Patterns of health-care use and comorbidities present in patients in the period before diagnosis of chronic obstructive pulmonary disease (COPD) are unknown. We investigated these factors to inform ...future case-finding strategies.
We did a retrospective analysis of a clinical cohort in the UK with data from Jan 1, 1990 to Dec 31, 2009 (General Practice Research Database and Optimum Patient Care Research Database). We assessed patients aged 40 years or older who had an electronically coded diagnosis of COPD in their primary care records and had a minimum of 3 years of continuous practice data for COPD (2 years before diagnosis up to a maximum of 20 years, and 1 year after diagnosis) and at least two prescriptions for COPD since diagnosis. We identified missed opportunites to diagnose COPD from routinely collected patient data by reviewing patterns of health-care use and comorbidities present before diagnosis. We assessed patterns of health-care use in terms of lower respiratory consultations (infective and non-infective), lower respiratory consultations with a course of antibiotics or oral steroids, and chest radiography. If these events did not lead to a diagnosis of COPD, they were deemed to be missed opportunities. This study is registered with ClinicalTrials.gov, number NCT01655667.
We assessed data for 38,859 patients. Opportunities for diagnosis were missed in 32,900 (85%) of 38,859 patients in the 5 years immediately preceding diagnosis of COPD; in 12,856 (58%) of 22,286 in the 6-10 years before diagnosis, in 3943 (42%) of 9351 in the 11-15 years before diagnosis; and in 95 (8%) of 1167 in the 16-20 years before diagnosis. Between 1990 and 2009, we noted decreases in the age at diagnosis (0·05 years of age per year, 95% CI 0·03-0·07) and yearly frequency of lower respiratory prescribing consultations (rate ratio 0·982 opportunities per year, 95% CI 0·979-0·985). Prevalence of all comorbidities present at COPD diagnosis increased except for asthma and bronchiectasis, which decreased between 1990 and 2007, from 281 (33·4%) of 842 patients to 451 of 1465 (30·8%) for asthma, and from 53 of 842 (6·3%) to 53 of 1465 (3·6%) for bronchiectasis. In the 2 years before diagnosis, of 6897 patients who had had a chest radiography, only 2296 (33%) also had spirometry.
Opportunities to diagnose COPD at an earlier stage are being missed, and could be improved by case-finding in patients with lower respiratory tract symptoms and concordant long-term comorbidities.
UK Department of Health, Research in Real Life.
Purpose
The purpose of this paper is to identify the strategic leveraging goals associated with a portfolio of small-scale events and to analyze their implementation process (actors/tactics: who did ...what?) in order to propose new leverage typologies through new empirical research evidence.
Design/methodology/approach
Three techniques of data collection conducted the fieldwork: qualitative interviewing, direct observation and documental research. Based on the principles of grounded theory and using qualitative data analysis software (Nvivo) data were inductively analyzed.
Findings
Results showed the coexistence of a plurality of strategic leveraging goals, namely: “strengthen political advantage”; “integrate and retain partners/sponsors”; and “develop sports dynamics”. There was a set of tactics and actions identified and successfully implemented due to the coordination of the network of organizations part of the events, which included local and external actors.
Research limitations/implications
Researchers realized that it was impossible to take a neutral research stand. In fact, in qualitative research, the investigator is the first instrument of data collection. In this sense, it was important for researchers to constantly reflect on their role, as Pelias (2011) says “reflexive writing strategies include indicating how the researcher emerged as a contaminant, how the researcher´s insider status was revelatory or blinding, and how the researcher is implicated in the problem being addressed” (p. 662). It is also considered that, when organizing events, the network of interactions is extremely complex, making it difficult to capture all the actors’ perspectives.
Practical implications
In relation to the practical implications, it is important that sports event managers have in-depth knowledge and skills on event leveraging; it is also important that managers understand the sports culture in order to recognize the multidimensionality of strategic leveraging in sporting events. The strategic dynamic should be developed and coevolved with community/local and external actors. The coordination between the actors is a key point to achieve successful leveraging.
Social implications
A theoretical implication related to the event leverage is the creation of a new strategic objective – “developing the sport dynamics”. The sport participation tactic among other tactics were found, namely “enhancing of the sports shows” and “tuning of skills in sports management”.
Originality/value
The dynamics and plurality of strategic goals associated with the leverage of an event portfolio, namely the actions that were developed and also the actors’ interaction in small-scale events. Another factor is the identification of the prominent role of the external event organization committee in the dynamics of event leveraging, as well as the deep analysis of the leveraging process supported by the observation of all the events.
In the early steps of an emerging infectious disease epidemic such as Covid-19, uncertainties about the nature of the disease, its spread and impact can lead to emotional distress. In addition, the ...studies on confinement during an epidemic have shown a psychological impact of this measure on the feelings of anxiety and depression in the general population.
We assessed the psychological health of 550 patients followed up in outpatient psychiatry, via a pandemic-related teleconsultation during the first confinement period between March and June 2020. Patients were assessed at the beginning and at the end of the confinement on their personal situation, social relationships, professional activity, anxiety and mood. We also evaluated patients' symptomatology and their quality of life.
Patients were well informed about Covid-19 via the media and complied with the confinement and barrier procedures. They appreciated the phone-calls and the teleconsultation follow-up. A small proportion of patients were completely socially isolated mainly at the beginning of the confinement (10%).
There was no difference between the beginning and the end of the confinement in terms of depressive and anxiety symptoms or quality of life. The women were more anxious and depressed than men. Only smoking was significantly increased during this period.
The expected and feared health catastrophe in psychiatry during this first phase of the pandemic in 2020 did not occur. Will the psychiatric wave appear in the "post- pandemic", the future will tell.
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