Welcome to the 26th WONCA Europe Virtual Conference Programme Scheduling
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On-Demand 1 Slide 5 Mins
DEPRESSION AND ERECTILE DYSFUNCTION - A TWO-WAY RELATIONSHIP
Abstract
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Background/Purpose: Depression and its pharmacological treatment are associated with decreased libido and erectile dysfunction (ED). However, the comorbidity between ED and depression is probably bidirectional. The aim is to characterize depression and its treatment in men with ED in a Family Health Unit (FHU).
Methods: Retrospective, observational and descriptive study, carried out in a FHU in men with ED (Y07-Impotence; ICPC-2 classification) until April 2020. Data collected in August 2020 using SClinico® and MIM@uf. Analysis performed in Excel®.
Results: 127 men with ED with an average age of 62.5 ± 11.7 years were identified. 32.4% have depression, of those 36.6% also have anxiety disorder and 2 attempted suicide. The diagnosis of depression was made before the ED in 63.4%, after in 21% and simultaneously in 14.6% of men. 21% use antidepressants (77.8% Selective Serotonin Reuptake Inhibitor (SSRI) and 11.1% tricyclic) and 7% use antipsychotics.
Conclusions: There is a high prevalence of depression in this group. Despite the ages’ dispersion, most men with depression are younger – agreeing with psychogenic ED being mainly associated with young ages. Most depressive patients use antidepressants (more commonly SSRIs and tricyclics) or antipsychotics, having ED as a relevant side effect. In most, depression’s diagnosis was previous/simultaneous to the diagnosis of ED, which can be explained by depression’s natural history or by introduction of its treatment. Family Doctor has a privileged role in the diagnosis and intervention of both sexual and psychiatric symptoms - its correct approach and treatment can improve men's life quality.
FLUCTUATIONS IN PERSISTENT SOMATIC SYMPTOMS: A PATIENT PERSPECTIVE
Abstract
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1.Background and purpose
Patients with somatic symptoms not attributable to verifiable, conventionally defined diseases are common in general practice. More knowledge on the course of persistent somatic symptoms (PSS) over time is needed. Our prior quantitative findings suggested that most patients with PSS might experience exacerbations and remissions of symptoms. The aim of this qualitative study was to explore patients’ experiences with fluctuations in PSS and to understand which factors -from their viewpoint- play a role in these fluctuations.
2. Methods
Qualitative study based on fifteen semi-structured interviews and thematic content analysis. Patients were recruited in general practices and specialized treatment facilities for PPS throughout the Netherlands.
3. Results
We identified three themes in the analysis: (1) Patterns in symptom fluctuations (2) Perceived causes of symptom exacerbations, and (3) Patients’ strategies in gaining control over symptom exacerbations. Daily and weekly fluctuations in symptoms were an important element in patients’ experiences. In particular anticipating on the worsening of symptoms impacted their daily routines and posed various challenges. Symptom exacerbations were attributed to overstepping physical limits and/or the impact of negative emotions. Strategies mentioned to gain control over symptom exacerbations included resigning to physical limits, adjusting one’s daily planning, weighing personal needs and learning to say ‘no’.
4. Conclusion
Our study highlights that fluctuations in the experienced severity of symptoms -and in particular daily and weekly symptom exacerbations- are an important element of the symptom experience in PSS and deserve more attention in care for these patients and in research.
MORTALITY IN PATIENTS PRESCRIBED MIRTAZAPINE COMPARED TO OTHER ANTIDEPRESSANTS: AN ACTIVE-COMPARATOR NEW USER COHORT STUDY
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Background and purpose
Existing evidence suggests increased mortality in patients prescribed the antidepressant mirtazapine. This study compared all-cause and cause-specific mortality for patients prescribed mirtazapine versus other antidepressants.
Methods
Data source: English primary care electronic health records provided by the Clinical Practice Research Datalink. Study population: adult patients diagnosed with depression who were first prescribed a selective serotonin reuptake inhibitor (SSRI) and then prescribed mirtazapine, a different SSRI, amitriptyline, or venlafaxine. Time window: 01 January 2005 – 30 November 2018. Outcomes: all-cause mortality and mortality due to cardiovascular disease, cancer, or respiratory disease. Analyses: age-sex standardised mortality rates were calculated and survival analyses were performed to calculate hazard ratios (HRs). Propensity score weighting was used to account for patient characteristics.
