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2.
Medicine (Baltimore) ; 99(15): e19707, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-32282726

RESUMEN

BACKGROUND: Increasing studies were performed to explore the prognostic value of E-cadherin in prostatic carcinoma, however, with inconsistent results. Hence, this systematic review is aimed to evaluate the prognostic role of E-cadherin in patients with prostatic carcinoma (PCa). METHODS: A comprehensive literature search in all available databases will be conducted to identify eligible studies. We will employ hazard ratios (HRs) and 95% confidence intervals (95% CIs) to estimate the correlations between E-cadherin expression and overall survival (OS), disease-free survival (DFS), relapse-free survival (RFS), progression-free survival (PFS) and clinicopathological features. Meta-analysis will be performed using Review Manager (Revman) 5.3.5 software (Cochrane Community, London, United Kingdom) and STATA 14 software (version 14.0; Stata Corp, College Station, TX). RESULTS: This study will provide a high-quality synthesis of current evidence of the correlations between snail expression and OS, DFS/RFS, PFS and clinicopathological features. CONCLUSION: The study will provide updated evidence to assess whether the expression of E-cadherin is in association with poor prognosis in patients with PCa. ETHICS AND DISSEMINATION: It is not necessary for ethical approval because individuals cannot be identified. The protocol will be disseminated in a peer-reviewed journal or presented at a relevant conference. PROSPERO REGISTRATION NUMBER: This systematic review protocol has been registered in the PROSPERO network (No. CRD42019128353).


Asunto(s)
Biomarcadores de Tumor/metabolismo , Cadherinas/metabolismo , Carcinoma/metabolismo , Neoplasias de la Próstata/patología , Antígenos CD/metabolismo , Supervivencia sin Enfermedad , Humanos , Incidencia , Londres/epidemiología , Masculino , Pronóstico , Neoplasias de la Próstata/epidemiología , Neoplasias de la Próstata/mortalidad , Sensibilidad y Especificidad , Reino Unido/epidemiología
3.
PLoS One ; 15(2): e0229093, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32059050

RESUMEN

AIM: To examine patterns of hazardous, harmful and dependent drinking across different socio-economic groups, and how this relationship may be explained by common mental disorder. METHODS AND FINDINGS: Between 2011-2013, 1,052 participants (age range 17-91, 53% female) were interviewed for Phase 2 of the South East London Community Health study. Latent class analysis was used to define six groups based on multiple indicators of socio-economic status in three domains. Alcohol use (low risk, hazardous, harmful/dependent) was measured using the Alcohol Use Disorders Identification Test and the presence of common mental disorder was measured using the revised Clinical Interview Schedule. Multinomial regression was used to explore associations with hazardous, harmful and dependent alcohol use, including after adjustment for common mental disorder. Harmful and dependent drinking was more common among people in Class 2 'economically inactive renters' (relative risk ratio (RRR) 3.05, 95% confidence interval (CI) 1.07-8.71), Class 3 'economically inactive homeowners' (RRR 4.11, 95% CI 1.19-14.20) and Class 6 'professional renters' (RRR 3.51, 95% CI 1.14-10.78) than in Class 1 'professional homeowners'. Prevalent common mental disorder explained some of the increased risk of harmful or dependent drinking in Class 2, but not Class 3 or 6. CONCLUSIONS: Across distinct socio-economic groups in a large inner-city sample, we found important differences in harmful and dependent drinking, only some of which were explained by common mental disorder. The increased risk of harmful or dependent drinking across classes which are very distinct from each other suggests differing underlying drivers of drinking across these groups. A nuanced understanding of alcohol use and problems is necessary to understand the inequalities in alcohol harms.


Asunto(s)
Consumo de Bebidas Alcohólicas/epidemiología , Disparidades en el Estado de Salud , Trastornos Mentales/epidemiología , Salud Mental/estadística & datos numéricos , Clase Social , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Consumo de Bebidas Alcohólicas/psicología , Estudios Transversales , Femenino , Humanos , Londres/epidemiología , Masculino , Trastornos Mentales/psicología , Persona de Mediana Edad , Factores de Riesgo , Adulto Joven
4.
Am J Obstet Gynecol ; 222(4): 367.e1-367.e22, 2020 04.
Artículo en Inglés | MEDLINE | ID: mdl-31953115

RESUMEN

BACKGROUND: Early pregnancy losses are common, but their psychologic sequelae are often overlooked. Previous studies have established links between miscarriage and early symptoms of anxiety and depression. However, the incidence of posttraumatic stress symptoms and the psychologic response specifically to ectopic pregnancies have not been investigated. OBJECTIVE: The purpose of this study was to investigate levels of posttraumatic stress, depression, and anxiety in women in the 9 months after early pregnancy loss, with a focus on miscarriage and ectopic pregnancy. Morbidity at 1 month was compared with a control group in healthy pregnancy. STUDY DESIGN: This was a prospective cohort study. Consecutive women were recruited from the early pregnancy and antenatal clinics at 3 London hospitals and received emailed surveys that contained standardized psychologic assessments that included the Hospital Anxiety and Depression Scale and Posttraumatic stress Diagnostic Scale, at 1, 3, and 9 months after loss. Control subjects were assessed after a dating scan. We assessed the proportion of participants who met the screening criteria for posttraumatic stress and moderate/severe anxiety or depression. We used logistic regression to calculate adjusted odds ratios. RESULTS: Seven hundred thirty-seven of 1098 women (67%) with early pregnancy loss (including 537 miscarriages and 116 ectopic pregnancies) and 171 of 187 control subjects (91%) agreed to participate. Four hundred ninety-two of the women with losses (67%) completed the Hospital Anxiety and Depression Scale after 1 month; 426 women (58%) completed it after 3 months, and 338 women (46%) completed it after 9 months. Eighty-seven control subjects (51%) participated. Criteria for posttraumatic stress were met in 29% of women with early pregnancy loss after 1 month and in 18% after 9 months (odds ratio per month, 0.80; 95% confidence interval, 0.72-0.89). Moderate/severe anxiety was reported in 24% after 1 month and in 17% after 9 months (odds ratio per month, 0.69; 95% confidence interval, 0.50-0.94). Moderate/severe depression was reported in 11% of the women after 1 month and 6% of the women after 9 months (odds ratio per month, 0.87; 95% confidence interval, 0.53-1.44). After miscarriage, proportions after 9 months were 16% for posttraumatic stress, 17% for anxiety, and 5% for depression. Corresponding figures after ectopic pregnancy were 21%, 23%, and 11%, respectively. In contrast, among control women with viable pregnancies, 13% reported moderate-to-severe anxiety (odds ratio loss at 1 month vs controls: 2.14; 95% confidence interval, 1.14-4.36), and 2% reported moderate-to-severe depression (odds ratio loss at 1 month vs control subjects: 3.88; 95% confidence interval, 1.27-19.2). CONCLUSION: Women experience high levels of posttraumatic stress, anxiety, and depression after early pregnancy loss. Distress declines over time but remains at clinically important levels at 9 months.


