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2.
Lancet ; 397(10285): 1646-1657, 2021 05 01.
Artículo en Inglés | MEDLINE | ID: mdl-33901420

RESUMEN

BACKGROUND: The BNT162b2 mRNA (Pfizer-BioNTech) and ChAdOx1 nCoV-19 (Oxford-AstraZeneca) COVID-19 vaccines have shown high efficacy against disease in phase 3 clinical trials and are now being used in national vaccination programmes in the UK and several other countries. Studying the real-world effects of these vaccines is an urgent requirement. The aim of our study was to investigate the association between the mass roll-out of the first doses of these COVID-19 vaccines and hospital admissions for COVID-19. METHODS: We did a prospective cohort study using the Early Pandemic Evaluation and Enhanced Surveillance of COVID-19-EAVE II-database comprising linked vaccination, primary care, real-time reverse transcription-PCR testing, and hospital admission patient records for 5·4 million people in Scotland (about 99% of the population) registered at 940 general practices. Individuals who had previously tested positive were excluded from the analysis. A time-dependent Cox model and Poisson regression models with inverse propensity weights were fitted to estimate effectiveness against COVID-19 hospital admission (defined as 1-adjusted rate ratio) following the first dose of vaccine. FINDINGS: Between Dec 8, 2020, and Feb 22, 2021, a total of 1 331 993 people were vaccinated over the study period. The mean age of those vaccinated was 65·0 years (SD 16·2). The first dose of the BNT162b2 mRNA vaccine was associated with a vaccine effect of 91% (95% CI 85-94) for reduced COVID-19 hospital admission at 28-34 days post-vaccination. Vaccine effect at the same time interval for the ChAdOx1 vaccine was 88% (95% CI 75-94). Results of combined vaccine effects against hospital admission due to COVID-19 were similar when restricting the analysis to those aged 80 years and older (83%, 95% CI 72-89 at 28-34 days post-vaccination). INTERPRETATION: Mass roll-out of the first doses of the BNT162b2 mRNA and ChAdOx1 vaccines was associated with substantial reductions in the risk of hospital admission due to COVID-19 in Scotland. There remains the possibility that some of the observed effects might have been due to residual confounding. FUNDING: UK Research and Innovation (Medical Research Council), Research and Innovation Industrial Strategy Challenge Fund, Health Data Research UK.


Asunto(s)
/prevención & control , Hospitalización/estadística & datos numéricos , Vacunación Masiva , Pandemias/prevención & control , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Factores de Riesgo , Escocia/epidemiología , Clase Social , Adulto Joven
3.
Artículo en Inglés | MEDLINE | ID: mdl-33917067

RESUMEN

The study investigated if rurality, area deprivation, access to outside space (Study 1), and frequency of visiting and duration in green space (Study 2) are associated with mental health during the COVID-19 pandemic and examined if individual demographics (age, gender, COVID-19 shielding status) and illness beliefs have a direct association with mental health during the COVID-19 pandemic. A serial, weekly, nationally representative, cross-sectional, observational study of randomly selected adults was conducted in Scotland during June and July 2020. If available, validated instruments were used to measure psychological distress, individual demographics, illness beliefs, and the following characteristics: Rurality, area deprivation, access to residential outside space, frequency of visiting, and duration in green space. Simple linear regressions followed by examination of moderation effect were conducted. There were 2969 participants in Study 1, of which 1765 (59.6%) were female, 349 (11.9%) were in the shielding category, and the median age was 54 years. There were 502 participants in Study 2, of which 295 (58.60%) were female, 58 (11.6%) were in shielding category, and the median age was 53 years. Direct effects showed that psychological distress was worse if participants reported the following: Urban, in a deprived area, no access to or sharing residential outside space, fewer visits to green space (environment), younger, female, in the shielding category (demographics), worse illness (COVID-19) representations, and greater threat perception (illness beliefs). Moderation analyses showed that environmental factors amplified the direct effects of the individual factors on psychological distress. This study offers pointers for public health and for environmental planning, design, and management, including housing design and public open space provision and regulation.


Asunto(s)
Pandemias , Adulto , Estudios Transversales , Femenino , Humanos , Masculino , Salud Mental , Persona de Mediana Edad , Parques Recreativos , Escocia/epidemiología
4.
Artículo en Inglés | MEDLINE | ID: mdl-33923170

RESUMEN

This study examined the impact of social distancing during the COVID-19 pandemic on loneliness, wellbeing, and social activity, including social support, in Scottish older adults. A mixed methods online survey was used to examine these factors during social distancing mid-lockdown, July 2020. Participants were asked to state whether loneliness, wellbeing, social activity, and social support had changed since pre-social distancing, and to provide details of strategies used to keep socially active. A total of 1429 adults (84% aged 60+ years) living in Scotland took part. The majority reported that social distancing regulations made them experience more loneliness and less social contact and support. Loneliness during lockdown was higher than reported norms for this age group before the pandemic. A larger social network, more social contact, and better perceived social support seemed to be protective against loneliness and poor wellbeing. Positive coping strategies reported included increasing online social contact with both existing social networks and reconnecting with previous networks, as well as increasing contact with neighbours and people in the community. This underlines the importance of addressing loneliness and social support in older adults but particularly during situations where risk of isolation is high.


