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Fulltext AVERT2 (a very early rehabilitation trial, a very effective reproductive trigger): retrospective observational analysis of the number of babies born to trial staff

Bernhardt J, Lindley RI, Lalor E, Ellery F, Chamberlain J, Van Holsteyn J, et al.

BMJ, 2015 Dec 11;351:h6432.
PMID: 26658193 DOI: 10.1136/bmj.h6432

OBJECTIVE: To report the number of participants needed to recruit per baby born to trial staff during AVERT, a large international trial on acute stroke, and to describe trial management consequences.
DESIGN: Retrospective observational analysis.
SETTING: 56 acute stroke hospitals in eight countries.
PARTICIPANTS: 1074 trial physiotherapists, nurses, and other clinicians.
OUTCOME MEASURES: Number of babies born during trial recruitment per trial participant recruited.
RESULTS: With 198 site recruitment years and 2104 patients recruited during AVERT, 120 babies were born to trial staff. Births led to an estimated 10% loss in time to achieve recruitment. Parental leave was linked to six trial site closures. The number of participants needed to recruit per baby born was 17.5 (95% confidence interval 14.7 to 21.0); additional trial costs associated with each birth were estimated at 5736 Australian dollars on average.
CONCLUSION: The staff absences registered in AVERT owing to parental leave led to delayed trial recruitment and increased costs, and should be considered by trial investigators when planning research and estimating budgets. However, the celebration of new life became a highlight of the annual AVERT collaborators' meetings and helped maintain a cohesive collaborative group.
TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry no 12606000185561.
DISCLAIMER: Participation in a rehabilitation trial does not guarantee successful reproductive activity.

Matched MeSH terms: Great Britain/epidemiology
An analysis of suicide and undetermined deaths in 17 predominantly Islamic countries contrasted with the UK

Pritchard C, Amanullah S

Psychol Med, 2007 Mar;37(3):421-30.
PMID: 17176500

Suicide is expressly condemned in the Qu'ran, and traditionally few Islamic countries have reported suicide. Undetermined deaths are classified by the World Health Organization (WHO) as Other Violent Deaths (OVD) in ICD-9, or Other External Causes (OEC) in ICD-10. It has been suggested that to avoid under-reporting of suicides, both formal suicide verdicts and OVD should be considered together because OVD may contain 'hidden' suicides.

Matched MeSH terms: Great Britain/epidemiology
International comparison of UK registry data (chapter 17)

Caskey F, Steenkamp R, Ansell D

Nephrol Dial Transplant, 2007 Aug;22 Suppl 7:vii185-93.
PMID: 17724048

In 2005, the incidence of renal replacement therapy (RRT) in the United Kingdom was 110 per million of the population (pmp) using the day 0 definition and 103 pmp using the day 90 definition. Relative to the 42 countries reporting data to the USRDS, the day 0 and day 90 rates for RRT incidence in the UK are the 32nd and 35th lowest, respectively. However, the overall incidence for the UK masks higher rates in Scotland, Wales and Northern Ireland (123, 129 and 140 pmp, respectively). Of the six countries with RRT incidence rates comparable with those in the UK (Australia, Finland, Malaysia, New Zealand, Norway and the Netherlands) three had relatively high rates for the age band 20-44, and two had relatively high rates for the age band 45-60. The proportion of incident patients with diabetes as the cause of established renal failure also varied considerably among these six comparator countries from 16% to 40% but rates of peritoneal dialysis utilization were comparable with that in the UK and generally higher than in countries with higher rates of RRT incidence. When transplantation rates were considered alongside prevalence rates for RRT, the UK position appeared relatively high at 46% (11th out of 37 countries), although still considerably lower than in Norway and the Netherlands (72 and 54%, respectively). Although variation in RRT incidence rate exists within the four countries of the UK, the overall RRT incidence, reported for the first time this year, appears similar to that observed in a number of demographically similar countries around the world. Examining the UK alongside the six comparator countries, different patterns of RRT incidence were observed across the age bands and variation in the RRT incidence secondary to diabetes mellitus raised interesting questions. The higher rates of renal transplantation achieved in several of the comparator countries also justifies further analysis.

Matched MeSH terms: Great Britain/epidemiology
Fulltext Investment in pneumonia and pneumococcal research

Head MG, Fitchett JR, Newell ML, Scott JAG, Clarke SC, Atun R

Lancet Infect Dis, 2014 Nov;14(11):1037-1038.
PMID: 25444398 DOI: 10.1016/S1473-3099(14)70949-1
Matched MeSH terms: Great Britain/epidemiology
Fulltext Genome-wide gene-environment analyses of major depressive disorder and reported lifetime traumatic experiences in UK Biobank

Coleman JRI, Peyrot WJ, Purves KL, Davis KAS, Rayner C, Choi SW, et al.

Mol Psychiatry, 2020 Jul;25(7):1430-1446.
PMID: 31969693 DOI: 10.1038/s41380-019-0546-6

Depression is more frequent among individuals exposed to traumatic events. Both trauma exposure and depression are heritable. However, the relationship between these traits, including the role of genetic risk factors, is complex and poorly understood. When modelling trauma exposure as an environmental influence on depression, both gene-environment correlations and gene-environment interactions have been observed. The UK Biobank concurrently assessed Major Depressive Disorder (MDD) and self-reported lifetime exposure to traumatic events in 126,522 genotyped individuals of European ancestry. We contrasted genetic influences on MDD stratified by reported trauma exposure (final sample size range: 24,094-92,957). The SNP-based heritability of MDD with reported trauma exposure (24%) was greater than MDD without reported trauma exposure (12%). Simulations showed that this is not confounded by the strong, positive genetic correlation observed between MDD and reported trauma exposure. We also observed that the genetic correlation between MDD and waist circumference was only significant in individuals reporting trauma exposure (rg = 0.24, p = 1.8 × 10-7 versus rg = -0.05, p = 0.39 in individuals not reporting trauma exposure, difference p = 2.3 × 10-4). Our results suggest that the genetic contribution to MDD is greater when reported trauma is present, and that a complex relationship exists between reported trauma exposure, body composition, and MDD.

Matched MeSH terms: Great Britain/epidemiology
Fulltext Joint Associations Between Body Mass Index and Waist Circumference With Atrial Fibrillation in Men and Women

Poorthuis MHF, Sherliker P, de Borst GJ, Carter JL, Lam KBH, Jones NR, et al.

J Am Heart Assoc, 2021 04 20;10(8):e019025.
PMID: 33853362 DOI: 10.1161/JAHA.120.019025

Background Associations between adiposity and atrial fibrillation (AF) might differ between sexes. We aimed to determine precise estimates of the risk of AF by body mass index (BMI) and waist circumference (WC) in men and women. Methods and Results Between 2008 and 2013, over 3.2 million adults attended commercial screening clinics. Participants completed health questionnaires and underwent physical examination along with cardiovascular investigations, including an ECG. We excluded those with cardiovascular and cardiac disease. We used multivariable logistic regression and determined joint associations of BMI and WC and the risk of AF in men and women by comparing likelihood ratio χ2 statistics. Among 2.1 million included participants 12 067 (0.6%) had AF. A positive association between BMI per 5 kg/m2 increment and AF was observed, with an odds ratio of 1.65 (95% CI, 1.57-1.73) for men and 1.36 (95% CI, 1.30-1.42) for women among those with a BMI above 20 kg/m2. We found a positive association between AF and WC per 10 cm increment, with an odds ratio of 1.47 (95% CI, 1.36-1.60) for men and 1.37 (95% CI, 1.26-1.49) for women. Improvement of likelihood ratio χ2 was equal after adding BMI and WC to models with all participants. In men, WC showed stronger improvement of likelihood ratio χ2 than BMI (30% versus 23%). In women, BMI showed stronger improvement of likelihood ratio χ2 than WC (23% versus 12%). Conclusions We found a positive association between BMI (above 20 kg/m2) and AF and between WC and AF in both men and women. BMI seems a more informative measure about risk of AF in women and WC seems more informative in men.

Matched MeSH terms: Great Britain/epidemiology
Fulltext Associations of clothing size, adiposity and weight change with risk of postmenopausal breast cancer in the UK Women's Cohort Study (UKWCS)

Moy FM, Greenwood DC, Cade JE

BMJ Open, 2018 Sep 28;8(9):e022599.
PMID: 30269068 DOI: 10.1136/bmjopen-2018-022599

OBJECTIVES: Breast cancer is associated with overweight and obesity after menopause. However, clothing size as a proxy of adiposity in predicting postmenopausal breast cancer is not widely studied. We aimed to explore the relationships between postmenopausal breast cancer risk with adipose indicators (including clothing sizes) and weight change over adulthood.
DESIGN: Prospective cohort study.
SETTING: England, Wales and Scotland.
PARTICIPANTS: 17 781 postmenopausal women from the UK Women's Cohort Study.
PRIMARY OUTCOME MEASURE: Incident cases of malignant breast cancers (International Classification of Diseases (ICD) 9 code 174 and ICD 10 code C50).
RESULTS: From 282 277 person-years follow-up, there were 946 incident breast cancer cases with an incidence rate of 3.35 per 1000 women. Body mass index (HR: 1.04; 95% CI: 1.02 to 1.07), blouse size (HR: 1.10; 1.03 to 1.18), waist circumference (HR: 1.07; 1.01 to 1.14) and skirt size (HR: 1.14;1.06 to 1.22) had positive associations with postmenopausal breast cancer after adjustment for potential confounders. Increased weight over adulthood (HR: 1.02; 1.01 to 1.03) was also associated with increased risk for postmenopausal breast cancer.
CONCLUSIONS: Blouse and skirt sizes can be used as adipose indicators in predicting postmenopausal breast cancer. Maintaining healthy body weight over adulthood is an effective measure in the prevention of postmenopausal breast cancer.

Matched MeSH terms: Great Britain/epidemiology
Fulltext The role of CT in case ascertainment and management of COVID-19 pneumonia in the UK: insights from high-incidence regions

Chua F, Armstrong-James D, Desai SR, Barnett J, Kouranos V, Kon OM, et al.

Lancet Respir Med, 2020 May;8(5):438-440.
PMID: 32220663 DOI: 10.1016/S2213-2600(20)30132-6
Matched MeSH terms: Great Britain/epidemiology
The expression of rheumatoid arthritis in Malaysian and British patients: a comparative study

Veerapen K, Mangat G, Watt I, Dieppe P

Br J Rheumatol, 1993 Jul;32(7):541-5.
PMID: 8339122

Seventy consecutive patients with definite or classical RA attending a University Hospital Rheumatology Clinic in Malaysia, were compared with an age, sex, disease duration matched group of RA patients seen in a British University Hospital. There were no differences in measures of disease activity, overall functional status or serological status in the two groups. However significant differences were seen in both the articular and extra-articular manifestations of the disease in the two countries. British patients had more severe disease in the feet, and a higher prevalence of nodules, vasculitis and pulmonary fibrosis. The Malaysian population had fewer erosions, more frequent involvement of the wrists and cervical spine, and a much higher incidence of secondary sicca syndrome. Radiographic changes were generally milder in Malaysian patients. Possible reasons for these differences in the expression of RA in the two countries are discussed.

Matched MeSH terms: Great Britain/epidemiology
Baseline characteristics of the omega-3 fatty acids (Fish oils) and Aspirin in Vascular access OUtcomes in REnal Disease (FAVOURED) study

Viecelli AK, Pascoe EM, Polkinghorne KR, Hawley CM, Paul-Brent PA, Badve SV, et al.

Nephrology (Carlton), 2016 Mar;21(3):217-28.
PMID: 26205903 DOI: 10.1111/nep.12573

The Fish oils and Aspirin in Vascular access OUtcomes in REnal Disease (FAVOURED) trial investigated whether 3 months of omega-3 polyunsaturated fatty acids, either alone or in combination with aspirin, will effectively reduce primary access failure of de novo arteriovenous fistulae. This report presents the baseline characteristics of all study participants, examines whether study protocol amendments successfully increased recruitment of a broader and more representative haemodialysis cohort, including patients already receiving aspirin, and contrasts Malaysian participants with those from Australia, New Zealand and the United Kingdom (UK).

Matched MeSH terms: Great Britain/epidemiology
Fulltext Cross-cultural comparison of maternal sleep

Mindell JA, Sadeh A, Kwon R, Goh DY

Sleep, 2013 Nov;36(11):1699-706.
PMID: 24179304 DOI: 10.5665/sleep.3132

BACKGROUND:
To characterize cross-cultural sleep patterns and sleep problems in a large sample of mothers of children (ages birth to 6 years) in multiple predominantly Asian and predominantly Caucasian countries.