Asunto(s)
Aborto Espontáneo/psicología , Ansiedad/epidemiología , Depresión/epidemiología , Embarazo Ectópico/psicología , Trastornos por Estrés Postraumático/epidemiología , Adulto , Estudios de Casos y Controles , Femenino , Humanos , Incidencia , Londres/epidemiología , Persona de Mediana Edad , Periodo Posparto , Embarazo , Estudios Prospectivos , Escalas de Valoración Psiquiátrica , Factores de Tiempo , Adulto Joven
5.
BJOG ; 127(3): 364-375, 2020 02.
Artículo en Inglés | MEDLINE | ID: mdl-31507061

RESUMEN

OBJECTIVE: Unselected population-based BRCA testing provides the opportunity to apply genomics on a population-scale to maximise primary prevention for breast-and-ovarian cancer. We compare long-term outcomes of population-based and family-history (FH)/clinical-criteria-based BRCA testing on psychological health and quality of life. DESIGN: Randomised controlled trial (RCT) (ISRCTN73338115) GCaPPS, with two-arms: (i) population-screening (PS); (ii) FH/clinical-criteria-based testing. SETTING: North London Ashkenazi-Jewish (AJ) population. POPULATION/SAMPLE: AJ women/men. METHODS: Population-based RCT (1:1). Participants were recruited through self-referral, following pre-test genetic counselling from the North London AJ population. INCLUSION CRITERIA: AJ women/men >18 years old; exclusion-criteria: prior BRCA testing or first-degree relatives of BRCA-carriers. INTERVENTIONS: Genetic testing for three Jewish BRCA founder-mutations: 185delAG (c.68_69delAG), 5382insC (c.5266dupC) and 6174delT (c.5946delT), for (i) all participants in PS arm; (ii) those fulfilling FH/clinical criteria in FH arm. Linear mixed models and appropriate contrast tests were used to analyse the impact of BRCA testing on psychological and quality-of-life outcomes over 3 years. MAIN OUTCOME MEASURES: Validated questionnaires (HADS/MICRA/HAI/SF12) used to analyse psychological wellbeing/quality-of-life outcomes at baseline/1-year/2-year/3-year follow up. RESULTS: In all, 1034 individuals (691 women, 343 men) were randomised to PS (n = 530) or FH (n = 504) arms. There was a statistically significant decrease in anxiety (P = 0.046) and total anxiety-&-depression scores (P = 0.0.012) in the PS arm compared with the FH arm over 3 years. No significant difference was observed between the FH and PS arms for depression, health-anxiety, distress, uncertainty, quality-of-life or experience scores associated with BRCA testing. Contrast tests showed a decrease in anxiety (P = 0.018), health-anxiety (P < 0.0005) and quality-of-life (P = 0.004) scores in both PS and FH groups over time. Eighteen of 30 (60%) BRCA carriers identified did not fulfil clinical criteria for BRCA testing. Total BRCA prevalence was 2.9% (95% CI 1.97-4.12%), BRCA1 prevalence was 1.55% (95% CI 0.89-2.5%) and BRCA2 prevalence was 1.35% (95% CI 0.74-2.26%). CONCLUSION: Population-based AJ BRCA testing does not adversely affect long-term psychological wellbeing or quality-of-life, decreases anxiety and could identify up to 150% additional BRCA carriers. TWEETABLE ABSTRACT: Population BRCA testing in Ashkenazi Jews reduces anxiety and does not adversely affect psychological health or quality of life.


Asunto(s)
Ansiedad , Detección Precoz del Cáncer , Genes BRCA1 , Genes BRCA2 , Síndrome de Cáncer de Mama y Ovario Hereditario , Calidad de Vida , Adulto , Ansiedad/fisiopatología , Ansiedad/prevención & control , Detección Precoz del Cáncer/métodos , Detección Precoz del Cáncer/psicología , Femenino , Predisposición Genética a la Enfermedad/psicología , Pruebas Genéticas/métodos , Pruebas Genéticas/estadística & datos numéricos , Síndrome de Cáncer de Mama y Ovario Hereditario/diagnóstico , Síndrome de Cáncer de Mama y Ovario Hereditario/etnología , Síndrome de Cáncer de Mama y Ovario Hereditario/genética , Síndrome de Cáncer de Mama y Ovario Hereditario/psicología , Humanos , Judíos/genética , Judíos/estadística & datos numéricos , Londres/epidemiología , Masculino , Anamnesis/estadística & datos numéricos , Incertidumbre
6.
PLoS Comput Biol ; 15(9): e1007305, 2019 09.
Artículo en Inglés | MEDLINE | ID: mdl-31513578

