Biomedical subjects

Ajay K Thapar

Publications and source records attributed to Ajay K Thapar.

3 recordsLinked to original sources

PubMed2005

The presence and clinical implications of depression in a community population of adults with epilepsy.

Depression is the most common psychiatric comorbidity in epilepsy, but clinical and other factors associated with this observation and their impact on detection and management of depression in people with epilepsy are poorly understood. This study used a community-based postal questionnaire of primary care-identified people with epilepsy. We were therefore able to explore depression in a nonspecialist care-identified population. Clinical and demographic associative factors were examined. The dependent variable was depression, as defined by a score of 11 or greater on the Hospital Anxiety and Depression Scale (HADS). The prevalence of depression in our sample (n = 499) was found to be 11.2% (95% CI: 8.3-13.7%). Depression was most strongly associated with unemployment. It was also associated with having had a recent seizure and complaints of side effects of antiepileptic medications. Depression was not associated with gender, marital status, or monotherapy or polytherapy antiepileptic medication. The prevalence of depression in epilepsy is greater than in the general population, with no associated female preponderance. Our findings underline important variations in the associative features between depression in the general population and in people with epilepsy, with particular implications for management of this comorbidity.

Adult↗

PubMed2005

General practitioner attitudes to the care of people with epilepsy: an examination of clustering within practices and prediction of patient-rated quality of care.

BACKGROUND: There is wide variation in the quality of care provided by primary care practices to individuals with chronic illnesses. Individual doctor attitudes and interest have been demonstrated to influence patient outcomes in some instances. Given the trend towards larger practices and part-time working, continuity of care is likely to fall and thus practice-based rather than individual general practitioner attributes and attitudes are likely to become increasingly important. The aim in this paper was to examine the extent to which individual general practitioner (G.P.) attitudes to the care of people with epilepsy cluster within practices and predict patient-rated quality of care. METHODS: The sample consisted of 1255 people with active epilepsy (a recent seizure or on anti-convulsant medication for epilepsy) and 199 GPs from 82 general practices. Measures of GP attitudes (a 17-item GP attitudes questionnaire) and patient-rated quality of epilepsy care were obtained. 1210 individuals completed initial questionnaires and 975 patients filled in final questionnaires one year later. Responses were achieved from 64 practices (83% of total) and 115 GPs (60% of total). RESULTS: 2 main factors were found to underlie GP attitudes to the care of people with epilepsy and these demonstrated clustering within practices "epilepsy viewed as a primary care responsibility" (Eigenvalue 3.98, intra-class correlation coefficient (ICC) 0.40), and "medication skills"(Eigenvalue 2.74, ICC 0.35). GP-rated scores on "epilepsy care being a primary care responsibility" were a significant predictor of patient-rated quality of GP care (p = 0.031). Other contributory factors were seizure frequency (p = 0.044), and patient-rated "shared decision making" (p = 0.022). CONCLUSION: Specific general practitioner attitudes to the care of people with epilepsy cluster within practices and are significantly associated with patient-rated quality of epilepsy care. It is important to take these findings into consideration when planning primary care interventions to ensure people with epilepsy receive the benefits of available medical and surgical expertise.

Attitude of Health Personnel↗

PubMed2003

Attention-deficit hyperactivity disorder.

Attention-deficit hyperactivity disorder (ADHD) affects between 1.4% and 6% of children. The importance of the role of primary care in the recognition and joint management of this disorder is being increasingly highlighted. Despite a wealth of research, the diagnosis and management of ADHD have attracted a good deal of controversy. In this discussion paper, we focus on the empirical basis for some of the more controversial aspects of ADHD, such as diagnosis (discussing both under- and overdiagnosis), aetiology, outcomes, and the role of psychosocial factors in this disorder. We conclude that, provided the diagnosis of ADHD is made accurately and systematically, there are no good scientific grounds for dismissing the concept of ADHD or for failing to intervene.

Attention Deficit Disorder with Hyperactivity↗