Hyperglycaemic Environment: Contribution to the Anaemia Associated with Diabetes Mellitus in Rats Experimentally Induced with Alloxan.

UNLABELLED: Background. Diabetes mellitus characterized by hyperglycaemia presents with various complications amongst which anaemia is common particularly in those with overt nephropathy or renal impairment. The present study has examined the contribution of the hyperglycaemic environment in diabetic rats to the anaemia associated with diabetes mellitus. METHOD: Sixty male albino rats weighing 175-250 g were selected for this study and divided equally into control and test groups. Hyperglycaemia was induced with 170 kgbwt(-1) alloxan intraperitoneally in the test group while control group received sterile normal saline. Blood samples obtained from the control and test rats were assayed for packed cell volume (PCV), haemoglobin (Hb), red blood cell count (RBC), reticulocyte count, glucose, plasma haemoglobin, potassium, and bilirubin. Result. Significant reduction (P < 0.01) in PCV (24.40 ± 3.87 versus 40.45 ± 3.93) and haemoglobin (7.81 ± 1.45 versus 13.39 ± 0.40) with significant increase (P < 0.01) in reticulocyte count (12.4 ± 1.87 versus 3.69 ± 0.47), plasma haemoglobin (67.50 ± 10.85 versus 34.20 ± 3.83), and potassium (7.04 ± 0.75 versus 4.52 ± 0.63) was obtained in the test while plasma bilirubin showed nonsignificant increase (0.41 ± 0.04 versus 0.24 ± 0.06). Conclusion. The increased plasma haemoglobin and potassium levels indicate an intravascular haemolytic event while the nonsignificant increased bilirubin showed extravascular haemolysis. These play contributory roles in the anaemia associated with diabetes mellitus.

Herpes zoster-associated mortality in Europe: a systematic review.

BACKGROUND: Reactivation of latent varicella zoster virus, partly due to age-related immunosenescence and immunosuppressive conditions, results in herpes zoster (HZ) and its associated complications. The management of the most important complication, post-herpetic neuralgia (PHN), is challenging, particularly in the elderly, and is generally unsatisfactory. No previous reviews have reported the incidence of HZ-associated mortality. METHODS: We carried out a systematic literature review to identify studies and databases providing data for HZ-associated mortality in adults aged ≥ 50 years in Europe. RESULTS: We identified 12 studies: Belgium (1); France (1); Germany (1); the Netherlands (2); Portugal (1); Spain (4) and England/Wales (2) and 4 databases from Europe: France; Germany and England/Wales. The incidence was available from eight studies; it was highest in those aged ≥ 95 in France (19.48/100,000). In the European (WHO) database, the overall mortality ranged from 0 to > 0.07/100,000. The age- and gender-specific HZ mortality rates from the other databases showed that while in younger age groups the HZ mortality rate was higher in males, in older patients the rate was much higher in women. The case fatality rate was 2 and 61/100,000 in those 45-65 and ≥ 65 years, respectively. A similar increase with age was seen for the hospital fatality rate; 0.6% in those 45-65 years in the UK and 7.1% in those ≥ 80 in Spain. CONCLUSIONS: Although the data were sparse and heterogeneous, HZ-associated mortality clearly increases with age. In addition, the elderly who develop HZ often have underlying diseases and are at increased risk of functional decline and loss of independence. Mortality should be taken into account in health-economics models.

Disability-free life expectancy: comparison of sources and small area estimates in England, 2006-08.