Asunto(s)
Pandemias , Anciano , Control de Enfermedades Transmisibles , Humanos , Soledad , Persona de Mediana Edad , Escocia/epidemiología , Aislamiento Social
5.
Animal ; 15(2): 100121, 2021 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-33712212

RESUMEN

The work presented in this pilot study aimed to identify potential risk factors associated with bovine periodontitis development. Bovine periodontitis is a multifactorial polymicrobial infectious disease for which the aetiopathogenesis and risk factors are not fully understood. From cattle slaughtered in an abattoir in Scotland, 35 dental arcades with periodontal lesions and 40 periodontally healthy arcades were selected over seven visits for study. Multivariable logistic regression analysis was used to evaluate the association between periodontitis and the independent variables, gender, age and breed. For every increase in year of age, cattle were 1.5 times more likely to have periodontitis. A graphical analysis indicated that within the limits of this study, we could not detect any major influence of breed on the age-effect. Although logistic regression analysis demonstrated that periodontitis lesions are more prevalent with increasing age of cattle the underlying mechanisms remain unclear. It is likely that periodontitis is an important cause of oral pain in older cattle and can contribute to reduced productivity/performance. Further studies with a larger sample size are necessary to elucidate the associations between potential risk factors and periodontitis in cattle and to define its effects on animal welfare and productivity.


Asunto(s)
Enfermedades de los Bovinos , Periodontitis , Animales , Bovinos , Enfermedades de los Bovinos/epidemiología , Periodontitis/epidemiología , Periodontitis/veterinaria , Proyectos Piloto , Factores de Riesgo , Escocia/epidemiología
6.
BMC Cancer ; 21(1): 313, 2021 Mar 24.
Artículo en Inglés | MEDLINE | ID: mdl-33761919

RESUMEN

BACKGROUND: Hormone replacement therapy (HRT) is widely used and has proven benefits for women with menopausal symptoms. An increasing number of women with cancer experience menopausal symptoms but the safety of HRT use in women with cancer is unclear. There are particular concerns that HRT could accelerate cancer progression in women with cancer, and also that HRT could increase the risk of cardiovascular disease in such women. Therefore, our primary aim is to determine whether HRT use alters the risk of cancer-specific mortality in women with a range of common cancers. Our secondary objectives are to investigate whether HRT alters the risk of second cancers, cardiovascular disease, venous thromboembolism and all-cause mortality. METHODS: The study will utilise independent population-based data from Wales using the SAIL databank and Scotland based upon the national Prescribing Information System. The study will include women newly diagnosed with common cancers from 2000 to 2016, identified from cancer registries. Women with breast cancers will be excluded. HRT will be ascertained using electronic prescribing in Wales or dispensing records in Scotland. The primary outcome will be time to cancer-specific mortality from national mortality records. Time-dependent cox regression models will be used to calculate hazard ratios (HR) and 95% confidence intervals (95% CIs) for cancer specific death in HRT users compared with non-users after cancer diagnosis after adjusting for relevant confounders, stratified by cancer site. Analysis will be repeated investigating the impact of HRT use immediately before cancer diagnosis. Secondary analyses will be conducted on the risk of second cancers, cardiovascular disease, venous thromboembolism and all-cause mortality. Analyses will be conducted within each cohort and pooled across cohorts. DISCUSSION: Our study will provide evidence to inform guidance given to women diagnosed with cancer on the safety of HRT use and/or guide modifications to clinical practice.


Asunto(s)
Enfermedades Cardiovasculares/epidemiología , Terapia de Reemplazo de Estrógeno/efectos adversos , Neoplasias Primarias Secundarias/epidemiología , Neoplasias/mortalidad , Estudios de Cohortes , Femenino , Humanos , Menopausia , Sistema de Registros/estadística & datos numéricos , Medición de Riesgo/estadística & datos numéricos , Escocia/epidemiología , Gales/epidemiología
7.
Ann R Coll Surg Engl ; 103(3): 167-172, 2021 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-33645286

