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1.
BJOG ; 128(3): 584-592, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33426798

RESUMO

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.


Assuntos
Parto Obstétrico/normas , Lacerações/epidemiologia , Complicações do Trabalho de Parto/epidemiologia , Melhoria de Qualidade/estatística & dados numéricos , Adulto , Canal Anal/lesões , Cesárea/efeitos adversos , Cesárea/normas , Cesárea/estatística & dados numéricos , Análise por Conglomerados , Parto Obstétrico/efeitos adversos , Parto Obstétrico/estatística & dados numéricos , Inglaterra/epidemiologia , Episiotomia/efeitos adversos , Episiotomia/normas , Episiotomia/estatística & dados numéricos , Feminino , Humanos , Lacerações/prevenção & controle , Modelos Logísticos , Complicações do Trabalho de Parto/prevenção & controle , Períneo/lesões , Gravidez , Projetos de Pesquisa , Fatores de Risco , Escócia/epidemiologia , País de Gales/epidemiologia
2.
PLoS One ; 16(1): e0244873, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33400700

RESUMO

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.


Assuntos
/psicologia , Quarentena/psicologia , Isolamento Social/psicologia , Adulto , Ansiedade/epidemiologia , Ansiedade/prevenção & controle , /prevenção & controle , Controle de Doenças Transmissíveis/métodos , Estudos Transversais , Exercício Físico/psicologia , Família/psicologia , Feminino , Humanos , Masculino , Escócia/epidemiologia , Sono/fisiologia , Higiene do Sono , Estresse Psicológico/prevenção & controle , Estresse Psicológico/psicologia , Inquéritos e Questionários
3.
J Environ Manage ; 279: 111762, 2021 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-33341727

RESUMO

Offshore wind power generation requires large areas of sea to accommodate its activities, with increasing claims for exclusive access. As a result, pressure is placed on other established maritime uses, such as commercial fisheries. The latter sector has often been taking a back seat in the thrust to move energy production offshore, thus leading to disagreements and conflicts among the different stakeholder groups. In recognition of the latter, there has been a growing international interest in exploring the combination of multiple maritime activities in the same area (multi-use; MU), including the re-instatement of fishing activities within, or in close proximity to, offshore wind farms (OWFs). We summarise local stakeholder perspectives from two sub-national case studies (East coast of Scotland and Germany's North Sea EEZ) to scope the feasibility of combining multiple uses of the sea, such as offshore wind farms and commercial fisheries. We combined a desk-based review with 15 semi-structured qualitative interviews with key knowledge holders from both industries, regulators, and academia to aggregate key results. Drivers, barriers and resulting effects (positive and negative) for potential multi-use of fisheries and OWFs are listed and ranked (57 factors in total). Factors are of economic, social, policy, legal, and technical nature. To date, in both case study areas, the offshore wind industry has shown little interest in multi-use solutions, unless clear added value is demonstrated and no risks to their operations are involved. In contrast, the commercial fishing sector is proactive towards multi-use projects and acts as a driving force for MU developments. We provide a range of management recommendations, based on stakeholder input, to support progress towards robust decision making in relation to multi-use solutions, including required policy and regulatory framework improvements, good practice guidance, empirical studies, capacity building of stakeholders and improvements of the consultation process. Our findings represent a comprehensive depiction of the current state and key stakeholder aspirations for multi-use solutions combining fisheries and OWFs. We believe that the pathways towards robust decision making in relation to multi-use solutions suggested here are transferable to other international locations.


Assuntos
Fontes Geradoras de Energia , Vento , Pesqueiros , Alemanha , Mar do Norte , Escócia
4.
PLoS One ; 15(12): e0243369, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33347451

RESUMO

After the Battle Dunbar between English and Scottish forces in 1650, captured Scottish soldiers were imprisoned in Durham and many hundreds died there within a few weeks. The partial skeletal remains of 28 of these men were discovered in 2013. Building on previous osteological work, here we report wide-ranging scientific studies of the remains to address the following questions: Did they have comparable diet, health and disease throughout their lives? Did they have common histories of movement (or lack of movement) during their childhoods? Can we create a collective biography of these men? Strontium and oxygen isotope analysis of tooth enamel investigated childhood movement. Carbon and nitrogen isotope analysis of incrementally sampled dentine addressed childhood diet and nutrition. Metaproteomic analysis of dental calculus investigated oral microbiomes and food residues; this was complemented by microscopic analysis of debris in calculus from ingested materials. Selected individuals were examined for dental microwear. The extent of hydroxylation of proline in collagen was examined as a potential biomarker for scurvy. An osteobiography for each man was created using the full range of data generated about him, and these were synthesised using an approach based on the historical method for a collective biography or prosopography. The childhood residences of the men were primarily within the Midland Valley of Scotland, though some spent parts of their childhood outside the British Isles. This is concordant with the known recruitment areas of the Scottish army in 1650. Their diets included oats, brassicas and milk but little seafood, as expected for lowland rather than highland diets of the period. Childhood periods of starvation or illness were almost ubiquitous, but not simultaneous, suggesting regionally variable food shortages in the 1620s and 1630s. It is likely there was widespread low-level scurvy, ameliorating in later years of life, which suggests historically unrecorded shortages of fruit and vegetables in the early 1640s. Almost all men were exposed to burnt plant matter, probably as inhaled soot, and this may relate to the high proportion of them with of sinusitis. Interpersonal violence causing skeletal trauma was rare. Based on commonalities in their osteobiographies, we argue that these men were drawn from the same stratum of society. This study is perhaps the most extensive to date of individuals from 17th century Scotland. Combined with a precise historical context it allows the lives of these men to be investigated and compared to the historical record with unprecedented precision. It illustrates the power of archaeological science methods to confirm, challenge and complement historical evidence.