BACKGROUND: Health expectancies (HEs) at sub-national geographies or by clusters of areas defined by relative deprivation are important tools to monitor inequalities in health. Previously, analyses have had limited usefulness due to a lack of timeliness or local relevance caused by limitations on the frequency or coverage of survey data. Here we explore the potential of the Annual Population Survey (APS) to provide robust estimates of disability-free life expectancy (DFLE) for men and women by clusters of area deprivation, English regions and local authority districts (LAs) in the period 2006-08. METHODS: DFLE estimates for the UK were compared using the prevalence of limiting long-standing illness (LLSI) calculated using data from the APS and from the General Lifestyle Survey (GLF) covering Great Britain and equivalent data from the Continuous Household Survey (CHS) covering Northern Ireland, aggregated over the period 2006-08. The further use of APS data for England enabled the calculation of estimates of DFLE at age 16 and at age 65 for men and women by area deprivation quintiles (each quintile comprises a fifth of areas ranked according to their relative deprivation), English regions and LAs in order to measure inequality in DFLE between these population groupings. RESULTS: The prevalence of LLSI and estimates of DFLE at national level were broadly comparable using APS and GLF/CHS data. Substantial inequality in DFLE was present between clusters of areas defined by relative deprivation and between English regions and LAs. The scale of inequality increased markedly with each finer geographical scale analysed. CONCLUSION: The APS is a viable data source to provide LLSI data for use in DFLE estimation across a range of areas and clusters of area deprivation. While increasingly fine-grained analysis decreases statistical precision, it is possible to detect clear differences between areas within regions and in making comparisons with the England average. The estimates presented here provide scope to set benchmarks for assessing the impact of interventions designed to reduce inequality in DFLE beyond the period 2006-08.

Inequalities in disability-free life expectancy by area deprivation: England, 2001-04 and 2005-08.

BACKGROUND: The reduction of health inequalities is a long-standing public health priority. Accurate and timely measurement of the magnitude of health inequalities over time is complex, often relying on data available from a decennial census to conduct detailed analyses of social and geographical inequalities. While inequalities in mortality rates and life expectancy are well-established, the scale of inequality in health expectancies has been reported to be even greater. This study examines changes in inequality in disability-free life expectancy (DFLE) over time between Lower Super Output Areas (LSOAs) in England, grouped into quintiles of an area-based measure of relative deprivation. METHODS: Life expectancy (LE) and DFLE for males and females at birth and at age 65 were estimated using a combination of survey, mortality and population data; survey data provided an estimate of the prevalence of limiting long-standing illness or disability (LLSI) used in the DFLE metric. An estimate of the inequality in DFLE between area-based quintiles of relative deprivation (using the Index of Multiple Deprivation 2007) in the periods 2001-04 and 2005-08 enabled the measurement of change in equality over time between advantaged and disadvantaged areas. RESULTS: The prevalence of LLSI among males and females rose incrementally with increasing levels of deprivation in both periods. Males and females in the most deprived areas were more than 1.5 times more likely to report LLSI compared to those in the least deprived areas. There were also large inequalities in LE and DFLE in a similar pattern to LLSI. The extent of inequality in DFLE between the most and least deprived quintiles was approximately twice that of LE. Although LE and DFLE generally increased over time, this improvement varied across quintiles, causing the gap between the most and least deprived quintiles to increase. In comparison with more advantaged areas, people experiencing the greatest deprivation spent the greatest proportion of their lives with a limiting illness or disability, and this proportion increased over time. CONCLUSIONS: Males and females at birth and at age 65 in the less deprived areas could expect longer, healthier lives than their counterparts in more deprived areas in both 2001-04 and 2005-08. This analysis suggests that the inequality in DFLE between deprived and affluent area clusters has increased during the first decade of the 21st century.

Life expectancy and disability-free life expectancy estimates for Middle Super Output Areas; England, 1999-2003.

BACKGROUND: In recent years, there has been increasing demand for health indicators at small area level to support monitoring and planning. This study investigates the use of a small area geography, Middle Layer Super Output Areas (MSOAs) for the estimation and comparison of disability-free life expectancy (DFLE) in England. METHODS: Using death registrations from 1999 to 2003 and data on limiting long-term illness from the Census 2001, life expectancy and DFLE are estimated for English MSOAs and Government Office Regions. Figures are presented for quintiles based on MSOA DFLE values, and quintiles of relative deprivation using the Index of Multiple Deprivation 2004. Health inequalities are assessed at regional level and between quintile extremes for both measures. RESULTS: The distribution of DFLE across MSOAs was characterised by a north-south geographical divide: the highest DFLE at birth for males was in Kensington and Chelsea 016 (73.9 years) and lowest was in Manchester 013 (44.1 years). For females the highest value was in Kensington and Chelsea 012 (74.4 years) and the lowest in Liverpool 039 (48.2 years). Over 40 per cent of MSOAs in the South East, but only about 3 per cent of those in the North East, were in the quintile with the highest DFLE values at birth. Conversely, the equivalent proportions in the quintile with the lowest values were approximately 4 per cent and 50 per cent respectively.At birth, males in the most affluent areas could expect to spend an additional 12.6 years without a disability compared to those in the most deprived areas. For females this inequality was 10.9 years. At age 65 inequalities persisted but the differences were narrower. CONCLUSIONS: This is the first use of MSOAs in estimating DFLE, and the results highlight the substantial inequalities between quintile groupings based on DFLE values as well as between the least and most deprived MSOAs in England. These findings provide useful health outcomes information to planners at the local level, for benchmarking purposes and to assist in resource allocation through the identification of differences in relative need between local populations.