RESUMEN

INTRODUCTION: We describe a new service model, the Orthopaedic Assessment Unit (OAU), designed to provide care for trauma patients during the COVID-19 pandemic. Patients without COVID-19 symptoms and isolated musculoskeletal injuries were redirected to the OAU. METHODS: We prospectively reviewed patients throughput during the peak of the global pandemic (7 May 2020 to 7 June 2020) and compared with our historic service provision (7 May 2019 to 7 June 2019). The Mann-Whitney and Fisher Exact tests were used to test the statistical significance of data. RESULTS: A total of 1,147 patients were seen, with peak attendances between 11am and 2pm; 96% of all referrals were seen within 4h. The majority of patients were seen by orthopaedic registrars (52%) and nurse practitioners (44%). The majority of patients suffered from sprains and strains (39%), followed by fractures (22%) and wounds (20%); 73% of patients were discharged on the same day, 15% given follow up, 8% underwent surgery and 3% were admitted but did not undergo surgery. Our volume of trauma admissions and theatre cases decreased by 22% and 17%, respectively (p=0.058; 0.139). There was a significant reduction of virtual fracture clinic referrals after reconfiguration of services (p<0.001). CONCLUSIONS: Rapid implementation of a specialist OAU during a pandemic can provide early definitive trauma care while exceeding national waiting time standards. The fall in trauma attendances was lower than anticipated. The retention of orthopaedic staff in the department to staff the unit and maintain a high standard of care is imperative.


Asunto(s)
Prestación de Atención de Salud/organización & administración , Fracturas Óseas/terapia , Ortopedia/organización & administración , Esguinces y Distensiones/terapia , Adulto , Anciano , Atención Ambulatoria/estadística & datos numéricos , Servicio de Urgencia en Hospital , Planificación Ambiental , Femenino , Fracturas Óseas/diagnóstico , Fracturas Óseas/epidemiología , Hospitalización/estadística & datos numéricos , Humanos , Masculino , Persona de Mediana Edad , Enfermeras Practicantes , Procedimientos Ortopédicos , Cirujanos Ortopédicos , Escocia/epidemiología , Esguinces y Distensiones/diagnóstico , Esguinces y Distensiones/epidemiología , Centros Traumatológicos , Triaje , Heridas y Traumatismos/diagnóstico , Heridas y Traumatismos/epidemiología , Heridas y Traumatismos/terapia
8.
BMJ Open ; 11(2): e042606, 2021 02 15.
Artículo en Inglés | MEDLINE | ID: mdl-33589459

RESUMEN

BACKGROUND: The diagnosis of lower urinary tract symptoms related to suspected bladder outflow obstruction from benign prostate hyperplasia/enlargement in men is increasing. This is leading to high demand on healthcare services; however, there is limited knowledge of differences in pharmacotherapy prescribing for this condition based on geography. OBJECTIVE: To investigate potential variation in drug prescribing for suspected bladder outflow obstruction in Scotland, based on analysis of publicly available data, to identify trends and inform future prescribing. STUDY DESIGN: A longitudinal register-based data study of prescribing and patient data publicly available from Scottish registries. All information is available as monthly aggregates at the level of single general practices. SETTING AND PARTICIPANTS: 903 (97%) general practices in Scotland, over a 50-month period (October 2015 to November 2019). OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: We analysed numbers of daily doses of drugs for suspected bladder outflow obstruction prescribed per month using a Bayesian Poisson regression analysis, incorporating random effects to account for spatial and temporal elements. RESULTS: Prescriptions for suspected bladder outflow obstruction medications increased during the observation period (overall average rate of change 1.24±0.28, ranging from 0.893 in Orkney to 1.95 in Lanarkshire). While some determinants of health inequality regarding prescribing practices across health boards are consistent with those known from the literature, other inequalities remain unexplained after accounting for practice-specific and patient-specific characteristics such as deprivation and rurality. CONCLUSIONS: Inequalities in prescribing for suspected bladder outflow obstruction medications exist in Scotland, partially ascribable to accepted sociodemographic and geographic factors.


Asunto(s)
Disparidades en el Estado de Salud , Obstrucción del Cuello de la Vejiga Urinaria , Teorema de Bayes , Humanos , Masculino , Escocia/epidemiología , Apoyo Social , Obstrucción del Cuello de la Vejiga Urinaria/tratamiento farmacológico
9.
BMC Public Health ; 21(1): 169, 2021 02 11.
Artículo en Inglés | MEDLINE | ID: mdl-33568116

RESUMEN

BACKGROUND: For many years smoking has been the major threat to public health in developed countries. However, smoking prevalence has declined over a period when adiposity has increased. The aim of this study was to determine whether adiposity now accounts for more deaths than smoking in the general population as a whole or sub-groups of it. METHODS: This is a comparative risk assessment study using Health Surveys for England and Scottish Health Surveys from 2003 to 2017. Annual prevalence of overweight, obesity, current and former smoking were obtained and combined using population-based weights. Sex-specific risk ratios for all-cause mortality were obtained from the most recently published meta-analyses. Population attributable fractions across yeas were then estimated. FINDINGS: Overall, deaths attributable to current/former smoking declined from 23.1% (95% CI 20.6-25.8%) in 2003 to 19.4% (95% CI 17.3-21.6%) in 2017, whilst those attributable to adiposity (overweight or obesity) increased from 17.9% (95% CI 17.3-18.4%) in 2003 to 23.1% (95% CI 22.3-23.8%) in 2017 with cross-over occurring in 2013. Cross-over occurred earlier in men (2011) than women (2014). It occurred in 2006 for those aged over 65 years of age and in 2012 for those aged 45-64 years. Below 45 years, smoking remained the larger contributor to mortality. INTERPRETATION: Adiposity now accounts for more deaths in England and Scotland than smoking among people in middle- and old-age. National strategies to address adiposity should be a public health priority.


