement of more than one additional healthcare provider, a second opinion initiated by the patient and delay caused by a healthcare provider. When only the GP and the neurologist were involved, women were more likely to be dissatisfied than men. Conclusions: PD patients’ dissatisfaction with the diagnostic pathway is related to a lower level of education, a second opinion initiated by the patient and experienced diagnostic delay. GPs can positively influence patients’ experiences if they are aware of these risk factors for dissatisfaction and pay extra attention to communication and shared decision making. This will contribute to a trusting therapeutic relationship that is indispensable with progression of the diseaseThis study was supported by funds of the Dutch Parkinson’s Disease Association (Funding number 2012-V15) and the Health Insurers Innovation Foundation (Funding number 2687)

Low back pain around retirement age and physical occupational exposure during working life

<p>Abstract</p> <p>Background</p> <p>Physical occupational exposure is a risk factor for low back pain in workers but the long term effects of exposure remain unclear. As several countries consider increasing the retirement age, further information on this topic is relevant. This study aimed to describe the prevalence of low back pain among middle aged and aging individuals in the general French population according to physical occupational exposure and retirement status.</p> <p>Methods</p> <p>The study population originated from the French national survey 'Enquête décennale santé 2002'. Low back pain for more than 30 days within the previous twelve months (LBP) was assessed using a French version of the Nordic questionnaire. Occupational exposure was self assessed. Subjects were classified as "exposed" if they were currently or had previously been exposed to handling of heavy loads and/or to tiring postures. The weighted prevalence of LBP was computed separately for men and women, for active (aged 45-59) and retiree (aged 55-74), according to 5-year age group and past/present occupational exposure.</p> <p>Results</p> <p>For active men, the prevalence of LBP was significantly higher in those currently or previously exposed (n = 1051) compared with those never exposed (n = 1183), respectively over 20% versus less than 11%. Among retired men, the prevalence of LBP tended towards equivalence with increasing age among those previously exposed (n = 748) and those unexposed (n = 599).</p> <p>Patterns were quite similar for women with a higher prevalence in exposed active women (n = 741) compared to unexposed (n = 1260): around 25% versus 15%. Similarly, differences between previously exposed (n = 430) and unexposed (n = 489) retired women tended to reduce with age.</p> <p>Conclusion</p> <p>The prevalence of LBP in active workers was associated with occupational exposure. The link with past exposure among retirees decreased with age. These results should be considered for policies dealing with prevention at the workplace and retirement.</p

Lombalgies, âge et expositions professionnelles

Les effets à court ou moyen terme de certaines expositions professionnelles biomécaniques sur lerisque de lombalgie sont reconnus. Les effets à long terme sont moins connus. Ces expositionscontribuent aux inégalités sociales de lombalgies,mais ceci est peu documenté une fois la carrièreterminée.Dans un contexte de débat sur l âge de la retraite et la prise en compte de la pénibilité au travail,l'objectif de cette thèse était d'apporter des éléments de connaissances sur les liens entreexposition aux risques professionnels physiques et lombalgies autour de l âge de la retraite, ainsique sur la présence d'inégalités sociale de lombalgies parmi des actifs vieillissants et des retraitéset la contribution de ces expositions à ces inégalités.Les lombalgies ayant duré plus de 30 jours au cours des 12 mois précédents ont été étudiéesdans la cohorte Gazel et l'Enquête Décennale Santé 2002 (EDS).Des arguments en faveur de la persistance des effets d'expositions physiques professionnelles audelà de la période d'activité ont été trouvés. Les données de l EDS suggèrent que ces effetss estomperaient au-delà d un certain âge.Les expositions professionnelles, en particulier biomécaniques, jouent un rôle majeur dans lesinégalités sociales de lombalgies chez les hommes de la cohorte Gazel, actifs vieillissants etjeunes retraités. Par contre, de telles inégalités ne sont pas observées chez les retraités de 60 à74 ans de l'EDS.Ce travail montre l'importance en matière de lombalgies persistantes/récidivantes d'expositionsprofessionnelles a priori accessibles à une démarche de prévention, et l'intérêt de considérer leparcours professionnel dans les politiques de retraiteSome biomechanical exposures at work are recognized short term risk factors for low back pain(LBP). However, long term effects, are not well known. In addition, occupational exposures seemto contribute to social inequalities in low back pain, but this contribution is less documented forolder subjects.In many developed countries, governments are now reconsidering retirement policies. In thiscontext, the objective of this work was firstly to provide additional knowledge about the linksbetween physical exposure and LBP among aging workers and retirees, and secondly to assesssocial inequalities in LBP in this age group and the contribution of occupational factors to suchinequalities.Two populations were studied : volunteers from the Gazel cohort and participants to a Frenchnational survey on health (EDS 2002). The same definition for LBP could be used in bothpopulations : LBP which lasted more than 30 days in the previous 12 months.LBP was associated with physical occupational exposures among aging workers and youngretirees in both populations. Results were consistent with the hypothesis of a persistence of effectsonce occupational exposure has ceased, except among the oldest retirees in the EDS 2002.Biomechanical exposures played a major role in social inequalities for LBP among aging workersand young retirees in the GAZEL cohort. Such inequalities were not observed among the retireesaged 60 to 74 years (men and women) from the EDS 2002.The results highlight the importance of past occupational exposures at retirement age.PARIS11-SCD-Bib. électronique (914719901) / SudocSudocFranceF