Monitoring inequalities in health expectancies in England - small area analyses from the Census 2001 and General Household Survey 2001-05.

BACKGROUND: Deprivation and ill health are intimately linked. Monitoring this relationship in detail and with sufficient frequency is key in attempts to reduce health inequalities through more efficient targeting of healthcare resources. This study explores the potential of the General Household Survey (GHS) to provide an inter-censal measure of health expectancies in small areas experiencing differing degrees of deprivation. METHODS: The prevalence of health status and the health expectancy of males and females at birth and at age 65 by quintiles of small area deprivation are estimated. Comparisons are made between census 2001 and GHS 2001-05 to inform the suitability of the latter as an inter-censal measure of health expectancy across small areas. Comparisons are also made between the health expectancies of people living in more and less deprived areas. RESULTS: Reports of 'good' and 'fairly good' health fell and health expectancies declined as deprivation increased. Consistency between census and GHS data indicates that the latter is a suitable source for the inter-censal measurement of health expectancies across quintiles of deprivation. At birth, people living in the least deprived areas can expect more than 12 additional years of life in good or fairly good health than those in the most deprived areas, at age 65 the difference was more than four years. In terms of the proportion of life spent in favourable health states; at birth, those living in the least deprived areas could expect to spend around 91 per cent or more of their lives in good or fairly good health compared to 82 per cent for those in the most deprived areas. At age 65, people in the least deprived areas could expect to spend around 82 per cent of their remaining life in good or fairly good health compared to 69 per cent or less for those in the most deprived areas. CONCLUSIONS: This study represents the first use of the Index of Multiple Deprivation (IMD) 2004 in the measurement of health expectancy across small areas. Both the census and GHS highlighted substantial differences in the health status and health expectancies of people experiencing differing degrees of ecological deprivation. These findings serve as a useful measure and benchmark in the targeting and assessment of interventions designed to ameliorate health inequalities.

Update to the methodology used to calculate health expectancies for the UK and constituent countries.

BACKGROUND: Changes to the design of the General Household Survey (GHS) risk a discontinuity in the ONS Health Expectancy (HE) series. This report compares methodological approaches to ensure consistency of this important National Statistic and reports improvements to the methodology surrounding standard error (SE) estimation. METHODS: A comparison of the use of cross-sectional and longitudinal GHS data in estimating health state prevalence and HE in the UK, GB and constituent countries for the period 2005-07. Incorporation of the GHS sampling design effect into the calculation of standard errors surrounding estimates of HE backdated to 2000-02. RESULTS: The prevalence of favourable health states was significantly higher in the longitudinal compared to the cross-sectional sample of the GHS. Compared to established trends, the inclusion of longitudinal data in estimates of healthy life expectancy (HLE) led to implausible increases in this metric. However, the prevalence of limiting long-standing illness and estimates of disability-free life expectancy (DFLE) using longitudinal data were broadly comparable and in line with recent trends.Inclusion of the design effect had only a minor impact on the estimation of current and historic HE standard errors. On three occasions, increases in HLE over time were no longer significant using this enhanced method of SE estimation and in a single instance differences in DFLE between countries were no longer significant. CONCLUSIONS: Attrition in the GHS longitudinal dataset introduces significant bias into estimates of health state prevalence and a discontinuity in the established trend of HLE. Utilising the cross-sectional GHS sample alone in 2005-07 represents the most reliable approach to maintain the consistency of this important series. Incorporation of the design effect enhances the precision of estimates of HE.