Asunto(s)
Adiposidad , Obesidad , Anciano , Inglaterra/epidemiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Obesidad/epidemiología , Factores de Riesgo , Escocia/epidemiología , Fumar/epidemiología
10.
BMJ Open ; 11(2): e041317, 2021 02 03.
Artículo en Inglés | MEDLINE | ID: mdl-33536318

RESUMEN

OBJECTIVE: To estimate future palliative care need and complexity of need in Scotland, and to identify priorities for future service delivery. DESIGN: We estimated the prevalence of palliative care need by analysing the proportion of deaths from defined chronic progressive illnesses. We described linear projections up to 2040 using national death registry data and official mortality forecasts. An expert consultation and subsequent online consensus survey generated recommendations on meeting future palliative care need. SETTING: Scotland, population of 5.4 million. PARTICIPANTS: All decedents in Scotland over 11 years (2007 to 2017). The consultation had 34 participants; 24 completed the consensus survey. PRIMARY AND SECONDARY OUTCOMES: Estimates of past and future palliative care need in Scotland from 2007 up to 2040. Multimorbidity was operationalised as two or more registered causes of death from different disease groups (cancer, organ failure, dementia, other). Consultation and survey data were analysed descriptively. RESULTS: We project that by 2040, the number of people requiring palliative care will increase by at least 14%; and by 20% if we factor in multimorbidity. The number of people dying from multiple diseases associated with different disease groups is projected to increase from 27% of all deaths in 2017 to 43% by 2040. To address increased need and complexity, experts prioritised sustained investment in a national digital platform, roll-out of integrated electronic health and social care records; and approaches that remain person-centred. CONCLUSIONS: By 2040 more people in Scotland are projected to die with palliative care needs, and the complexity of need will increase markedly. Service delivery models must adapt to serve growing demand and complexity associated with dying from multiple diseases from different disease groups. We need sustained investment in secure, accessible, integrated and person-centred health and social care digital systems, to improve care coordination and optimise palliative care for people across care settings.


Asunto(s)
Enfermedad Crónica/terapia , Prestación de Atención de Salud/métodos , Neoplasias/terapia , Cuidados Paliativos/tendencias , Predicción , Humanos , Cuidados Paliativos/estadística & datos numéricos , Escocia/epidemiología
11.
Br J Cancer ; 124(8): 1353-1356, 2021 04.
Artículo en Inglés | MEDLINE | ID: mdl-33526866

RESUMEN

Understanding the impact of the COVID-19 pandemic on systemic anticancer therapy delivery (SACT) is crucial to appreciate the short- and long-term consequences for cancer patients and plan future care. Here, we report real-time national SACT delivery data from NHS Scotland. We demonstrate an initial rapid reduction in patient attendance of 28.7% with subsequent rapid recovery following service redesign. The smallest decrease was seen in breast cancer (19.7%), which also had the most rapid recovery and the largest decrease seen in colorectal cancer (43.4%). Regional variation in the magnitude of impact on SACT delivery was observed, but nadirs occurred at the same time and the rate of recovery was similar across all regions. This recovery reflected a coordinated national approach and associated patient and clinician support structures, which facilitated the creation of COVID-19-protected areas for SACT delivery in Scottish cancer centres enabling rapid sharing of successful and innovative strategies. The data show that these actions have limited the disadvantage to cancer patients.


Asunto(s)
/terapia , Neoplasias Colorrectales/terapia , Pandemias , /complicaciones , /virología , Neoplasias Colorrectales/complicaciones , Neoplasias Colorrectales/epidemiología , Neoplasias Colorrectales/virología , Femenino , Humanos , Masculino , /patogenicidad , Escocia/epidemiología
12.
BMJ Open ; 11(2): e044135, 2021 02 18.
Artículo en Inglés | MEDLINE | ID: mdl-33602711

