Dataset Information

Rectal and postmenopausal bleeding: consultation and referral of patients with and without severe mental health problems.

ABSTRACT:

Background

People with severe mental health problems receive less effective care for some physical conditions. There is concern that this could apply to rectal bleeding or postmenopausal bleeding. Published estimates of consultation rates and outcomes for these symptoms vary widely.

Aim

To estimate rates of first-ever consultation for rectal bleeding and postmenopausal bleeding in general practice, together with subsequent referrals and outcomes. To identify inequalities for patients with severe mental health problems.

Design of study

Cohort study.

Setting

Primary care.

Method

Patients with first-ever consultations for rectal or postmenopausal bleeding were identified among more than 3 million patients from 328 practices contributing routine data to the QRESEARCH database. Their records were followed for 2 years.

Results

There were 30 175 first consultations for rectal bleeding (2.6 per thousand patients per year at age 25-29 years, rising to 4.8 over age 85 years) and 10 142 for postmenopausal bleeding (highest at 7.4 per thousand per year aged 55-59 years). Overall, 2.2% of those with rectal bleeding and 1.7% of those with postmenopausal bleeding went on to have a relevant cancer diagnosis within 2 years. Cancer risk was strongly related to age, and was higher for males with rectal bleeding than females with rectal bleeding. Recorded referrals were at similar rates among patients with and without severe mental health problems.

Conclusion

The rate of first consultations for rectal bleeding or postmenopausal bleeding is relatively low. Less than 2.5% overall have a relevant cancer diagnosis within 2 years. There is no evidence of inequality in referral for patients with severe mental health problems.

SUBMITTER: Parker C

PROVIDER: S-EPMC2047011 | biostudies-literature | 2007 May

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Rectal and postmenopausal bleeding: consultation and referral of patients with and without severe mental health problems.

Parker Chris C Hippisley-Cox Julia J Coupland Carol C Vinogradova Yana Y

The British journal of general practice : the journal of the Royal College of General Practitioners 20070501 538

<h4>Background</h4>People with severe mental health problems receive less effective care for some physical conditions. There is concern that this could apply to rectal bleeding or postmenopausal bleeding. Published estimates of consultation rates and outcomes for these symptoms vary widely.<h4>Aim</h4>To estimate rates of first-ever consultation for rectal bleeding and postmenopausal bleeding in general practice, together with subsequent referrals and outcomes. To identify inequalities for patie ...[more]

PMID: 17504587

Similar Datasets

Project description:Introduction: The recovery approach aims to have users' perspectives at the heart of service development and research; it is a holistic perspective that considers social needs, personal growth and inclusion. In the last decade recovery-oriented research and practice has increased greatly, however, a comprehensive model of recovery considering exclusively the perspectives of people with lived experience has not been devised. Aims: This review aimed to develop a framework and contextualize service users' and informal caregivers' understanding of recovery from severe mental health problems. Methods: We systematically searched 6 databases including key terms related to knowledge, experience and narratives AND mental health AND personal recovery. The search was supplemented with reference sourcing through gray literature, reference tracking and expert consultation. Data analysis consisted of a qualitative meta-synthesis using constant comparative methods. Results: Sixty-two studies were analyzed. A pattern emerged regarding the recovery paradigms that the studies used to frame their findings. The resulting recovery framework included the domains Social recovery; Prosperity (Legal, political, and economic recovery); Individual Recovery; and Clinical Recovery Experience (SPICE). Service users' definitions of recovery tended to prioritize social aspects, particularly being accepted and connecting with others, while caregivers focused instead on clinical definitions of recovery such as symptom remission. Both groups emphasized individual aspects such as becoming self-sufficient and achieving personal goals, which was strongly linked with having economic means for independence. Conclusions: The recovery model provided by this review offers a template for further research in the field and a guide for policy and practice. Predominant definitions of recovery currently reflect understandings of mental health which focus on an individual perspective, while this review found an important emphasis on socio-political aspects. At the same time, only a small number of studies took place in low-income countries, focused on minoritized populations, or included caregivers' perspectives. These are important gaps in the literature that require further attention. Systematic Review Registration: The review protocol was registered on PROSPERO (CRD42017076450); https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=76450.