Assuntos
Esmalte Dentário/metabolismo , Dieta/história , Ingestão de Energia , Militares , Escorbuto/metabolismo , Arqueologia , História do Século XVII , Humanos , Masculino , Escócia , Escorbuto/história , Escorbuto/patologia
5.
Artigo em Inglês | MEDLINE | ID: mdl-33327556

RESUMO

We examine the impact of the COVID-19 outbreak and concomitant restrictions (i.e., lockdown) on 24-hour movement behaviors (i.e., physical activity, sitting, sleep) in a purposive sample of people (n = 3230) reporting change recruited online. Participants' self-reported time spent in moderate-to-vigorous physical activity (MVPA), walking, sitting and sleep prior to lockdown (T1), during the first national lockdown (T2) and as restrictions initially started to ease (T3). For each 24-hour movement behavior, category-shifts are reported (positive, negative or did not change), as well as the percentage of participants recording positive/negative changes across clusters of behaviors and the percentage of participants recording improvement or maintenance of change across time. From T1 to T2 walking decreased, whereas MVPA, sitting and sleep increased, from T2 to T3 levels returned to pre-lockdown for all but MVPA. Participants who changed one behavior positively were more likely to report a positive change in another and 50% of those who reported positive changes from T1 to T2 maintained or improved further when restrictions started to ease. The current study showed that a large proportion of the sample reported positive changes, most notably those displaying initially poor levels of each behavior. These findings will inform salutogenic intervention development.


Assuntos
Exercício Físico , Pandemias , Comportamento Sedentário , Sono , Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Escócia , Postura Sentada , Adulto Jovem
7.
Rev Med Suisse ; 16(713): 2108-2111, 2020 Nov 04.
Artigo em Francês | MEDLINE | ID: mdl-33146960

RESUMO

Blending public health and primary care together means building bridges between professionals - those who deal with the health and care of individuals and those who deal with the health of a population. At the organizational level, many factors facilitate the integration of these two areas among which : a clear mandate with a vision, identified goals, and the development of a collaborative culture. In French-speaking Switzerland, the integration of public health and general medicine into a common university dynamic was one of the driving forces behind the Alliance santé project that led to the creation of Unisanté in 2019. Elsewhere in the world, similar institutions already exist and sometimes take different forms. In this article, we will briefly present four of them in Wales, Scotland, Canada and the Netherlands.


Assuntos
Atenção Primária à Saúde/tendências , Saúde Pública/tendências , Canadá , Humanos , Países Baixos , Escócia , Suíça , País de Gales
9.
Trials ; 21(1): 935, 2020 Nov 19.
Artigo em Inglês | MEDLINE | ID: mdl-33213530