RESUMEN

A key question in ecology is the relative impact of internal nonlinear dynamics and external perturbations on the long-term trajectories of natural systems. Measles has been analyzed extensively as a paradigm for consumer-resource dynamics due to the oscillatory nature of the host-pathogen life cycle, the abundance of rich data to test theory, and public health relevance. The dynamics of measles in London, in particular, has acted as a prototypical test bed for such analysis using incidence data from the pre-vaccination era (1944-1967). However, during this timeframe there were few external large-scale perturbations, limiting an assessment of the relative impact of internal and extra demographic perturbations to the host population. Here, we extended the previous London analyses to include nearly a century of data that also contains four major demographic changes: the First and Second World Wars, the 1918 influenza pandemic, and the start of a measles mass vaccination program. By combining mortality and incidence data using particle filtering methods, we show that a simple stochastic epidemic model, with minimal historical specifications, can capture the nearly 100 years of dynamics including changes caused by each of the major perturbations. We show that the majority of dynamic changes are explainable by the internal nonlinear dynamics of the system, tuned by demographic changes. In addition, the 1918 influenza pandemic and World War II acted as extra perturbations to this basic epidemic oscillator. Our analysis underlines that long-term ecological and epidemiological dynamics can follow very simple rules, even in a non-stationary population subject to significant perturbations and major secular changes.


Asunto(s)
Sarampión , Pandemias/estadística & datos numéricos , Vacunación/estadística & datos numéricos , Biología Computacional , Historia del Siglo XX , Humanos , Incidencia , Gripe Humana/epidemiología , Gripe Humana/historia , Londres/epidemiología , Sarampión/epidemiología , Sarampión/historia , Sarampión/prevención & control , Sarampión/transmisión , Pandemias/historia , Vacunación/historia , Primera Guerra Mundial , Segunda Guerra Mundial
7.
Traffic Inj Prev ; 20(sup1): S71-S77, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31381440

RESUMEN

Objective: Although bus travel is one of the safest modes of transport, a substantial number of bus passengers in London are still injured in collision and harsh maneuver incidents, in particular emergency braking. It is not well understood how these passengers are injured. The objective was to better understand the injury mechanisms and develop countermeasures with a test and assessment procedure to prevent or mitigate these injuries. Methods: The UK national STATS19 data were used to determine the size of the problem. Data, including CCTV footage, in combination with inspection of current buses, were used to determine injury mechanisms and identify features and areas in buses associated with more injuries. An assessment system based on visual inspection was developed to encourage a reduction in the number of features associated with injury. Results: The STATS19 analysis showed that three quarters of all injured casualties occurred in incidents where there was no impact, with this proportion rising for seriously injured casualties. Overrepresentation of older females was also seen. The CCTV analysis and bus examinations highlighted issues with poorly positioned handrails, lack of compartmentalization (restraint), and objects with sharp edges and corners. It also showed that a much higher proportion of passengers seated in the area close to the middle doors and wheelchair area were injured compared to other areas of the bus. Factors contributing to this result were that this area contained more features associated with injury and that persons with reduced mobility have greater exposure in this area; that is, more vulnerable passengers currently sit in the less safe areas of the bus. Conclusions: A novel analysis of CCTV footage has enabled a better understanding of injury mechanisms for bus passengers to be developed. In combination with inspection of current buses, this has been used to develop an assessment system to improve the safety of buses in London.


Asunto(s)
Traumatismos Craneocerebrales/epidemiología , Traumatismos Craneocerebrales/prevención & control , Vehículos a Motor , Accidentes de Tránsito/prevención & control , Accidentes de Tránsito/estadística & datos numéricos , Anciano , Femenino , Humanos , Londres/epidemiología
8.
Environ Pollut ; 253: 1030-1037, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31434180

RESUMEN

OBJECTIVES: Evaluate the relationship between arthritis diagnosis in those over 50 and exposure to extreme air pollution in utero or infancy (<1 year of age). METHODS: Compare rates of arthritis diagnosis between groups that experienced differential air pollution exposure in early-life due to quasi-random variation in birth location and date relative to the 1952 Great Smog in London. We use regression-estimated difference-in-differences analyses based on English Longitudinal Study of Aging (ELSA) data. RESULTS: In the 2816 respondent sample, aged 51-62, the arthritis diagnosis rate is 22.8%, with 16.4% reporting osteoarthritis and 4.6% reporting rheumatoid arthritis. We estimate that exposure to the Great Smog in infancy increases the arthritis diagnosis rate by 23.4 percentage points (95% CI: 1.97 to 44.8). Decomposing these results by type of arthritis reveals that the rheumatoid arthritis diagnosis rate increases due to infant exposure are larger and more significant than those for osteoarthritis: 14.9 percentage points (95% CI: 0.495 to 29.4) versus 9.5 percentage points (95% CI: -11.9 to 30.8). In utero exposure is not associated with significant increases in arthritis diagnosis rates. CONCLUSIONS: Our results are the first to link early-life air pollution exposure to later-life arthritis diagnoses, and suggest a particularly strong link for RA. These findings are consistent with those of shorter-term, correlational studies, and indicate that health effects of air pollution exposure can span decades and extend beyond cardiopulmonary systems.


Asunto(s)
Contaminación del Aire/estadística & datos numéricos , Artritis/epidemiología , Exposición a Riesgos Ambientales/estadística & datos numéricos , Contaminantes Atmosféricos/análisis , Contaminación del Aire/análisis , Femenino , Humanos , Lactante , Londres/epidemiología , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Material Particulado/análisis , Análisis de Regresión , Esmog/análisis
9.
BMC Infect Dis ; 19(1): 490, 2019 Jun 03.
Artículo en Inglés | MEDLINE | ID: mdl-31159769

RESUMEN

BACKGROUND: We describe the clinical features of a cohort of patients with liver abscesses and investigate relationships between clinical, radiological and microbiological findings and mortality. METHODS: Retrospective review of pyogenic (PLA) or amoebic liver abscesses (ALA) diagnosed and treated at a major infectious diseases department in London over 9 years. RESULTS: One hundred forty-one patient records were identified; 132 (93.6%) had PLA and 9 (6.4%) ALA. No organism was identified in 38.6% (51/132); a single bacterial species was isolated in 47.0% (62/132) of PLA, ≥ 2 in 14.4% (19/132). There was weak evidence of variation in abscess size by type of microorganism, with streptococcal PLA typically larger (p = 0.03 for Streptococcus milleri group, p = 0.05 for non-milleri streptococci). Patients with ALA were younger (median 41, IQR 37-51 years) than those with PLA (median 68, IQR 50.5-78 years) (p = 0.003) and all were male (9/9, 100%, (p = 0.03)), with a history of recent travel in the majority (6/9, 66.7% (p = 0.003)). C-reactive protein was higher in ALA than in PLA (p = 0.06). In the entire cohort, loculation (HR = 2.51 (95% CI 1.00-6.32), p = 0.04) and baseline ALP (HR = 4.78 (95% CI 1.19-19.2) per log10 increase, p = 0.03) were associated with mortality. 16S ribosomal RNA (rRNA) analysis was used in a subset of culture-negative cases and increased the diagnostic yield by 13%. CONCLUSIONS: Clinical or radiological features cannot be used to distinguish between PLA and ALA, or help identify the bacterial cause of PLA. However, ALA is more common in young, male patients with a history of travel. 16S rRNA analysis of abscess fluid has a role in improving microbiological diagnosis in culture-negative cases.


Asunto(s)
Absceso Hepático Amebiano/epidemiología , Absceso Hepático Amebiano/microbiología , Absceso Hepático Amebiano/terapia , Absceso Piógeno Hepático/epidemiología , Absceso Piógeno Hepático/microbiología , Absceso Piógeno Hepático/terapia , Adulto , Anciano , Técnicas de Tipificación Bacteriana , Estudios de Cohortes , Femenino , Humanos , Absceso Hepático Amebiano/diagnóstico , Absceso Piógeno Hepático/diagnóstico , Londres/epidemiología , Masculino , Persona de Mediana Edad , ARN Ribosómico 16S/análisis , ARN Ribosómico 16S/genética , Estudios Retrospectivos , Streptococcus/clasificación , Streptococcus/genética , Streptococcus milleri (Grupo)/genética , Resultado del Tratamiento
10.
Diabetes Res Clin Pract ; 152: 166-170, 2019 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-31150726

RESUMEN

OBJECTIVES: Fasting in summer months for Muslim people with diabetes during Ramadan is challenging, particularly in temperate climates, where duration of fasting is prolonged. Risk of fasting may be greater in people with diabetes and chronic kidney disease (CKD). We aimed to prospectively monitor the outcomes of patients with diabetes and CKD stage 3 during Ramadan 2018 in East London. METHODS: Patients with type 2 diabetes (T2D) and CKD stage 3 attending community diabetes clinics were approached prior to Ramadan 2018 to discuss fasting. Patients were risk categorised according to Diabetes and Ramadan Alliance guidelines. If they chose to fast, Ramadan education was given, and biomedical assessments were undertaken within one week prior to and one week after fasting. Outcomes between patients fasting and non-fasting groups were compared. RESULTS: Fasting (n = 68) and non-fasting groups (n = 71) were similar apart from slightly higher insulin use in the non-fasting group. Median days fasted was 21 (range 12-29). There were no significant changes in weight, blood pressure, creatinine, glycated haemoglobin, cholesterol and urinary PCR pre- and post-Ramadan, and no significant differences between the fasting and non-fasting groups. There was no difference in adverse events (acute kidney injury, hypoglycaemia or cardiovascular events) between the fasting and non-fasting groups. CONCLUSIONS: No significant differences were seen in clinical or biochemical parameters, or adverse events between fasting and non-fasting patients. Patients with T2D and stable CKD stage 3 may be able to fast safely during Ramadan.


Asunto(s)
Diabetes Mellitus Tipo 2/diagnóstico , Nefropatías Diabéticas/diagnóstico , Ayuno/fisiología , Islamismo , Insuficiencia Renal Crónica/diagnóstico , Adulto , Anciano , Anciano de 80 o más Años , Peso Corporal/fisiología , Estudios de Casos y Controles , Diabetes Mellitus Tipo 2/sangre , Diabetes Mellitus Tipo 2/complicaciones , Diabetes Mellitus Tipo 2/epidemiología , Nefropatías Diabéticas/sangre , Nefropatías Diabéticas/epidemiología , Ayuno/sangre , Femenino , Hemoglobina A Glucada/análisis , Hemoglobina A Glucada/metabolismo , Humanos , Hipoglucemia/sangre , Hipoglucemia/epidemiología , Hipoglucemia/etiología , Londres/epidemiología , Masculino , Persona de Mediana Edad , Pronóstico , Insuficiencia Renal Crónica/sangre , Insuficiencia Renal Crónica/complicaciones , Insuficiencia Renal Crónica/epidemiología , Estudios Retrospectivos , Encuestas y Cuestionarios
11.
J Hosp Infect ; 103(2): 142-146, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31047935

RESUMEN

BACKGROUND: Over the last decade there has been a rapid, worldwide increase in carbapenem resistance, which is of growing concern. The main protagonists, the carbapenemases Klebsiella pneumoniae carbapenemase (KPC), oxacillinase ß-lactamase 48 (OXA-48), imipenemase metallo-ß-lactamase (IMP), Verona integron-borne metallo-ß-lactamase (VIM), and New Delhi metallo-ß-lactamase (NDM) have also been reported across the UK. However, these reports are derived from a combination of reactive screening, outbreak control, inpatient surveillance, and diagnostic samples. Therefore, the true community prevalence is unknown. AIM: To determine the community prevalence of carbapenemase-producing organisms (CPOs) in the area served by Barts Health NHS Trust. METHODS: Active screening of 200 non-duplicate community stool samples was performed. Patient demographics and foreign travel history were extracted from the laboratory information management system to identify potential risk factors for carriage of CPOs. FINDINGS: Patients in this study were aged from one to 93 years and were evenly distributed between male and female. Foreign travel in the last year was listed for 46 out of 200 (23%) patients, with the most commonly visited countries including Bangladesh (4%), India (2.5%), Morocco (2%), and Turkey (1.5%). However, only one patient tested positive for a CPO, an NDM-producing Pseudomonas aeruginosa, and this patient had travelled to the Caribbean. CONCLUSION: To date, there have been no studies investigating the prevalence of CPOs in the UK community. Given the high-risk patient population served by Barts Health NHS Trust, it is reassuring that the prevalence observed here was low. However, it should be highlighted that travel to countries not previously categorized as high risk may also pose a threat.


Asunto(s)
Proteínas Bacterianas/metabolismo , Infecciones Comunitarias Adquiridas/epidemiología , Bacterias Gramnegativas/enzimología , Infecciones por Bacterias Gramnegativas/epidemiología , beta-Lactamasas/metabolismo , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Infecciones Comunitarias Adquiridas/microbiología , Heces/microbiología , Femenino , Bacterias Gramnegativas/aislamiento & purificación , Infecciones por Bacterias Gramnegativas/microbiología , Humanos , Lactante , Londres/epidemiología , Masculino , Tamizaje Masivo/métodos , Persona de Mediana Edad , Prevalencia , Factores de Riesgo , Adulto Joven
12.
Cardiovasc Diabetol ; 18(1): 51, 2019 04 23.
Artículo en Inglés | MEDLINE | ID: mdl-31014330

RESUMEN

BACKGROUND: Evidence from imaging studies suggests a high prevalence of coronary artery disease (CAD) in patients with type 2 diabetes mellitus (T2DM). However, there are no criteria for initiating screening for CAD in this population. The current study investigated whether clinical and demographic characteristics can be used to predict significant CAD in patients with T2DM. METHODS: Computed tomography coronary angiography (CTCA) and laboratory assessments were performed in 259 patients diagnosed with T2DM attending clinics in Northwest London, UK. Coronary artery calcium (CAC) was calculated during CTCA. Significant plaque was defined as one causing more than 50% luminal stenosis. Associations between groups and variables were evaluated using Student's t test, Chi-square tests and univariate and multivariate regression analysis. P < 0.05 was considered statistically significant. RESULTS: Among patients with a median duration of T2DM of 13 years and a mean age of 62.0 years, median CAC score was 105.91 Agatston Units. In a multivariate analyses, duration of diabetes, CAC score and the presence and number of coronary artery plaques and presence of significant plaque were significant predictors of cardiovascular adverse events. Systolic blood pressure (SBP) had borderline significance as a predictor of cardiovascular events (p = 0.05). In a receiver operating characteristic curve (ROC) analysis, duration of diabetes of > 10.5 years predicted significant CAD (sensitivity, 75.3%; specificity 48.2%). Area under the ROC curve was 0.67 when combining duration of T2DM > 10.5 years and SBP of > 139 mm Hg. Adverse cardiovascular events after a median follow-up of 22.8 months were also significantly higher in those with duration of T2DM > 10.5 years and SBP > 140 mm Hg (log rank p = 0.02 and 0.009, respectively). CONCLUSIONS: Routine screening for CAD using CTCA should be considered for patients with a diagnosis of T2DM for > 10.5 years and SBP > 140 mm Hg. Trial registration Clinicaltrials.gov identifier: NCT02109835, 10 April 2014 (retrospectively registered).


Asunto(s)
Presión Sanguínea , Angiografía por Tomografía Computarizada , Angiografía Coronaria/métodos , Estenosis Coronaria/diagnóstico por imagen , Diabetes Mellitus Tipo 2/epidemiología , Tamizaje Masivo/métodos , Calcificación Vascular/diagnóstico por imagen , Adulto , Anciano , Enfermedades Asintomáticas , Biomarcadores/sangre , Glucemia/metabolismo , Estenosis Coronaria/epidemiología , Diabetes Mellitus Tipo 2/sangre , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/fisiopatología , Femenino , Humanos , Londres/epidemiología , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Prevalencia , Pronóstico , Medición de Riesgo , Factores de Riesgo , Índice de Severidad de la Enfermedad , Factores de Tiempo , Calcificación Vascular/epidemiología
13.
Br J Surg ; 106(7): 872-878, 2019 06.
Artículo en Inglés | MEDLINE | ID: mdl-30938840