RESUMEN

INTRODUCTION: COVID-19 has unprecedented consequences on population health, with governments worldwide issuing stringent public health directives. In the absence of a vaccine, a key way to control the pandemic is through behavioural change: people adhering to transmission-reducing behaviours (TRBs), such as physical distancing, hand washing and wearing face covering. Non-adherence may be explained by theories of how people think about the illness (the common-sense model of self-regulation) and/or how they think about the TRBs (social cognition theory and protection motivation theory). In addition, outbreaks of infectious diseases and the measures employed to curb them are likely to have detrimental effects on people's mental and general health. Therefore, in representative repeated surveys, we will apply behavioural theories to model adherence to TRBs and the effects on mental and general health in the Scottish population from June to November 2020, following the initial outbreak of COVID-19. METHODS AND ANALYSIS: Repeated 20 min structured telephone surveys will be conducted with nationally representative random samples of 500 adults in Scotland. The first 6 weeks the survey will be conducted weekly, thereafter fortnightly, for a total of 14 waves (total n=7000). Ipsos MORI will recruit participants through random digit dialling. The core survey will measure the primary outcomes of adherence to TRBs, mental and general health, and explanatory variables from the theories. Further questions will be added, enabling more detailed measurement of constructs in the core survey, additional themes and questions that align with the evolving pandemic. ETHICS AND DISSEMINATION: Ethical approval for this study was granted by the Life Sciences and Medicine College Ethics Review Board (CERB) at the University of Aberdeen (CERB/2020/5/1942). Results will be made available to policy makers, funders, interested lay people and other researchers through weekly reports and three bimonthly bulletins placed on the CHARIS website and advertised through social media.


Asunto(s)
/prevención & control , Control de Enfermedades Transmisibles , Cooperación del Paciente , Proyectos de Investigación , Adulto , Estudios Transversales , Femenino , Humanos , Masculino , Salud Mental , Estudios Observacionales como Asunto , Pandemias , Escocia/epidemiología , Encuestas y Cuestionarios
13.
BMC Health Serv Res ; 21(1): 153, 2021 Feb 17.
Artículo en Inglés | MEDLINE | ID: mdl-33596884

RESUMEN

BACKGROUND: The COVID-19 pandemic halted non-emergency surgery across Scotland. Measures to mitigate the risks of transmitting COVID-19 are creating significant challenges to restarting all surgical services safely. We describe the development of a risk stratification tool to prioritise patients for cataract surgery taking account both specific risk factors for poor outcome from COVID-19 infection as well as surgical 'need'. In addition we report the demographics and comorbidities of patients on our waiting list. METHODS: A prospective case review of electronic records was performed. A risk stratification tool was developed based on review of available literature on systemic risk factors for poor outcome from COVID-19 infection as well as a surgical 'need' score. Scores derived from the tool were used to generate 6 risk profile groups to allow prioritised allocation of surgery. RESULTS: There were 744 patients awaiting cataract surgery of which 66 (8.9 %) patients were 'shielding'. One hundred and thirty-two (19.5 %) patients had no systemic comorbidities, 218 (32.1 %) patients had 1 relevant systemic comorbidity and 316 (46.5 %) patients had 2 or more comorbidities. Five hundred and ninety patients (88.7 %) did not have significant ocular comorbidities. Using the risk stratification tool, 171 (23 %) patients were allocated in the highest 3 priority stages. Given an aging cohort with associated increase in number of systemic comorbidities, the majority of patients were in the lower priority stages 4 to 6. CONCLUSIONS: COVID-19 has created an urgent challenge to deal safely with cataract surgery waiting lists. This has driven the need for a prompt and pragmatic change to the way we assess risks and benefits of a previously regarded as low-risk intervention. This is further complicated by the majority of patients awaiting cataract surgery being elderly with comorbidities and at higher risk of mortality related to COVID-19. We present a pragmatic method of risk stratifying patients on waiting lists, blending an evidence-based objective assessment of risk and patient need combined with an element of shared decision-making. This has facilitated safe and successful restarting of our cataract service.


Asunto(s)
/epidemiología , Extracción de Catarata , Catarata/epidemiología , Pandemias , Listas de Espera , Anciano , Anciano de 80 o más Años , Comorbilidad , Femenino , Humanos , Masculino , Estudios Prospectivos , Medición de Riesgo , Factores de Riesgo , Escocia/epidemiología
14.
BMC Med ; 19(1): 51, 2021 02 22.
Artículo en Inglés | MEDLINE | ID: mdl-33612113