RESUMO

OBJECTIVES: The GETAFIX trial will test the hypothesis that favipiravir is a more effective treatment for COVID-19 infection in patients who have early stage disease, compared to current standard of care. This study will also provide an important opportunity to investigate the safety and tolerability of favipiravir, the pharmacokinetic and pharmacodynamic profile of this drug and mechanisms of resistance in the context of COVID-19 infection, as well as the effect of favipiravir on hospitalisation duration and the post COVID-19 health and psycho-social wellbeing of patients recruited to the study. TRIAL DESIGN: GETAFIX is an open label, parallel group, two arm phase II/III randomised trial with 1:1 treatment allocation ratio. Patients will be randomised to one of two arms and the primary endpoint will assess the superiority of favipiravir plus standard treatment compared to standard treatment alone. PARTICIPANTS: This trial will recruit adult patients with confirmed positive valid COVID-19 test, who are not pregnant or breastfeeding and have no prior major co-morbidities. This is a multi-centre trial, patients will be recruited from in-patients and outpatients from three Glasgow hospitals: Royal Alexandra Hospital; Queen Elizabeth University Hospital; and the Glasgow Royal Infirmary. Patients must meet all of the following criteria: 1. Age 16 or over at time of consent 2. Exhibiting symptoms associated with COVID-19 3. Positive for SARS-CoV-2 on valid COVID-19 test 4. Point 1, 2, 3, or 4 on the WHO COVID-19 ordinal severity scale at time of randomisation. (Asymptomatic with positive valid COVID-19 test, Symptomatic Independent, Symptomatic assistance needed, Hospitalized, with no oxygen therapy) 5. Have >=10% risk of death should they be admitted to hospital as defined by the ISARIC4C risk index: https://isaric4c.net/risk 6. Able to provide written informed consent 7. Negative pregnancy test (women of childbearing potential*) 8. Able to swallow oral medication Patients will be excluded from the trial if they meet any of the following criteria: 1. Renal impairment requiring, or likely to require, dialysis or haemofiltration 2. Pregnant or breastfeeding 3. Of child bearing potential (women), or with female partners of child bearing potential (men) who do not agree to use adequate contraceptive measures for the duration of the study and for 3 months after the completion of study treatment 4. History of hereditary xanthinuria 5. Other patients judged unsuitable by the Principal Investigator or sub-Investigator 6. Known hypersensitivity to favipiravir, its metabolites or any excipients 7. Severe co-morbidities including: patients with severe hepatic impairment, defined as: • greater than Child-Pugh grade A • AST or ALT > 5 x ULN • AST or ALT >3 x ULN and Total Bilirubin > 2xULN 8. More than 96 hours since first positive COVID-19 test sample was taken 9. Unable to discontinue contra-indicated concomitant medications This is a multi-centre trial, patients will be recruited from in-patients and outpatients from three Glasgow hospitals: Royal Alexandra Hospital; Queen Elizabeth University Hospital; and the Glasgow Royal Infirmary. INTERVENTION AND COMPARATOR: Patients randomised to the experimental arm of GETAFIX will receive standard treatment for COVID-19 at the discretion of the treating clinician plus favipiravir. These patients will receive a loading dose of favipiravir on day 1 of 3600mg (1800mg 12 hours apart). On days 2-10, patients in the experimental arm will receive a maintenance dose of favipiravir of 800mg 12 hours apart (total of 18 doses). Patients randomised to the control arm of the GETAFIX trial will receive standard treatment for COVID-19 at the discretion of the treating clinician. MAIN OUTCOMES: The primary outcome being assessed in the GETAFIX trial is the efficacy of favipiravir in addition to standard treatment in patients with COVID-19 in reducing the severity of disease compared to standard treatment alone. Disease severity will be assessed using WHO COVID 10 point ordinal severity scale at day 15 +/- 48 hours. All randomised participants will be followed up until death or 60 days post-randomisation (whichever is sooner). RANDOMISATION: Patients will be randomised 1:1 to the experimental versus control arm using computer generated random sequence allocation. A minimisation algorithm incorporating a random component will be used to allocate patients. The factors used in the minimisation will be: site, age (16-50/51-70/71+), history of hypertension or currently obsess (BMI>30 or obesity clinically evident; yes/no), 7 days duration of symptoms (yes/no/unknown), sex (male/female), WHO COVID-19 ordinal severity score at baseline (1/2or 3/4). BLINDING (MASKING): No blinding will be used in the GETAFIX trial. Both participants and those assessing outcomes will be aware of treatment allocation. NUMBERS TO BE RANDOMISED (SAMPLE SIZE): In total, 302 patients will be randomised to the GETAFIX trial: 151 to the control arm and 151 to the experimental arm. There will be an optional consent form for patients who may want to contribute to more frequent PK and PD sampling. The maximum number of patients who will undergo this testing will be sixteen, eight males and eight females. This option will be offered to all patients who are being treated in hospital at the time of taking informed consent, however only patients in the experimental arm of the trial will be able to undergo this testing. TRIAL STATUS: The current GETAFIX protocol is version 4.0 12th September 2020. GETAFIX opened to recruitment on 26th October 2020 and will recruit patients over a period of approximately six months. TRIAL REGISTRATION: GETAFIX was registered on the European Union Drug Regulating Authorities Clinical Trials (EudraCT) Database on 15th April 2020; Reference number 2020-001904-41 ( https://www.clinicaltrialsregister.eu/ctr-search/trial/2020-001904-41/GB ). GETAFIX was registered on ISRCTN on 7th September 2020; Reference number ISRCTN31062548 ( https://www.isrctn.com/ISRCTN31062548 ). FULL PROTOCOL: The full protocol is attached as an additional file, accessible from the Trials website (Additional file 1). In the interest in expediting dissemination of this material, the familiar formatting has been eliminated; this Letter serves as a summary of the key elements of the full protocol. The study protocol has been reported in accordance with the Standard Protocol Items: Recommendations for Clinical Interventional Trials (SPIRIT) guidelines (see Additional file 2).