RESUMEN

BACKGROUND: Carotid stenosis is a common cause of ischaemic stroke and transient ischaemic attack (TIA). Despite rising recognition and centralization of stroke services there has been a decline in interventions for carotid stenosis in recent years. The aim of this study was to determine the current prevalence and management of carotid stenosis in the UK. METHODS: This was a 1-year prospective observational study of consecutive patients presenting with ischaemic stroke, TIA or ischaemic retinal artery occlusion to a central London hyperacute stroke unit. Patients with significant carotid stenosis, defined as atherosclerotic narrowing of 50 per cent or greater, underwent multidisciplinary team (MDT) discussion to determine the cause of stroke/TIA and classify carotid stenosis as symptomatic or incidental. RESULTS: In total, 2707 patients were seen; half had an ischaemic event and the majority had carotid imaging (1252 of 1444). Carotid stenosis of at least 50 per cent was seen in 238 (prevalence 19·0 (95 per cent c.i. 16·6 to 21·4) per cent). Patients with significant carotid stenosis were more likely to have hypertension, hypercholesterolaemia, diabetes and ischaemic heart disease. Carotid stenosis was deemed symptomatic in 99 patients (7·9 (6·3 to 9·5) per cent); of these, 17 had carotid occlusion, 17 were unfit for surgery and 58 patients were referred for carotid intervention. Among 139 patients with asymptomatic stenosis, 75 had carotid stenosis ipsilateral to the stroke but, after MDT discussion, the cause was deemed to be atrial fibrillation (32), small-vessel disease (15), another determined cause (5), or not determined owing to atypical imaging or clinical presentation. CONCLUSION: Carotid stenosis is common, affecting one in five patients presenting with stroke or TIA. Careful MDT discussion may avoid unnecessary intervention and should be the standard of care.


Asunto(s)
Estenosis Carotídea/epidemiología , Accidente Cerebrovascular/etiología , Enfermedad Aguda , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Estenosis Carotídea/complicaciones , Estenosis Carotídea/diagnóstico , Estenosis Carotídea/terapia , Femenino , Estudios de Seguimiento , Humanos , Londres/epidemiología , Masculino , Persona de Mediana Edad , Prevalencia , Estudios Prospectivos , Factores de Riesgo , Accidente Cerebrovascular/epidemiología , Accidente Cerebrovascular/terapia , Resultado del Tratamiento , Adulto Joven
14.
J Stroke Cerebrovasc Dis ; 28(6): 1495-1499, 2019 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-30935808

RESUMEN

INTRODUCTION: Atrial fibrillation (AF) is a major cause of ischemic stroke and Transient Ischemic Attack (TIA) and investigation for paroxysmal AF is recommended following an embolic brain event. In contrast, retinal ischemic monocular blindness is traditionally considered most linked to carotid artery disease (CAS) and investigating for AF is less vigilant. We aimed to determine the prevalence of AF in patients with ischemic monocular blindness. METHODS: Consecutive records of all patients presenting to a daily TIA clinic with transient or permanent ischemic monocular blindness were reviewed, January 2014-October 2016. RESULTS: Of 400 patients, 224 (56.0%) were male, mean age 64.5 years (SD 15.1). A total of 263 (66%) presented with transient and 137 (34%) with permanent ischemic monocular blindness. ECG was performed in 364 patients (91%) but only 211 (52%) had further cardiac monitoring. The vast majority (97.3%) had carotid imaging. Thirty-six patients (9%) were found to have AF while 53 (14%) had ipsilateral CAS. Median ABCD2 score was 1 in AF and non-AF groups. Only 55% of known AF patients were anticoagulated at presentation, despite all having CHADVASC2 score greater than or equal to 1. Patients with AF had more hypertension (P = .004), previous TIA (P = .002), previous stroke (P = .044) and ischemic heart disease (P = .022) with no difference in age (P = .791), diabetes (P = .563), smoking (P = .460) nor hypercholesterolaemia (P = .083). CONCLUSIONS: A total of 9% of patients with ischemic monocular blindness had AF. This is an underestimate, as only 53% of patients had prolonged cardiac monitoring. Known AF was suboptimally managed with only 55% receiving anticoagulation despite being eligible.


Asunto(s)
Fibrilación Atrial/epidemiología , Ceguera/epidemiología , Isquemia Encefálica/epidemiología , Ataque Isquémico Transitorio/epidemiología , Oclusión de la Arteria Retiniana/epidemiología , Accidente Cerebrovascular/epidemiología , Visión Monocular , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Amaurosis Fugax/epidemiología , Amaurosis Fugax/fisiopatología , Fibrilación Atrial/diagnóstico , Fibrilación Atrial/fisiopatología , Ceguera/diagnóstico , Ceguera/fisiopatología , Isquemia Encefálica/diagnóstico , Isquemia Encefálica/fisiopatología , Ecocardiografía , Electrocardiografía , Femenino , Humanos , Ataque Isquémico Transitorio/diagnóstico , Ataque Isquémico Transitorio/fisiopatología , Londres/epidemiología , Masculino , Persona de Mediana Edad , Prevalencia , Pronóstico , Recurrencia , Oclusión de la Arteria Retiniana/diagnóstico , Oclusión de la Arteria Retiniana/fisiopatología , Estudios Retrospectivos , Factores de Riesgo , Accidente Cerebrovascular/diagnóstico , Accidente Cerebrovascular/fisiopatología , Factores de Tiempo , Adulto Joven
15.
JAMA Netw Open ; 2(4): e191868, 2019 04 05.
Artículo en Inglés | MEDLINE | ID: mdl-30951164