RESUMEN

BACKGROUND: The objective of this study was to investigate the relation of severe COVID-19 to prior drug prescribing. METHODS: Severe cases were defined by entry to critical care or fatal outcome. For this matched case-control study (REACT-SCOT), all 4251 cases of severe COVID-19 in Scotland since the start of the epidemic were matched for age, sex and primary care practice to 36,738 controls from the population register. Records were linked to hospital discharges since June 2015 and dispensed prescriptions issued in primary care during the last 240 days. RESULTS: Severe COVID-19 was strongly associated with the number of non-cardiovascular drug classes dispensed. This association was strongest in those not resident in a care home, in whom the rate ratio (95% CI) associated with dispensing of 12 or more drug classes versus none was 10.8 (8.8, 13.3), and in those without any of the conditions designated as conferring increased risk of COVID-19. Of 17 drug classes postulated at the start of the epidemic to be "medications compromising COVID", all were associated with increased risk of severe COVID-19 and these associations were present in those without any of the designated risk conditions. The fraction of cases in the population attributable to exposure to these drug classes was 38%. The largest effect was for antipsychotic agents: rate ratio 4.18 (3.42, 5.11). Other drug classes with large effects included proton pump inhibitors (rate ratio 2.20 (1.72, 2.83) for = 2 defined daily doses/day), opioids (3.66 (2.68, 5.01) for = 50 mg morphine equivalent/day) and gabapentinoids. These associations persisted after adjusting for covariates and were stronger with recent than with non-recent exposure. CONCLUSIONS: Severe COVID-19 is associated with polypharmacy and with drugs that cause sedation, respiratory depression, or dyskinesia; have anticholinergic effects; or affect the gastrointestinal system. These associations are not easily explained by co-morbidity. Measures to reduce the burden of mortality and morbidity from COVID-19 should include reinforcing existing guidance on reducing overprescribing of these drug classes and limiting inappropriate polypharmacy. REGISTRATION: ENCEPP number EUPAS35558.


Asunto(s)
/diagnóstico , Cuidados Críticos/tendencias , Polifarmacia , Psicotrópicos/efectos adversos , Índice de Severidad de la Enfermedad , Anciano , Anciano de 80 o más Años , Estudios de Casos y Controles , Comorbilidad , Relación Dosis-Respuesta a Droga , Prescripciones de Medicamentos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Psicotrópicos/uso terapéutico , Escocia/epidemiología
15.
Eur J Obstet Gynecol Reprod Biol ; 257: 144-148, 2021 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-33388182

RESUMEN

OBJECTIVE: To explore the risk of melanoma in women with endometriosis. STUDY DESIGN: A retrospective cohort study using Scottish national population-based data was conducted. The study comprised 281,937 women with nearly 5 million person years (4,923,628) of follow up from 1981 to 2010. 17,834 women with a new surgical diagnosis of endometriosis were compared with 83,303 women with no evidence of endometriosis at laparoscopy, 162,966 women who underwent laparoscopic sterilisation and 17,834 age-matched women from the general population to determine the risk of melanoma. Cox proportional hazards regression was used to calculate crude and adjusted Hazards ratios with 95 % Confidence Intervals. RESULTS: Women with endometriosis had a significantly higher risk of melanoma when compared to women with no evidence of endometriosis at laparoscopy (HR 1.59, 95 % CI 1.19-2.13), women who had undergone laparoscopic sterilisation (HR 1.82, 95 % CI 1.39-2.40) and age-matched women from the general population (HR 1.63, 95 % CI 1.08-2.45). CONCLUSION: A diagnosis of endometriosis was associated with an increased risk of developing melanoma compared to those without endometriosis. These findings highlight the need for further research to explore shared pathways in the pathogenesis of the two conditions. It is important to acknowledge that the absolute increase in the risk of melanoma in women with endometriosis remains low, which should be considered when counselling women.


Asunto(s)
Endometriosis , Melanoma , Estudios de Cohortes , Endometriosis/complicaciones , Endometriosis/epidemiología , Femenino , Humanos , Melanoma/epidemiología , Melanoma/etiología , Estudios Retrospectivos , Factores de Riesgo , Escocia/epidemiología
16.
Public Health ; 190: 132-134, 2021 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-33453689

RESUMEN

OBJECTIVES: The impact of the COVID-19 pandemic in Scotland has been amongst the most severe in Europe. Serological surveillance is critical to determine the overall extent of infection across populations and to inform the public health response. This study aimed to estimate the proportion of people who have antibodies to SARS-CoV-2 ('seroprevalence') in the general population of Scotland and to see if this changes over time. STUDY DESIGN/METHODS: Between International Organization for Standardization (ISO) week 17 (i.e. week commencing 20th April) and ISO week 25 (week commencing 15 June), 4751 residual blood samples were obtained from regional biochemistry laboratories in six participating regional health authority areas covering approximately 75% of the Scottish population. Samples were tested for the presence of anti-SARS-CoV-2 IgG antibodies using the LIAISON®SARS-CoV-2 S1/S2 IgG assay (DiaSorin, Italy). Seroprevalence rates were adjusted for the sensitivity and specificity of the assay using Bayesian methods. RESULTS: The combined adjusted seroprevalence across the study period was 4.3% (95% confidence interval: 4.2%-4.5%). The proportion varied each week between 1.9% and 6.8% with no difference in antibody positivity by age, sex or geographical area. CONCLUSIONS: At the end of the first wave of the COVID-19 pandemic, only a small fraction of the Scottish population had antibodies to SARS-CoV-2. Control of COVID-19 requires the ability to detect asymptomatic and mild infections that would otherwise remain undetected through existing surveillance systems. This is important to determine the true number of infections within the general population which, in turn, can help to understand transmission, inform control measures and provide a denominator for the estimation of severity measures such as the proportion of infected people who have been hospitalised and/or have died.


