Routes to diagnosis for hepatocellular carcinoma patients: predictors and associations with treatment and mortality.

BACKGROUND: Hepatocellular carcinoma (HCC) incidence has increased rapidly, and prognosis remains poor. We aimed to explore predictors of routes to diagnosis (RtD), and outcomes, in HCC cases. METHODS: HCC cases diagnosed 2006-2017 were identified from the National Cancer Registration Dataset and linked to Hospital Episode Statistics and the RtD metric. Multivariable logistic regression was used to explore associations between RtD, diagnosis year, 365-day mortality and receipt of potentially curative treatment. RESULTS: 23,555 HCC cases were identified; 36.1% via emergency presentation (EP), 30.2% GP referral (GP), 17.1% outpatient referral, 11.0% two-week wait and 4.6% other/unknown routes. Odds of 365-day mortality was >70% lower via GP or OP routes than EP, and odds of curative treatment 3-4 times higher. Further adjustment for cancer/cirrhosis stage attenuated the associations with curative treatment. People who were older, female, had alcohol-related liver disease, or were more deprived, were at increased risk of an EP. Over time, diagnoses via EP decreased, and via GP increased. CONCLUSIONS: HCC RtD is an important predictor of outcomes. Continuing to reduce EP and increase GP and OP presentations, for example by identifying and regularly monitoring patients at higher risk of HCC, may improve stage at diagnosis and survival.

A Pilot Study of a Videoconferencing-Based Binge Eating Disorder Program in Overweight or Obese Females.

Background:There has been increasing interest in using videoconferencing in health care, but limited research was conducted in Binge Eating Disorder (BED) patients. This 3-month pilot study aimed to assess the feasibility, acceptability, and preliminary efficacy of a videoconferencing (VC)-based treatment program in overweight and obese females with BED.Methods:Eighteen participants, aged 20-73, were diagnosed and randomized into either a face-to-face (F2F) group or a VC-based group. In the F2F group, participants received 12 one-on-one weekly counseling sessions from a Licensed Mental Health Counselor and Registered Dietitian Nutritionist. In the VC group, participants received the same counseling through an online telemedicine software. Measured outcomes include retention, adherence to treatment, and attitudinal and behavioral changes of participants.Results:In the end of study, of the 9 participants randomized into each group, 8 (88.9%) F2F participants and 4 (44.4%) VC participants completed the study. On average, F2F finishers attended 94.8% of sessions and completed 66.2% of dietary diaries. VC finishers attended 95.8% of sessions and completed 55.4% of diaries. No changes in weight and binge eating episode were observed in either group. F2F finishers had significant improvement on uncontrolled eating (p = 0.01), emotional eating (p = 0.004), food addiction diagnosis (p = 0.04), loss of control (p = 0.04), and clinical significance (p = 0.04). VC finishers observed significant improvements in eating disorder examination shape concern (p = 0.03) and global score (p = 0.03).Conclusion:VC-based treatment program is feasible and could be effective for BED patients. Long-term large-scale randomized clinical trials are warranted to further assess the efficacy.

Human-to-Human Transmission of Monkeypox Virus, United Kingdom, October 2018.

In September 2018, monkeypox virus was transmitted from a patient to a healthcare worker in the United Kingdom. Transmission was probably through contact with contaminated bedding. Infection control precautions for contacts (vaccination, daily monitoring, staying home from work) were implemented. Of 134 potential contacts, 4 became ill; all patients survived.

Two cases of monkeypox imported to the United Kingdom, September 2018.

In early September 2018, two cases of monkeypox were reported in the United Kingdom (UK), diagnosed on 7 September in Cornwall (South West England) and 11 September in Blackpool (North West England). The cases were epidemiologically unconnected and had recently travelled to the UK from Nigeria, where monkeypox is currently circulating. We describe the epidemiology and the public health response for the first diagnosed cases outside the African continent since 2003.

COVID-19 within a large UK prison with a high number of vulnerable adults, march to june 2020: An outbreak investigation and screening event.

OBJECTIVE: To describe the public health response to COVID-19 within a large prison with a high number of clinically vulnerable residents. DESIGN: An outbreak investigation was undertaken among all residents and staff. A screening event involved nose and throat swab samples from residents and staff, examined by polymerase chain reaction (PCR). An electronic questionnaire regarding risk factors was distributed to staff. RESULTS: 58 residents out of 1,156 (5.0%, 95% CI: 3.8 - 6.3) and 129 staff out of 510 (25.3%, 95% CI: 21.5 - 29.1) displayed COVID-19 symptoms, including six and eight confirmed, respectively. Residents reported cough symptoms with no fever (29.3%), followed by a cough and fever (15.5%). 62.1% of symptomatic residents were 50 years or older, placing them in the group at risk for severe COVID-19 disease. Wing I had the highest attack rate (12.5%). 1,063 individuals were swabbed during the 5-day screening event, and all had negative swab results. CONCLUSION: The findings were consistent with the hypothesis of a propagating outbreak with decreasing incidence since the peak date of onset. COVID-19 transmission within a high-risk setting was quickly contained, and an explosive outbreak was prevented through a multi-agency public health response.