METHODS:
Mothers of 10,085 young children (predominantly Asian countries/regions: China, Hong Kong, India, Korea, Japan, Malaysia, Philippines, Singapore, Thailand; predominantly Caucasian countries: Australia, Canada, New Zealand, United Kingdom, United States) completed an internet-based expanded version of the Pittsburgh Sleep Quality Index.

RESULTS:
Mothers in predominantly Asian countries/regions had later bedtimes, decreased number and duration of night wakings, more nighttime sleep, and more total sleep than mothers from predominantly Caucasian countries, P < 0.001. More than half (54.7%) of mothers reported having poor sleep, ranging from 50.9% of mothers in Malaysia to 77.8% of mothers in Japan. Sleep disturbance symptoms were quite common, especially symptoms related to insomnia, and were more likely to be reported by mothers in predominantly Caucasian countries. However, psychosocial factors, including having children of a younger age, being unemployed, and having a lower education level were the best predictors of poor sleep, whereas culture was not a significant predictor.

CONCLUSIONS:
Overall, mothers in predominantly Asian countries/regions reported later bedtimes but sleeping better and longer than mothers from predominantly Caucasian countries, which is dissimilar to cross-cultural findings of young children. Psychosocial factors were found to be the best predictors of poor sleep, irrespective of culture. Further studies are needed to understand the impact of these findings.

KEYWORDS:
Sleep; adult; cross-cultural; maternal; mother

Matched MeSH terms: Great Britain/epidemiology
Fulltext Lipid Metabolism Links Nutrient-Exercise Timing to Insulin Sensitivity in Men Classified as Overweight or Obese

Edinburgh RM, Bradley HE, Abdullah NF, Robinson SL, Chrzanowski-Smith OJ, Walhin JP, et al.

J Clin Endocrinol Metab, 2020 03 01;105(3).
PMID: 31628477 DOI: 10.1210/clinem/dgz104

CONTEXT: Pre-exercise nutrient availability alters acute metabolic responses to exercise, which could modulate training responsiveness.
OBJECTIVE: To assess acute and chronic effects of exercise performed before versus after nutrient ingestion on whole-body and intramuscular lipid utilization and postprandial glucose metabolism.
DESIGN: (1) Acute, randomized, crossover design (Acute Study); (2) 6-week, randomized, controlled design (Training Study).
SETTING: General community.
PARTICIPANTS: Men with overweight/obesity (mean ± standard deviation, body mass index: 30.2 ± 3.5 kg⋅m-2 for Acute Study, 30.9 ± 4.5 kg⋅m-2 for Training Study).
INTERVENTIONS: Moderate-intensity cycling performed before versus after mixed-macronutrient breakfast (Acute Study) or carbohydrate (Training Study) ingestion.
RESULTS: Acute Study-exercise before versus after breakfast consumption increased net intramuscular lipid utilization in type I (net change: -3.44 ± 2.63% versus 1.44 ± 4.18% area lipid staining, P < 0.01) and type II fibers (-1.89 ± 2.48% versus 1.83 ± 1.92% area lipid staining, P < 0.05). Training Study-postprandial glycemia was not differentially affected by 6 weeks of exercise training performed before versus after carbohydrate intake (P > 0.05). However, postprandial insulinemia was reduced with exercise training performed before but not after carbohydrate ingestion (P = 0.03). This resulted in increased oral glucose insulin sensitivity (25 ± 38 vs -21 ± 32 mL⋅min-1⋅m-2; P = 0.01), associated with increased lipid utilization during exercise (r = 0.50, P = 0.02). Regular exercise before nutrient provision also augmented remodeling of skeletal muscle phospholipids and protein content of the glucose transport protein GLUT4 (P < 0.05).
CONCLUSIONS: Experiments investigating exercise training and metabolic health should consider nutrient-exercise timing, and exercise performed before versus after nutrient intake (ie, in the fasted state) may exert beneficial effects on lipid utilization and reduce postprandial insulinemia.

