Evaluating pancreatitis in primary care: a population-based cohort study

Background

Pancreatitis is an important condition with significant mortality. Primary care may have an important role to play in its prevention, early diagnosis, and ongoing management.

Aim

To evaluate incidence, case fatality, and clinical features of acute and chronic pancreatitis in a large population.

Design and setting

Population-based cohort study using a primary care database in the UK from 1990 to 2013.

Method

Use of general practice records from 16 491 patients diagnosed with pancreatitis. Age-standardised incidence rates and case fatality were estimated. Clinical features, aetiology, and patterns of recurrence were evaluated.

Results

Incidence of pancreatitis increased from 14.8 in 100 000 (1990–1994) to 31.2 in 100 000 (2010–2013) in males, and from 14.5 to 28.3 in 100 000 in females (2010–2013). Overall case fatality after diagnosis was 4.3% (95% CI = 4.0% to 4.6%) at 90 days and 7.9% (95% CI = 7.5% to 8.4%) at 365 days. In 1990–1994, 10% of patients with acute pancreatitis were recorded as heavy drinkers, increasing to 12% in 2010–2012; for patients with chronic pancreatitis the proportions were 13%, rising to 21%. Among patients who died in the 90 days after diagnosis, 92% consulted with their general practice in the 2 months before first diagnosis.

Conclusion

The incidence of pancreatitis is increasing over time. Alcohol abuse may now account for at least one in eight cases of acute, and one in five cases of chronic pancreatitis. Consultations among those who subsequently died may have offered potential for earlier diagnosis and intervention.     

Addressing elder abuse through integrating law into health: What do allied health professionals at a Community Health Service in Melbourne,Australia, think?

This research looked at the attitudes of Community Health Service (CHS) staff regarding the integration of a lawyer into their CHS both before and after the integration occurred. It assessed their confidence in identifying and addressing elder abuse at each point. A written survey was distributed to staff before the lawyer commenced (n = 126), and approximately 12 months afterwards (n = 54). The preliminary survey demonstrated widespread agreement that legal issues can affect older people and supported having a lawyer in a CHS. Respondents were not confident about their capacity to identify abuse and provide referrals to a lawyer, but this improved in the follow‐up survey. These CHS staff were aware of the potential impacts of elder abuse and supported embedding a lawyer in the health service. Information and training as part of this service model should focus on the skills needed for CHS staff to play their role in such a partnership.     

Understanding Children's Medium for Disclosing Sexual Abuse: A Tool for Overcoming Potential Misconceptions in the Courtroom

Complainants in child sexual assault trials are often questioned by the defence about disclosure of the alleged abuse. The defence will often ask the child how they disclosed the alleged sexual abuse, including to whom the initial disclosure was made. Such questions are legitimate and directed towards testing the complainant's allegations. Sometimes, such questions are used to impeach the complainant's credibility. It is not uncommon in such instances for the defence to suggest that certain modes of disclosure are more consistent with having been sexually victimized and that a complainant who has disclosed otherwise is more likely to have fabricated the allegations of abuse. This article reviews the findings of empirical research on whom victims of child sexual abuse most commonly disclose their abuse to and by what means such disclosure is commonly made. This understanding is important to challenge misconceived views about how victims disclose child sexual abuse.     

The Effects of Evidence,Coherence and Credentials on Jury Decision-Making in Child Sexual Abuse Trials

Expert testimony is being used increasingly in child sexual assault cases. This study extended a prior study that examined factors related to expert testimony (evidence strength, coherence and credentials of the expert) on ratings of guilt and overall verdict. Specifically, we replicated our prior study but with two modifications: we used community samples as opposed to university students, and participants made their decisions in groups of 12 (as in the case of juries where one decision represents the overall group) rather than having participants decide and submit their verdicts and guilt ratings individually. Consistent with the prior (less ecologically valid) study, credentials of the expert had negligible impact. Evidence that was high in strength elicited a relatively high guilt rating even when the testimony was low in coherence. Further, it appears that when participants deliberate in a group (as in the case of juries) they are more conservative in their judgements (i.e., they are less likely to give a guilty verdict) compared to individual jurors who make their decisions alone. These findings suggest that caution must be exercised when drawing conclusions about the generalisability of prior research findings where participants did not engage in group deliberation.