RESUMEN

Importance: What is inherited or acquired in neurodevelopmental conditions such as autism spectrum disorder (ASD) is not a fixed outcome, but instead is a vulnerability to a spectrum of traits, especially social difficulties. Identifying the biological mechanisms associated with vulnerability requires looking as early in life as possible, before the brain is shaped by postnatal mechanisms and/or the experiences of living with these traits. Animal studies suggest that susceptibility to neurodevelopmental disorders arises when genetic and/or environmental risks for these conditions alter patterns of synchronous brain activity in the perinatal period, but this has never been examined in human neonates. Objective: To assess whether alternation of functional maturation of social brain circuits is associated with a family history of ASD in newborns. Design, Setting, and Participants: In this cohort study of 36 neonates with and without a family history of ASD, neonates underwent magnetic resonance imaging at St Thomas Hospital in London, England, using a dedicated neonatal brain imaging system between June 23, 2015, and August 1, 2018. Neonates with a first-degree relative with ASD (R+) and therefore vulnerable to autistic traits and neonates without a family history (R-) were recruited for the study. Synchronous neural activity in brain regions linked to social function was compared. Main Outcomes and Measures: Regions responsible for social function were selected with reference to a published meta-analysis and the level of synchronous activity within each region was used as a measure of local functional connectivity in a regional homogeneity analysis. Group differences, controlling for sex, age at birth, age at scan, and group × age interactions, were examined. Results: The final data set consisted of 18 R+ infants (13 male; median [range] postmenstrual age at scan, 42.93 [40.00-44.86] weeks) and 18 R- infants (13 male; median [range] postmenstrual age at scan, 42.50 [39.29-44.58] weeks). Neonates who were R+ had significantly higher levels of synchronous activity in the right posterior fusiform (t = 2.48; P = .04) and left parietal cortices (t = 3.96; P = .04). In addition, there was a significant group × age interaction within the anterior segment of the left insula (t = 3.03; P = .04) and cingulate cortices (right anterior: t = 3.00; P = .03; left anterior: t = 2.81; P = .03; right posterior: t = 2.77; P = .03; left posterior: t = 2.55; P = .03). In R+ infants, levels of synchronous activity decreased over 39 to 45 weeks' postmenstrual age, whereas synchronous activity levels increased in R- infants over the same period. Conclusions and Relevance: Synchronous activity is required during maturation of functionally connected networks. This study found that in newborn humans, having a first-degree relative with ASD was associated with higher levels of local functional connectivity and dysmaturation of interconnected regions responsible for processing higher-order social information.


Asunto(s)
Trastorno del Espectro Autista/genética , Encéfalo/fisiopatología , Vías Nerviosas/fisiopatología , Trastornos del Neurodesarrollo/genética , Trastorno por Déficit de Atención con Hiperactividad/genética , Encéfalo/anatomía & histología , Encéfalo/diagnóstico por imagen , Estudios de Cohortes , Ambiente , Femenino , Neuroimagen Funcional , Humanos , Lactante , Recién Nacido , Londres/epidemiología , Imagen por Resonancia Magnética/métodos , Masculino , Metaanálisis como Asunto , Trastornos del Neurodesarrollo/epidemiología
17.
PLoS One ; 14(4): e0214501, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-30939148

RESUMEN

African migrants in Europe and continental Africans are disproportionately affected by type 2 diabetes (T2D). Both groups develop T2D at a younger age, and have higher morbidity and mortality from T2D and complications, compared to European populations. To reduce risk, and avoidable disability and premature deaths, culturally congruent and context specific interventions are required. This study aimed to: (a) assess perceptions and knowledge of T2D among Ghanaian migrants in Europe and their compatriots in Ghana and (b) identify specific perceptions and knowledge gaps that might predispose migrants to higher risk of diabetes. Data was gathered through 26 focus groups with 180 individuals, aged 21 to 70, from Amsterdam, Berlin and London and rural and urban Ashanti Region, Ghana. Thematic analysis of the data was informed by Social Representations Theory, which focuses on the sources, content and functions of social knowledge. Three key insights emerged from analysis. First, there was general awareness, across migrant and non-migrant groups, of T2D as a serious chronic condition with life threatening complications, and some knowledge of biomedical strategies to prevent diabetes (e.g healthy eating) and diabetes complications (e.g medication adherence). However, knowledge of T2D prevention and reduction of diabetes complications was not comprehensive. Secondly, knowledge of biomedical diabetes theories and interventions co-existed with theories about psychosocial and supernatural causes of diabetes and the efficacy of herbal and faith-based treatment of diabetes. Finally, migrants' knowledge was informed by both Ghanaian and European systems of T2D knowledge suggesting enculturation dynamics. We discuss the development of culturally congruent and context-specific T2D interventions for the research communities.


Asunto(s)
Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/etnología , Conocimientos, Actitudes y Práctica en Salud , Migrantes , Adulto , Anciano , Berlin/epidemiología , Características Culturales , Diabetes Mellitus Tipo 2/terapia , Femenino , Grupos Focales , Ghana/epidemiología , Ghana/etnología , Humanos , Londres/epidemiología , Masculino , Persona de Mediana Edad , Países Bajos/epidemiología , Investigación Cualitativa , Factores de Riesgo , Población Rural , Población Urbana , Adulto Joven
18.
BMC Med ; 17(1): 71, 2019 04 01.
Artículo en Inglés | MEDLINE | ID: mdl-30929642

RESUMEN

BACKGROUND: Peer support can enable patient engagement with healthcare services, particularly for marginalised populations. In this randomised controlled trial, the efficacy of a peer support intervention at promoting successful engagement with clinical services for chronic hepatitis C was assessed. METHODS: In London, UK, potential participants were approached through outreach services for problematic drug use and homelessness. Individuals positive for hepatitis C virus (HCV) after confirmatory testing were randomised using an online service to the intervention (peer support) or standard of care. The primary outcome of interest was successful engagement with clinical hepatitis services. The study was non-blinded. Absolute differences were calculated using a generalised linear model and the results compared to logistic regression. RESULTS: Three hundred sixty-four individuals consented to participate. One hundred one had chronic hepatitis C and were randomised, 63 to receive the intervention (peer support). A successful outcome was achieved by 23 individuals in this arm (36.5%) and seven (18.4%) receiving the standard of care, giving an absolute increase of 18.1% (95% confidence interval 1.0-35.2%, p value = 0.04). This was mirrored in the logistic regression (odds ratio 2.55 (0.97-6.70), p = 0.06). No serious adverse events were reported. CONCLUSIONS: Peer support can improve the engagement of patients with chronic HCV with healthcare services. TRIAL REGISTRATION: ISRCTN24707359 . Registered 19th October 2012.