Matched MeSH terms: Great Britain/epidemiology
Changes in the prevalence of influenza-like illness and influenza vaccine uptake among Hajj pilgrims: A 10-year retrospective analysis of data

Alfelali M, Barasheed O, Tashani M, Azeem MI, El Bashir H, Memish ZA, et al.

Vaccine, 2015 May 21;33(22):2562-9.
PMID: 25887084 DOI: 10.1016/j.vaccine.2015.04.006

Influenza is an important health hazard among Hajj pilgrims. For the last ten years, pilgrims are being recommended to take influenza vaccine before attending Hajj. Vaccination coverage has increased in recent years, but whether there has been any change in the prevalence of influenza-like illness (ILI) is not known. In this analysis, we examined the changes in the rate of ILI against seasonal influenza vaccine uptake among Hajj pilgrims over the last decade.

Matched MeSH terms: Great Britain/epidemiology
COVID-19 first anniversary review of cases, hospitalization, and mortality in the UK

Merchant HA, Kow CS, Hasan SS

Expert Rev Respir Med, 2021 08;15(8):973-978.
PMID: 33573416 DOI: 10.1080/17476348.2021.1890035

Introduction: The first confirmed COVID-19 case in UK dates to 11 January 2020, exhibiting its first peak during April 2020. The country has since been hit by another wave in the winter 2020, almost at the first anniversary of the pandemic.Areas covered: An in-depth analysis of the COVID-19 positive cases in the UK throughout the year, hospitalizations, patients in critical care, and COVID-19 associated deaths.Expert opinion: The COVID-19 associated hospital admission accounts to 15% of total COVID-19 positive cases in November 2020. The percentage of total COVID-19 positive patients in the country died from the disease was under 4% in November 2020. Total deaths in England (all-cause) from June to October 2020 were similar to the historic averages. Age was the single most determinator of COVID-19 associated mortality, 50 years or older accounted for 98% of total COVID deaths. Age distribution of COVID-19 associated deaths in 2020 was similar to all-cause mortality age distribution in 2019. There was no significant improvement in the survival rate of COVID-19 patients receiving critical care. This prompts an urgent need to invest in novel antiviral therapeutics to save the most vulnerable in the society.

Matched MeSH terms: Great Britain/epidemiology
Fulltext Mortality risk in patients infected with SARS-CoV-2 of the lineage B.1.1.7 in the UK

Kow CS, Merchant HA, Hasan SS

J Infect, 2021 Jul;83(1):e14-e15.
PMID: 33992685 DOI: 10.1016/j.jinf.2021.05.008
Matched MeSH terms: Great Britain/epidemiology
Dietary change, energy balance and body weight regulation among migrating students

Reeves SL, Henry CJ

Int J Food Sci Nutr, 2000 Nov;51(6):429-38.
PMID: 11271846 DOI: 10.1080/09637480050208044

This study was conducted to examine how subjects modulate their food intake and energy balance when they migrate from a low energy density food intake pattern to one of high energy density. It was hypothesised that an increase in the energy density of food consumed would result in increased body weight of the migrating subjects unless food intake and energy balance could be modulated. Food selection, food intake, basal metabolic rate (BMR) and anthropometric measurements were made on 53 female and 56 male newly arrived overseas students. All subjects were from Malaysia, but the data was collected at Oxford Brookes University where the subjects were studying. Food intake using 3-day food diaries and food frequency questionnaires (FFQs). BMR and anthropometric measurements including body weight were measured on arrival in the UK and after 3 and 6 months' stay. Student's t-tests and analysis of variance (ANOVA) were used to compare the data. A significant difference (P < 0.05) was found between the energy density of the foods consumed in Malaysia and after 3 and 6 months in the UK. There was also a significant decrease (P < 0.05) in protein consumed. However, there were no differences in total energy intake. From results of the FFQs, differences were found in food selection due mainly to the lack of availability of certain foods in UK supermarkets. No significant differences were found in the BMR and anthropometric measurements made at the start of the study and later assessments. It appears that Malaysian students are able to remain in energy balance and are weight stable at least during the first 6 months of residence in the UK, despite the wider choice of energy dense food available. This suggests that at least in the short term, subjects are able to modulate their food intake in response to changes in the energy densities and free choice of food.

Matched MeSH terms: Great Britain/epidemiology
Fulltext VSHR: A Mathematical Model for the Prediction of Second-Wave COVID-19 Epidemics in Malaysia

Yu X, Lu L, Guo J, Qin H, Ji C

Comput Math Methods Med, 2022;2022:4168619.
PMID: 35087601 DOI: 10.1155/2022/4168619

Since December 2019, a novel coronavirus (COVID-19) has spread all over the world, causing unpredictable economic losses and public fear. Although vaccines against this virus have been developed and administered for months, many countries still suffer from secondary COVID-19 infections, including the United Kingdom, France, and Malaysia. Observations of COVID-19 infections in the United Kingdom and France and their governance measures showed a certain number of similarities. A further investigation of these countries' COVID-19 transmission patterns suggested that when a turning point appeared, the values of their stringency indices per population density (PSI) were nearly proportional to their absolute infection rate (AIR). To justify our assumptions, we developed a mathematical model named VSHR to predict the COVID-19 turning point for Malaysia. VSHR was first trained on 30-day infection records prior to the United Kingdom, Germany, France, and Belgium's known turning points. It was then transferred to Malaysian COVID-19 data to predict this nation's turning point. Given the estimated AIR parameter values in 5 days, we were now able to locate the turning point's appearance on June 2nd, 2021. VSHR offered two improvements: (1) gathered countries into groups based on their SI patterns and (2) generated a model to identify the turning point for a target country within 5 days with 90% CI. Our research on COVID-19's turning point for a country is beneficial for governments and clinical systems against future COVID-19 infections.

Matched MeSH terms: Great Britain/epidemiology
Unravelling the temporal association between lameness and body condition score in dairy cattle using a multistate modelling approach

Lim PY, Huxley JN, Willshire JA, Green MJ, Othman AR, Kaler J

Prev Vet Med, 2015 Mar 1;118(4):370-7.
PMID: 25579605 DOI: 10.1016/j.prevetmed.2014.12.015

Recent studies have reported associations between lameness and body condition score (BCS) in dairy cattle, however the impact of change in the dynamics of BCS on both lameness occurrence and recovery is currently unknown. The aim of this longitudinal study was to investigate the effect of change in BCS on the transitions from the non-lame to lame, and lame to non-lame states. A total of 731 cows with 6889 observations from 4 UK herds were included in the study. Mobility score (MS) and body condition score (BCS) were recorded every 13-15 days from July 2010 until December 2011. A multilevel multistate discrete time event history model was built to investigate the transition of lameness over time. There were 1042 non-lame episodes and 593 lame episodes of which 50% (519/1042) of the non-lame episodes transitioned to the lame state and 81% (483/593) of the lame episodes ended with a transition to the non-lame state. Cows with a lower BCS at calving (BCS Group 1 (1.00-1.75) and Group 2 (2.00-2.25)) had a higher probability of transition from non-lame to lame and a lower probability of transition from lame to non-lame compared to cows with BCS 2.50-2.75, i.e. they were more likely to become lame and if lame, they were less likely to recover. Similarly, cows who suffered a greater decrease in BCS (compared to their BCS at calving) had a higher probability of becoming lame and a lower probability of recovering in the next 15 days. An increase in BCS from calving was associated with the converse effect, i.e. a lower probability of cows moving from the non-lame to the lame state and higher probability of transition from lame to non-lame. Days in lactation, quarters of calving and parity were associated with both lame and non-lame transitions and there was evidence of heterogeneity among cows in lameness occurrence and recovery. This study suggests loss of BCS and increase of BCS could influence the risk of becoming lame and the chance of recovery from lameness. Regular monitoring and maintenance of BCS on farms could be a key tool for reducing lameness. Further work is urgently needed in this area to allow a better understanding of the underlying mechanisms behind these relationships.