Project description:ObjectiveMental health problems are more prevalent in people with than without intellectual disabilities, yet treatment options have received little attention. The aim of this study was to identify and evaluate the effectiveness of pharmacological and psychological interventions in the treatment of mental health problems in children and adults with severe and profound intellectual disabilities, given their difficulties in accessing standard mental health interventions, particularly talking therapies, and difficulties reporting drug side effects.DesignA systematic review using electronic searches of PsycINFO, PsycTESTS, EMBASE, MEDLINE, CINAHL, ERIC, ASSIA, Science Citation Index, Social Science Citation Index and CENTRAL was conducted to identify eligible intervention studies. Study selection, data extraction and quality appraisal were performed by two independent reviewers.ParticipantsStudy samples included at least 70% children and/or adults with severe or profound intellectual disabilities or reported the outcomes of this subpopulation separate from participants with other levels of intellectual disabilities.InterventionsEligible intervention studies evaluated a psychological or pharmacological intervention using a control condition or pre-post design.OutcomesSymptom severity, frequency or other quantitative dimension (e.g., impact), as assessed with standardised measures of mental health problems.ResultsWe retrieved 41 232 records, reviewed 573 full-text articles and identified five studies eligible for inclusion: three studies evaluating pharmacological interventions, and two studies evaluating psychological interventions. Study designs ranged from double-blind placebo controlled crossover trials to single-case experimental reversal designs. Quality appraisals of this very limited literature base revealed good experimental control, poor reporting standards and a lack of follow-up data.ConclusionsMental ill health requires vigorous treatment, yet the current evidence base is too limited to identify with precision effective treatments specifically for children or adults with severe and profound intellectual disabilities. Clinicians therefore must work on the basis of general population evidence, while researchers work to generate more precise evidence for people with severe and profound intellectual disabilities.Prospero registration numberCRD 42015024469.

Project description:Patients with moderate-to-severe atopic dermatitis (AD) experience intense chronic itch and impaired sleep. Reports from parents and teachers suggest that AD patients may also have attention problems. However, attention has not yet been directly assessed in AD patients. We utilized an objective, computer-based continuous performance test (CPT) validated for use in attention-deficit/hyperactivity disorder (ADHD) diagnosis to formally evaluate attention in adolescent AD subjects. This was a single-visit, cross-sectional, non-interventional study of moderate-to-severe (Investigator's Global Assessment [IGA] ≥ 3) AD subjects aged 12-17 years without clinician-diagnosed ADHD. Attention was evaluated using two performance-based measures: Conners, CPT-3 and the Stroop Color and Word Test. The primary parameter was CPT-3 detectability (d') measure. Lesional severity measures included Eczema Area and Severity Index (EASI) and body surface area (BSA) involvement. Subjects completed self-report rating scales assessing sensory responsiveness patterns (Adult/Adolescent Sensory Profile [AASP]), itch (Peak Pruritus Numerical Rating Scale [PP-NRS]), skin pain, quality of life, sleep, anxiety, and depressive symptoms. A total of 44 subjects were included in the study (61.4% female; mean age 15.0 [SD 1.78] years; mean EASI 20.4 [SD 7.8]; mean PP-NRS 7.0 [SD 1.8]). Results indicated substantial disease impact on sleep, quality of life, and comorbid anxiety and depressive symptoms. The mean (SD) Conners, CPT-3 d' T-score was 48.7 (SD 10.7), similar to the expected mean from a randomly selected age/gender-matched sample of the general population (50 [SD 10], by definition). Overall, 13.6% of subjects exhibited a d' T-score ≥ 60 (clinically significant poor performance), which was not greater than the expected general population value (15.9%). Subject-level data review by two psychologists determined that only 2 subjects demonstrated an overall response pattern that clearly indicated attention deficit. Many subjects had atypical sensory responsiveness profiles: sensory hypersensitivity (38.6%), sensory avoidance (50%), and low registration (hypo-sensitivity, 36.4%). Adolescents with moderate-to-severe AD without existing ADHD diagnosis did not demonstrate greater attention problems on performance-based measures than would be expected in age/gender-matched peers.Trial registration NCT05203380.

Dataset Information

Rectal and postmenopausal bleeding: consultation and referral of patients with and without severe mental health problems.

Background

Aim

Design of study

Setting

Method

Results

Conclusion

Publications

Rectal and postmenopausal bleeding: consultation and referral of patients with and without severe mental health problems.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets