INTRODUCTION: PD is more common with increasing age and shows male predominance, which is more obvious in Western studies. The reasons of this remain obscure. However, it has been suggested that exposure to endogenous and exogenous oestrogen contributes to these sex differences and that oestrogen prevents dopaminergic neuron depletion induced by neurotoxins in and therefore is neuroprotective. OBJECTIVES: we wanted to investigate if the exogenous administration of testosterone in males, and oestrogen with or without progesterone in females, had any protective effect towards to PD. METHODS: clinical records of 99929 residents in North West England were scrutinised in primary care setting for diagnosis of PD, HRT, and timing of onset in those cases were the adverse event had been identified.RESULTS: PD overall prevalence was of 0.55% in males and 0.36% in females (M/F=3:2). The NNT for HRT with testosterone was 1.016 (harm) significance level P<0.0001, and NNT for HRT oestrogen+/-progesterone was 17.092 (harm) significance level P<0.0001.CONCLUSIONS: HRT for males or females have not demonstrated any beneficial effects in terms of PD onset prevention or procrastination. On the contrary HRT, particularly with testosterone, is more likely to have a detrimental effect. Our results need to be interpreted cautiously as the treatment with HRT was not randomized and it cannot be excluded that stopping HRT may cause a sudden hormonal drop which in turn may have a negative effect.
Introduction In different Countries and different Healthcare Systems, GP workload is significantly burdened by a minority of patients seeing their GP a lot more often than their peers (1).Those are patients are generally well-known to their family physician as subjects that make the ”heart sink” and therefore were initially called by O’Dowd “heartsink patients” (2).But when, more precisely, a patient “becomes” a high user or frequent attender ”?Even if the phenomenon is not new, we do not have data to define quantitatively this “entity” and we ignore if the prevalence of FAs as increased over time, or if it hasn’t (3,4).We do not have precise data about the average duration of their GP encounters, which could well differ from the standards 10 minutes, hence likewise affecting the burden on GP time.To describe those patients, we still often reference to a work published in 1988. It is believed that Tom O’Dowd then coined the term ”heartsink”, to describe ”The feeling experienced (by the family doctor) when their names (of patients) appear in the list of the morning appointments. ” (1)Further work has been done to define the reasons behind the frequent GP visits. In 1988, O’Dowd acknowledged that the medical experience was subjective, but perceived that the problem and its solution resided both in the patient.A systematic review from Gill and Sharpe on prevalence, associations and clinical outcomes, and subsequent observations from other Authors, have shown that FAs have high rates of physical illnesses, psychiatric illnesses, social difficulties and emotional distress (3,5).Frequent attendance in General Practice is also considered an indicator of behaviour of inappropriate use of other health services, in particular emergency departments and Secondary Care services (6,7,8).Evidence of the effect of (mainly psychiatric) interventions on the rate of frequency and morbidity ofFAs have shown conflicting results (9,10). In a review of the interventions on FAs, it was found thatthe high frequency can be a sign of a major depressive disorder and that its treatment can improve the depressive symptoms, but there is no evidence that it is thereby possible to influence the use of the services (11).The interpretation of the studies on FAs is hampered by differences in Healthcare Systems and in the definition of FA (12).It has been shown that age and sex are highly associated to the number of GP visits and that the identification of FAs without adjustment by age and sex leads predominantly to the selection of older women (13).After reviewing the literature on high users, Vedsted suggested that the FA should be described as a subject that falls at the top 10% of the practice population stratified by age and gender (4).Vedsted, suggested to arbitrarily fix a threshold in the distribution of the frequency of consultation, such that they are considered FAs all those who go above the percentage or percentile set as threshold.However, this choice is associated with various problems of practicality with one key disadvantage that is of failing to identify a number of variabilities in relation Health Care System, for instances.In this work, we checked the frequency GP encounters, both in office and at patient’s domicile, over the course of 12 months, in both sexes, and in all age bands.We then looked at the number of visits over the course of a year above which such number increases rapidly, isolating a limited group of patients to whom was associated an extremely high number of GP encounters.Doing so, we aimed to clarify if and where the proportional threshold value and the absolute threshold value may converge.We believe that they do converge and that this number can be identified as the most useful threshold value for the definition FA.MethodIn the context of a General Practice medium density urban setting, we collected data on 9651 people registered with 