Matched MeSH terms: Great Britain/epidemiology
Etiology, outcome and prognostic indicators of childhood fulminant hepatic failure in the United kingdom

Lee WS, McKiernan P, Kelly DA

J Pediatr Gastroenterol Nutr, 2005 May;40(5):575-81.
PMID: 15861019

OBJECTIVE: To study the etiology, outcome and prognostic indicators in children with fulminant hepatic failure in the United Kingdom.
DESIGN: Retrospective review of all patients <17 years with fulminant hepatic failure from 1991 to 2000. Fulminant hepatic failure was defined as presence of coagulopathy (prothrombin time >24 seconds or International Normalized Ratio >2.0) with or without hepatic encephalopathy within 8 weeks of the onset of symptoms.
SETTING: Liver Unit, Birmingham Children's Hospital, United Kingdom.
RESULTS: Ninety-seven children (48 male, 49 female; median age, 27 months; range, 1 day-192.0 months) were identified with fulminant hepatic failure. The etiologies were: 22 metabolic, 53 infectious, 19 drug-induced, and 3 autoimmune hepatitis. The overall survival rate was 61%. 33% (32/97) recovered spontaneously with supportive management. Fifty-five children were assessed for liver transplantation. Four were unstable and were not listed for liver transplantation; 11 died while awaiting liver transplantation. Liver transplantation was contraindicated in 10 children. Of the 40 children who underwent liver transplantation, 27 survived. Children with autoimmune hepatitis, paracetamol overdose or hepatitis A were more likely to survive without liver transplantation. Children who had a delay between the first symptom of liver disease and the onset of hepatic encephalopathy (median, 10.5 days versus 3.5 days), higher plasma bilirubin (299 micromol/L versus 80 micromol/L), higher prothrombin time (62 seconds versus 40 seconds) or lower alanine aminotransferase (1288 IU/L versus 2929 IU/L) levels on admission were more likely to die of fulminant hepatic failure or require liver transplantation (P < 0.05). On multivariate analysis, the significant independent predictors for the eventual failure of conservative therapy were time to onset of hepatic encephalopathy >7 days, prothrombin time >55 seconds and alanine aminotransferase =2384 IU/L on admission.
CONCLUSIONS: Children with fulminant hepatic failure with severe coagulopathy, lower alanine aminotransferase on admission and prolonged duration of illness before the onset of hepatic encephalopathy are more likely to require liver transplantation. Early referral to a specialized center for consideration of liver transplantation is vital.

Matched MeSH terms: Great Britain/epidemiology
Fulltext Changes in trends and pattern of strong opioid prescribing in primary care

Zin CS, Chen LC, Knaggs RD

Eur J Pain, 2014 Oct;18(9):1343-51.
PMID: 24756859 DOI: 10.1002/j.1532-2149.2014.496.x

BACKGROUND: This study evaluated the prescribing trends of four commonly prescribed strong opioids in primary care and explored utilization in non-cancer and cancer users.
METHODS: This cross-sectional study was conducted from 2000 to 2010 using the UK Clinical Practice Research Datalink. Prescriptions of buprenorphine, fentanyl, morphine and oxycodone issued to adult patients were included in this study. Opioid prescriptions issued after patients had cancer medical codes were defined as cancer-related use; otherwise, they were considered non-cancer use. Annual number of prescriptions and patients, defined daily dose (DDD/1000 inhabitants/day) and oral morphine equivalent (OMEQ) dose were measured in repeat cross-sectional estimates.
RESULTS: In total, there were 2,672,022 prescriptions (87.8% for non-cancer) of strong opioids for 178,692 users (59.9% female, 83.9% non-cancer, mean age 67.1 ± 17.0 years) during the study period. The mean annual (DDD/1000 inhabitants/day) was higher in the non-cancer group than in the cancer group for all four opioids; morphine (0.73 ± 0.28 vs. 0.12 ± 0.04), fentanyl (0.46 ± 0.29 vs. 0.06 ± 0.24), oxycodone (0.24 ± 0.19 vs. 0.038 ± 0.028) and buprenorphine (0.23 ± 0.15 vs. 0.008 ± 0.006). The highest proportion of patients were prescribed low opioid doses (OMEQ ≤ 50 mg/day) in both non-cancer (50.3%) and cancer (39.9%) groups, followed by the dose ranks of 51-100 mg/day (26.2% vs. 28.7%), 101-200 mg/day (15.1% vs. 19.2%) and >200 mg/day (8.25% vs. 12.1%).
CONCLUSIONS: There has been a huge increase in strong opioid prescribing in the United Kingdom, with the majority of prescriptions for non-cancer pain. Morphine was the most frequently prescribed, but the utilization of oxycodone, buprenorphine and fentanyl increased markedly over time.

Matched MeSH terms: Great Britain/epidemiology

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