Asunto(s)
Anticuerpos Antivirales/sangre , Infecciones por Coronavirus/virología , Inmunoglobulina G/sangre , Pandemias , Vigilancia de la Población/métodos , /inmunología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Prevalencia , Vigilancia en Salud Pública , Escocia/epidemiología , Estudios Seroepidemiológicos , Pruebas Serológicas/métodos
17.
Bone Joint J ; 103-B(5): 888-897, 2021 May.
Artículo en Inglés | MEDLINE | ID: mdl-33487012

RESUMEN

AIMS: The primary aim was to determine the influence of COVID-19 on 30-day mortality following hip fracture. Secondary aims were to determine predictors of COVID-19 status on presentation and later in the admission; the rate of hospital acquired COVID-19; and the predictive value of negative swabs on admission. METHODS: A nationwide multicentre retrospective cohort study was conducted of all patients presenting with a hip fracture to 17 Scottish centres in March and April 2020. Demographics, presentation blood tests, COVID-19 status, Nottingham Hip Fracture Score, management, length of stay, and 30-day mortality were recorded. RESULTS: In all, 78/833 (9.4%) patients were diagnosed with COVID-19. The 30-day survival of patients with COVID-19 was significantly lower than for those without (65.4% vs 91%; p < 0.001). Diagnosis of COVID-19 within seven days of admission (likely community acquired) was independently associated with male sex (odds ratio (OR) 2.34, p = 0.040, confidence interval (CI) 1.04 to 5.25) and symptoms of COVID-19 (OR 15.56, CI 6.61 to 36.60, p < 0.001). Diagnosis of COVID-19 made between seven and 30 days of admission to hospital (likely hospital acquired) was independently associated with male sex (OR 1.73, CI 1.05 to 2.87, p = 0.032), Nottingham Hip Fracture Score ≥ 7 (OR 1.91, CI 1.09 to 3.34, p = 0.024), pulmonary disease (OR 1.68, CI 1.00 to 2.81, p = 0.049), American Society of Anesthesiologists (ASA) grade ≥ 3 (OR 2.37, CI 1.13 to 4.97, p = 0.022), and length of stay ≥ nine days (OR 1.98, CI 1.18 to 3.31, p = 0.009). A total of 38 (58.5%) COVID-19 cases were probably hospital acquired infections. The false-negative rate of a negative swab on admission was 0% in asymptomatic patients and 2.9% in symptomatic patients. CONCLUSION: COVID-19 was independently associated with a three times increased 30-day mortality rate. Nosocomial transmission may have accounted for approximately half of all cases during the first wave of the pandemic. Identification of risk factors for having COVID-19 on admission or acquiring COVID-19 in hospital may guide pathways for isolating or shielding patients respectively. Length of stay was the only modifiable risk factor, which emphasizes the importance of high-quality and timely care in this patient group. Cite this article: Bone Joint J 2021;103-B(5):888-897.


Asunto(s)
/complicaciones , Fracturas de Cadera/mortalidad , Anciano , /transmisión , Infección Hospitalaria/mortalidad , Infección Hospitalaria/transmisión , Femenino , Mortalidad Hospitalaria , Humanos , Tiempo de Internación/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Pandemias , Estudios Retrospectivos , Factores de Riesgo , Escocia/epidemiología
18.
PLoS One ; 16(1): e0244873, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33400700

RESUMEN

BACKGROUND: Multiple studies have highlighted the negative impact of COVID-19 and its particular effects on vulnerable sub-populations. Complementing this work, here, we report on the social patterning of self-reported positive changes experienced during COVID-19 national lockdown in Scotland. METHODS: The CATALYST study collected data from 3342 adults in Scotland during weeks 9-12 of a national lockdown. Using a cross-sectional design, participants completed an online questionnaire providing data on key sociodemographic and health variables, and completed a measure of positive change. The positive change measure spanned diverse domains (e.g., more quality time with family, developing new hobbies, more physical activity, and better quality of sleep). We used univariate analysis and stepwise regression to examine the contribution of a range of sociodemographic factors (e.g., age, gender, ethnicity, educational attainment, and employment status) in explaining positive change. RESULTS: There were clear sociodemographic differences across positive change scores. Those reporting higher levels of positive change were female, from younger age groups, married or living with their partner, employed, and in better health. CONCLUSION: Overall our results highlight the social patterning of positive changes during lockdown in Scotland. These findings begin to illuminate the complexity of the unanticipated effects of national lockdown and will be used to support future intervention development work sharing lessons learned from lockdown to increase positive health change amongst those who may benefit.