Biomechanical strains and low back disorders: quantifying the effects of the number of years of exposure on various types of pain.

International audienceOBJECTIVE: To assess the effects of duration of exposure to biomechanical strains on various types of low back pain (LBP). METHODS: The population study was a random sample from the GAZEL cohort. Durations of exposure to selected biomechanical strains during subjects' working lifetime and potential confounders were assessed in 1996 by self-administered questionnaires. Data on LBP in the previous 12 months were collected in 2001. Relations between various dimensions of LBP and durations of exposure to the biomechanical strains were analysed with multivariate regression models. Polytomous models were built to determine whether some biomechanical strains were specifically associated with some types of LBP. RESULTS: Analyses were performed separately for men (n = 2218) and women (n = 383). Significant associations were observed (ORs reported are those for 20 years of exposure) between LBP and durations of driving and bending/twisting for men (OR 1.24 and 1.37 respectively); LBP for more than 30 days and duration of exposure to bending/twisting for men and women (OR 2.20 and 2.00 respectively) and duration of driving for women (OR 3.15); LBP radiating to the leg and duration of driving for men (OR 1.43) and bending/twisting for women (OR 1.95); LBP radiating below the knee and duration of exposure to pulling/pushing/carrying for men (OR 1.88). Bending/twisting in both men and women, and driving for women appeared to be stronger risk factors for LBP for more than 30 days. Pulling/pushing/carrying heavy loads appeared to be a risk factor specific for LBP radiating below the knee for men. CONCLUSION: This study suggests that exposure to biomechanical strains has long-term effects and a dose-response relation with duration of exposure and specific effects for some types of LBP

Socioeconomic position and low-back pain--the role of biomechanical strains and psychosocial work factors in the GAZEL cohort.

International audienceOBJECTIVE: To analyze the role that biomechanical strains and psychosocial work factors play in occupational class disparities in low-back pain in the GAZEL cohort. METHODS: Recruited in 1989, the GAZEL cohort members were employees of the French national company in charge of energy who volunteered to enroll in an annual follow-up survey. The study population comprised 1487 men who completed questionnaires in 1996 (past occupational exposure to manual material handling, bending/twisting, and driving), 1997 (psychosocial work factors), and 2001 (low-back pain using a French version of the Nordic questionnaire for the assessment of low-back pain). Associations between low-back pain for >30 days in the preceding 12 months and social position at baseline (four categories) were described with a Cox model to determine prevalence ratios for each category. We compared adjusted and unadjusted ratios to quantify the contribution of occupational exposures. RESULTS: The prevalence of low-back pain for >30 days was 13.6%. The prevalence of low-back pain adjusted for age was significantly higher for blue-collar workers and clerks than for managers. The number of socioeconomic disparities observed was significantly reduced when biomechanical strains were taken into account; adjusting for psychosocial factors had little impact. CONCLUSION: In this population, occupational exposures--especially biomechanical strains--played an important role in occupational class disparities for persistent or recurrent low-back pain

A problem, but for whom?

Apathie bij dementie is een serieus probleem dat nare gevolgen kan hebben. Lastig eraan is echter dat apathisch gedrag vaak niet wordt opgemerkt of niet als problematisch wordt ervaren. Vooral in het verpleeghuis is dit het geval. Om daar verbetering in te brengen wordt er momenteel een nieuwe interventie ontwikkeld: Samen in Actie bij Apathie (SABA). Apathie komt voor bij een derde tot de helft van de mensen met dementie en kan nare gevolgen hebben. Zoals een verhoogde kans op versnelde cognitieve achteruitgang en op overlijden. Voor de omgeving is apathie vaak erg belastend, vooral in het geval van mensen met dementie die thuis wonen; in het verpleeghuis lijkt die belasting minder te spelen. Of apathie de kwaliteit van leven van mensen met dementie verlaagt, weten we eigenlijk nog niet precies. In de meer gevorderde stadia van dementie lijken hiervoor geen aanwijzingen te zijn