School Violence Among a Nationally Representative Sample of Adolescents in Chile.

Background: School violence is widely acknowledged as a public health problem with considerable consequences on student learning and social development. There are also a wide range of health consequences. A large share of previous research on school violence has focused on populations in the global north, with significant gaps in the state of knowledge in the world's emerging economies. To this end, the present study provides an examination of correlates for school-based violence in Chile using a nationally representative cohort. Methods: Six independent variables were considered (age, sex, physical activity, sedentary life style, bullying victimization, food insecurity) within a logistic regression model to ascertain the strength and direction of associations with physical fighting. Results: Among the surveyed students, ~13.08% reported being involved in two or more physical fights during the twelve month recall period. Males were significantly over represented among those reporting being involved in a fight OR 2.91 (CI = 1.98-4.27). Those who reported experiencing food insecurity were 5.29 (CI = 1.43-19.50) times more likely to have been involved in a physical fight. Students who reported being bullied were 2.41 (CI = 1.67-3.47) times more likely to have been involved in physical fights. While age provided protection from involvement in physical fights with an adjusted odds ratio of 0.91 (CI = 0.84-0.98). Conclusion: Consistent with previous research, our results suggest that the use of school-based interventions that target multiple risk behaviors may be helpful in reducing rates of physical fighting.

Identifying potential emerging threats through epidemic intelligence activities-looking for the needle in the haystack?

BACKGROUND: Epidemic intelligence (EI) for emerging infections is the process of identifying key information on emerging infectious diseases and specific incidents. Automated web-based infectious disease surveillance technologies are available; however, human input is still needed to review, validate, and interpret these sources. In this study, entries captured by Public Health England's (PHE) manual event-based EI system were examined to inform future intelligence gathering activities. METHODS: A descriptive analysis of unique events captured in a database between 2013 and 2017 was conducted. The top five diseases in terms of the number of entries were described in depth to determine the effectiveness of PHE's EI surveillance system compared to other sources. RESULTS: Between 2013 and 2017, a total of 22 847 unique entries were added to the database. The top three initial and definitive information sources varied considerably by disease. Ebola entries dominated the database, making up 23.7% of the total, followed by Zika (11.8%), Middle East respiratory syndrome (6.7%), cholera (5.5%), and yellow fever and undiagnosed morbidity (both 3.3%). Initial reports of major outbreaks due to the top five disease agents were picked up through the manual system prior to being publicly reported by official sources. CONCLUSIONS: PHE's manual EI process quickly and accurately detected global public health threats at the earliest stages and allowed for monitoring of events as they evolved.

Tear lacritin levels by age, sex, and time of day in healthy adults.

PURPOSE: Several small proteomic studies suggest that the prosecretory tear protein lacritin may be selectively downregulated in dry eye syndrome and in blepharitis, yet little information is available about normal baseline levels. This study assessed lacritin levels in tears from healthy individuals and addressed whether they differ according to sex, age, or time of day. METHODS: Rabbit antibodies against lacritin N-terminal peptide EDASSDSTGADPAQEAGTS (Pep Lac N-Term) were generated and characterized against human recombinant lacritin and N-65 truncation mutant. Basal tears were collected from 66 healthy individuals ranging in age from 18 to 52 years, and at four times during one 24-hour period from 34 other individuals. Lacritin levels were then analyzed by ELISA and Western blotting. RESULTS: Anti-Pep Lac N-Term bound lacritin, but not truncation mutant N-65 that lacks the N-terminal antigenic site. Tear lacritin levels followed a normal distribution with a mean of 4.2 ± 1.17 ng/100 ng total tear protein. Levels differed little by age or sex, and decreased slightly between 4 and 8 hours in a 24-hour cycle. Tear-blocking effects were minimal, as suggested by spiking of tears with recombinant lacritin. CONCLUSIONS: Anti-Pep Lac N-Term-detectable lacritin comprises ~4.2 ng/100 ng total tear protein in healthy individuals, with no significant differences between males and females or among individuals between 18 and 52 years old. Levels decrease slightly in the late afternoon. These findings provide a baseline for future immunodiagnostic studies of lacritin in dry eye and other ocular diseases.