Asunto(s)
Hepatitis C/terapia , Aceptación de la Atención de Salud , Defensa del Paciente , Participación del Paciente/métodos , Grupo Paritario , Sistemas de Apoyo Psicosocial , Adulto , Consejo , Femenino , Hepatitis C/epidemiología , Hepatitis C/psicología , Personas sin Hogar/psicología , Personas sin Hogar/estadística & datos numéricos , Humanos , Londres/epidemiología , Masculino , Persona de Mediana Edad , Aceptación de la Atención de Salud/estadística & datos numéricos , Defensa del Paciente/psicología , Defensa del Paciente/normas , Participación del Paciente/estadística & datos numéricos , Grupos de Autoayuda/organización & administración , Grupos de Autoayuda/normas , Nivel de Atención/estadística & datos numéricos , Trastornos Relacionados con Sustancias/epidemiología , Trastornos Relacionados con Sustancias/terapia
19.
J Acquir Immune Defic Syndr ; 81(4): e99-e103, 2019 08 01.
Artículo en Inglés | MEDLINE | ID: mdl-31021986

RESUMEN

BACKGROUND: Sharing needles/syringes and sexual transmission are widely appreciated as means of HIV transmission among persons who inject drugs (PWIDs). London, Canada, is experiencing an outbreak of HIV among PWIDs, despite a large needle/syringe distribution program and low rates of needle/syringe sharing. OBJECTIVE: To determine whether sharing of injection drug preparation equipment (IDPE) is associated with HIV infection. METHODS: Between August 2016 and June 2017, individuals with a history of injection drug use and residence in London were recruited to complete a comprehensive questionnaire and HIV testing. RESULTS: A total of 127 participants were recruited; 8 were excluded because of failure to complete HIV testing. The remaining 35 HIV-infected (cases) and 84 HIV-uninfected (controls) participants were assessed. Regression analysis found that sharing IDPE, without sharing needles/syringes, was strongly associated with HIV infection (adjusted odds ratio: 22.1, 95% confidence interval: 4.51 to 108.6, P < 0.001). CONCLUSIONS: Sharing of IDPE is a risk factor for HIV infection among PWIDs, even in the absence of needle/syringe sharing. Harm reduction interventions to reduce HIV transmission associated with this practice are urgently needed.


Asunto(s)
Composición de Medicamentos , Infecciones por VIH/epidemiología , Infecciones por VIH/transmisión , Inyecciones , Compartición de Agujas/estadística & datos numéricos , Adulto , Canadá/epidemiología , Estudios Transversales , Brotes de Enfermedades , Femenino , Humanos , Londres/epidemiología , Masculino , Persona de Mediana Edad , Compartición de Agujas/efectos adversos , Salud Pública , Factores de Riesgo , Asunción de Riesgos , Abuso de Sustancias por Vía Intravenosa/epidemiología , Jeringas
20.
JAMA Netw Open ; 2(3): e190864, 2019 03 01.
Artículo en Inglés | MEDLINE | ID: mdl-30901043

RESUMEN

Importance: Black African adults are disproportionately affected by HIV in the United Kingdom. Many within this population acquire HIV after migration or are diagnosed late. Data are needed to inform targeted interventions to increase HIV testing and prevention in this population. Objective: To inform future HIV prevention strategies by estimating diagnosed and undiagnosed HIV infection and measuring changes in HIV testing rates in black African adults in London, United Kingdom. Design, Setting, and Participants: This cross-sectional study used a self-completed survey conducted from September 20 to December 3, 2016. Questionnaires were linked to an optional, anonymous oral fluid HIV test and compared with data from a previous survey (2004). Respondents were recruited from social and commercial venues frequented by black African adults in London. Of 2531 individuals approached in 63 venues, 752 agreed to participate. Data were analyzed initially in March 2017 (as part of internal reporting) and again in August 2018. Main Outcomes and Measures: Self-reported HIV testing within the past 5 years; diagnosed and undiagnosed HIV prevalence. Logistic regression examined factors associated with HIV testing by sex. Results: In total, 292 women (median [interquartile range] age, 31 [25.0-41.5] years) and 312 men (median [interquartile range] age, 35 [25.0-41.5] years) were included in the analysis. More than half of men (159 [51.0%]) and women (154 [52.7%]) had been tested for HIV in the past 5 years. In multivariable analysis, HIV testing was associated with a range of factors in both sexes, including health service attendance, time in the United Kingdom, and sexually transmitted infection diagnosis. Increases in HIV testing in the past 5 years were observed between 2004 and 2016 for both sexes. In the 2016 sample, 219 of 235 women (93.2%) and 206 of 228 men (90.4%) tested HIV negative. Among those testing positive, 56.3% of women (9 of 16) and 40.9% of men (9 of 22) self-reported as HIV negative or untested, indicating they were living with undiagnosed HIV. A fifth of women (20.7%) and 25.0% of men reported condomless last sex with a partner of different or unknown HIV status in the past year. Conclusions and Relevance: Despite efforts to increase HIV testing, uptake in black African communities in London remains modest. This study identified a large fraction of undiagnosed infection-greater than other at-risk populations-suggesting that the prevention and care needs of this group are not adequately met.


Asunto(s)
Grupo de Ascendencia Continental Africana/estadística & datos numéricos , Infecciones por VIH/epidemiología , Salud Sexual/estadística & datos numéricos , Adulto , Estudios Transversales , Femenino , Infecciones por VIH/diagnóstico , Humanos , Londres/epidemiología , Masculino , Conducta Sexual/estadística & datos numéricos
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