Results
The study included 25,598 patients and there were 599 deaths. The mirtazapine group had the highest standardised all-cause mortality rate (21.6 deaths/1000 person-years) and the SSRI group the lowest (13.8 deaths/1000 person-years). Over two years of follow-up the mirtazapine group had a higher risk of all-cause mortality than the SSRI group (HR 1.62 [95% confidence interval: 1.28-2.06]), but a similar risk to the amitriptyline (HR 1.18 [0.85-1.63]) and venlafaxine (HR 1.11 [0.60-2.05]) groups. A similar pattern was found for deaths due to cancer and respiratory disease.
Conclusions
There was an increased mortality risk in patients prescribed mirtazapine compared to those prescribed an SSRI. This could reflect residual differences in patient characteristics. Patients prescribed mirtazapine, or other non-SSRI antidepressants, may need support to identify additional health risks and improve their outcomes.
MATERNAL AND PATERNAL SMOKING DURING PREGNANCY AND RISK OF TOBACCO SMOKING IN ADOLESCENCE: FINDINGS FROM A POPULATION-BASED PROSPECTIVE COHORT STUDY
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Background
Compelling, although inconsistent, epidemiological evidence suggests an association between maternal tobacco smoking during pregnancy and an increased risk of tobacco smoking in offspring. The aim of this study was to test the link between maternal tobacco smoking during pregnancy and the risk of tobacco smoking in offspring at the age of 17 years using paternal tobacco smoking during pregnancy as a negative control for intrauterine exposure.
Methods
Study participants were from the Raine Study, a prospective birth cohort study based in Perth, Western Australia (N=2730). Tobacco smoking in adolescents was measured using a self-reported questionnaire. Log-binomial regression was used to estimate the relative risks (RRs) of tobacco smoking in offspring exposed to maternal prenatal tobacco use during the first and third trimesters of pregnancy. We have also calculated the E-values to investigate the potential effect of unmeasured confounding.
Results
After adjusting for potential confounders, we found the increased risks of tobacco smoking in offspring exposed to maternal tobacco smoking during the first trimester [RR 1.50 (95% CI: 1.13-1.97)] (E-value for point estimate=2.37) and during both trimesters of pregnancy [RR 1.41 (95% CI: 1.03-1.89)] (E-value for point estimate=2.17). However, we found insufficient statistical evidence for an association between paternal tobacco smoking during pregnancy and the risk of tobacco smoking in offspring [RR 1.18 (95% CI: 0.84-1.67)].
Conclusion
Maternal tobacco smoking during pregnancy was associated with an increased risk of tobacco smoking in offspring at the age of 17 years. Tobacco smoking cessation at the early stages of gestation may reduce the risk of tobacco smoking in offspring.
EDUCATIONAL PAMPHLETS FOR IMPROVING UPTAKE OF CANCER SCREENING: A SYSTEMATIC REVIEW
Abstract
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BACKGROUND: The effectiveness of cancer screening programmes is highly dependent on screening uptake. Many interventions have been tested to increase screening uptake.
PURPOSE: The goal of this study was to evaluate the effectiveness of cancer screening pamphlets as a standalone intervention. The outcome of interest was uptake of cancer screening tests.
METHODS: A systematic review was performed on the effectiveness of pamphlets compared to usual care without pamphlets. We searched five databases for research papers in English from 2000 up to May 2019. Randomised controlled trials were included. This research group independently selected studies, extracted data, assessed risk of bias and then compared the information as a group.
RESULTS: A total of nine trials involving 4912 participants met our inclusion criteria, of which five were about colorectal cancer screening, three were about prostate cancer screening and one was about lung cancer screening. Five of the nine trials showed that pamphlets alone increased uptake significantly, while the remaining four trials did not show significant effects.
CONCLUSIONS: There is some evidence that pamphlets increase uptake for cancer screenings, especially for colorectal cancer. Due to the small number of studies in this area, generalisability could be limited.