Asunto(s)
/psicología , Cuarentena/psicología , Aislamiento Social/psicología , Adulto , Ansiedad/epidemiología , Ansiedad/prevención & control , /prevención & control , Control de Enfermedades Transmisibles/métodos , Estudios Transversales , Ejercicio Físico/psicología , Familia/psicología , Femenino , Humanos , Masculino , Escocia/epidemiología , Sueño/fisiología , Higiene del Sueño , Estrés Psicológico/prevención & control , Estrés Psicológico/psicología , Encuestas y Cuestionarios
19.
BJOG ; 128(3): 584-592, 2021 02.
Artículo en Inglés | MEDLINE | ID: mdl-33426798

RESUMEN

OBJECTIVE: To evaluate the impact of a care bundle (antenatal information to women, manual perineal protection and mediolateral episiotomy when indicated) on obstetric anal sphincter injury (OASI) rates. DESIGN: Multicentre stepped-wedge cluster design. SETTING: Sixteen maternity units located in four regions across England, Scotland and Wales. POPULATION: Women with singleton live births between October 2016 and March 2018. METHODS: Stepwise region by region roll-out every 3 months starting January 2017. The four maternity units in a region started at the same time. Multi-level logistic regression was used to estimate the impact of the care bundle, adjusting for time trend and case-mix factors (age, ethnicity, body mass index, parity, birthweight and mode of birth). MAIN OUTCOME MEASURES: Obstetric anal sphincter injury in singleton live vaginal births. RESULTS: A total of 55 060 singleton live vaginal births were included (79% spontaneous and 21% operative). Median maternal age was 30 years (interquartile range 26-34 years) and 46% of women were primiparous. The OASI rate decreased from 3.3% before to 3.0% after care bundle implementation (adjusted odds ratio 0.80, 95% CI 0.65-0.98, P = 0.03). There was no evidence that the effect of the care bundle differed according to parity (P = 0.77) or mode of birth (P = 0.31). There were no significant changes in caesarean section (P = 0.19) or episiotomy rates (P = 0.16) during the study period. CONCLUSIONS: The implementation of this care bundle reduced OASI rates without affecting caesarean section rates or episiotomy use. These findings demonstrate its potential for reducing perineal trauma during childbirth. TWEETABLE ABSTRACT: OASI Care Bundle reduced severe perineal tear rates without affecting caesarean section rates or episiotomy use.


Asunto(s)
Parto Obstétrico/normas , Laceraciones/epidemiología , Complicaciones del Trabajo de Parto/epidemiología , Mejoramiento de la Calidad/estadística & datos numéricos , Adulto , Canal Anal/lesiones , Cesárea/efectos adversos , Cesárea/normas , Cesárea/estadística & datos numéricos , Análisis por Conglomerados , Parto Obstétrico/efectos adversos , Parto Obstétrico/estadística & datos numéricos , Inglaterra/epidemiología , Episiotomía/efectos adversos , Episiotomía/normas , Episiotomía/estadística & datos numéricos , Femenino , Humanos , Laceraciones/prevención & control , Modelos Logísticos , Complicaciones del Trabajo de Parto/prevención & control , Perineo/lesiones , Embarazo , Proyectos de Investigación , Factores de Riesgo , Escocia/epidemiología , Gales/epidemiología
20.
J Infect Dis ; 223(6): 971-980, 2021 03 29.
Artículo en Inglés | MEDLINE | ID: mdl-33367847

RESUMEN

Identifying drivers of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) exposure and quantifying population immunity is crucial to prepare for future epidemics. We performed a serial cross-sectional serosurvey throughout the first pandemic wave among patients from the largest health board in Scotland. Screening of 7480 patient serum samples showed a weekly seroprevalence ranging from 0.10% to 8.23% in primary and 0.21% to 17.44% in secondary care, respectively. Neutralization assays showed that highly neutralizing antibodies developed in about half of individuals who tested positive with enzyme-linked immunosorbent assay, mainly among secondary care patients. We estimated the individual probability of SARS-CoV-2 exposure and quantified associated risk factors. We show that secondary care patients, male patients, and 45-64-year-olds exhibit a higher probability of being seropositive. The identification of risk factors and the differences in virus neutralization activity between patient populations provided insights into the patterns of virus exposure during the first pandemic wave and shed light on what to expect in future waves.


Asunto(s)
/inmunología , /inmunología , Adolescente , Adulto , Anciano , Anticuerpos Neutralizantes/sangre , Anticuerpos Antivirales/sangre , /epidemiología , Línea Celular , Estudios Transversales , Prestación de Atención de Salud , Demografía , Ensayo de Inmunoadsorción Enzimática , Femenino , Humanos , Inmunidad , Masculino , Persona de Mediana Edad , Pandemias , Factores de Riesgo , Escocia/epidemiología , Estudios Seroepidemiológicos , Adulto Joven
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