4 different GPs.Unlike most previous studies on FAs, we have not ruled out children and the most elderly.In fact, several studies have only used data from patients aged 15 to 74 years.For all patients registered during the 12 months prior to the audit date, we only counted the GP face to face consultations, either at the Surgery or at home of the patient. We have calculated the contact frequencies of all patients for each combination of age and gender. The top 5% of patients in terms of frequency of yearly encounters has been defined using the concept of proportional threshold.ResultsThe characteristics of the population studied is graphically represented in figure 1, they are the following:Mother population: Patients currently registeredLast Search: 01-mar-2018Relative Date: 01-Mar-2018Population count: 9651Males: 4540Females: 5111
Both acute otitis media (AOM) and tonsillitis are common presenting complaints in Primary Care and ENT setting. Tonsillitis accounts for between 5 and 10% of all cases of illness seen by the general practitioner. This has been a rather stable prevalence over the last 100 years or so (Collins, 1935). The analysis of the incidence by age shows, for both tonsillitis and sore throat, a relatively high incidence in childhood and young adults, while after that period there is a fall with age. Laryngitis, on the other hand, appears to occur more frequently among adults than among children. The incidence of tonsillitis, sore throat and other pharynx diseases is higher among females than males. There is no indication among school-age children that there is a higher incidence in women. There is a fairly regular seasonal variation in incidence as well, with higher incidence in winter and spring.Acute otitis media appears to be far more prevalent in children under the age of 10 and significantly less common from the third decade of live onwards. The UK was put into lockdown on 23 March 2020 in an unprecedented step to attempt to limit the spread of coronavirus. From an audit of over a total population of 9534 people, starting from the beginning of the lockdown to the 18 May 2020, the number of patients with diagnosis of tonsillitis was audited. The data were compared to those recorded in the 5 precedent five years during the very same period of time. Tonsillitis accounted, on average, for 8% of all cases of illness seen by the general practitioner from 2015 to 2019. The mean number of patients seen for tonsillitis was 805.8 with SD of 28.96. In 2020, the number of cases of tonsillitis was 593. From 2015 to 2020, the higher incidence in the female sex was confirmed from all the age bands>19. The greatest drop in cases was not recorded in the age group 0 to 9, but - in the order - 10 to 19, 20 to 29 and 30 to 39 with a reduction above the 30% in the first 2 age bands. Overall, the drop was seen across all the age bands (Cervoni, 2020).The same cannot be said for the diagnosis of acute otitis media in its various forms. To establish the impact of the lock-down on the diagnosis of acute otitis media, we audited a total population of 9534 people, starting from the beginning of the lock-down in March 2020, to the end of the phase 1 of the lock-down in May 2020, for the number of patients with diagnosis of AOM.  From 2015 to 2020, across the very same period of time, there has been a relatively stable prevalence with, perhaps, a slightly decreasing trend.The drop recorded during the pandemic does not reach statistical significance.Furthermore, differently from the diagnosis of tonsillitis, there is not obvious difference of incidence between males and females.  
Tonsillitis accounts for between 5 and 10% of all cases of illness seen by the general practitioner. This has been a rather stable prevalence over the last 100 years or so. The analysis of the incidence by age shows, for both tonsillitis and sore throat, a relatively high incidence in childhood and young adults, while after that period there is a fall with age. Laryngitis, on the other hand, appears to occur more frequently among adults than among children. The incidence of tonsillitis, sore throat and other pharynx diseases is higher among females than males. There is no indication among school-age children that there is a higher incidence in women. There is a fairly regular seasonal variation in incidence as well, with higher incidence in winter and spring. The UK was put into lockdown on 23 March 2020 in an unprecedented step to attempt to limit the spread of coronavirus. From an audit of over a total population of 9534 people, starting from the beginning of the lockdown to the 18 May 2020, the number of patients with diagnosis of tonsillitis was audited. The data were compared to those recorded in the 5 precedent five years during the very same period of time. Tonsillitis accounted, on average, for 8% of all cases of illness seen by the general practitioner from 2015 to 2019. The mean number of patients seen for tonsillitis was 805.8 with SD of 28.96. In 2020, the number of cases of tonsillitis was 593. From 2015 to 2020, the higher incidence in the female sex was confirmed from all the age bands>19.  The greatest drop in cases was not recorded in the age group 0 to 9, but - in the order - 10 to 19, 20 to 29 and 30 to 39 with a reduction above the 30% in the first 2 age bands. Overall, the drop was seen across all the age bands.