Assuntos
Amidas/uso terapêutico , Antivirais/uso terapêutico , Infecções por Coronavirus/tratamento farmacológico , Pneumonia Viral/tratamento farmacológico , Pirazinas/uso terapêutico , Adulto , Amidas/administração & dosagem , Amidas/farmacocinética , Amidas/farmacologia , Antivirais/administração & dosagem , Antivirais/farmacocinética , Antivirais/farmacologia , Betacoronavirus/genética , Betacoronavirus/isolamento & purificação , Estudos de Casos e Controles , Infecções por Coronavirus/classificação , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/virologia , Feminino , Hospitalização , Humanos , Masculino , Pandemias/classificação , Pneumonia Viral/classificação , Pneumonia Viral/epidemiologia , Pneumonia Viral/virologia , Pirazinas/administração & dosagem , Pirazinas/farmacocinética , Pirazinas/farmacologia , Segurança , Escócia/epidemiologia , Índice de Gravidade de Doença , Resultado do Tratamento
10.
Dis Aquat Organ ; 142: 41-46, 2020 Nov 19.
Artigo em Inglês | MEDLINE | ID: mdl-33210610

RESUMO

Campylobacter pinnipediorum was described recently for isolates recovered from pinnipeds. The novel species was further split into 2 subspecies based on host and geography, with C. pinnipediorum subsp. pinnipediorum recovered from otariid seals in California (USA) and C. pinnipediorum subsp. caledonicus recovered from phocid seals in Scotland. We report details of the infections of 7 pinnipeds from which C. pinnipediorum was isolated: C. pinnipediorum subsp. caledonicus was isolated from 2 harbour seals Phoca vitulina and a single grey seal Halichoerus grypus, and C. pinnipediorum subsp. pinnipediorum was isolated from California sea lions Zalophus californianus. Six of the isolates were recovered from samples collected at post-mortem investigation. In 2 of the Scottish seals and in 3 of the California seals, C. pinnipediorum was the sole bacterial isolate recovered from abscesses present and suggests they may have resulted from conspecific or intraspecific bite wounds.


Assuntos
Campylobacter , Caniformia , Phoca , Focas Verdadeiras , Abscesso/veterinária , Animais , Escócia
11.
PLoS Med ; 17(10): e1003374, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-33079969

RESUMO

BACKGROUND: The objectives of this study were to identify risk factors for severe coronavirus disease 2019 (COVID-19) and to lay the basis for risk stratification based on demographic data and health records. METHODS AND FINDINGS: The design was a matched case-control study. Severe COVID-19 was defined as either a positive nucleic acid test for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in the national database followed by entry to a critical care unit or death within 28 days or a death certificate with COVID-19 as underlying cause. Up to 10 controls per case matched for sex, age, and primary care practice were selected from the national population register. For this analysis-based on ascertainment of positive test results up to 6 June 2020, entry to critical care up to 14 June 2020, and deaths registered up to 14 June 2020-there were 36,948 controls and 4,272 cases, of which 1,894 (44%) were care home residents. All diagnostic codes from the past 5 years of hospitalisation records and all drug codes from prescriptions dispensed during the past 240 days were extracted. Rate ratios for severe COVID-19 were estimated by conditional logistic regression. In a logistic regression using the age-sex distribution of the national population, the odds ratios for severe disease were 2.87 for a 10-year increase in age and 1.63 for male sex. In the case-control analysis, the strongest risk factor was residence in a care home, with rate ratio 21.4 (95% CI 19.1-23.9, p = 8 × 10-644). Univariate rate ratios for conditions listed by public health agencies as conferring high risk were 2.75 (95% CI 1.96-3.88, p = 6 × 10-9) for type 1 diabetes, 1.60 (95% CI 1.48-1.74, p = 8 × 10-30) for type 2 diabetes, 1.49 (95% CI 1.37-1.61, p = 3 × 10-21) for ischemic heart disease, 2.23 (95% CI 2.08-2.39, p = 4 × 10-109) for other heart disease, 1.96 (95% CI 1.83-2.10, p = 2 × 10-78) for chronic lower respiratory tract disease, 4.06 (95% CI 3.15-5.23, p = 3 × 10-27) for chronic kidney disease, 5.4 (95% CI 4.9-5.8, p = 1 × 10-354) for neurological disease, 3.61 (95% CI 2.60-5.00, p = 2 × 10-14) for chronic liver disease, and 2.66 (95% CI 1.86-3.79, p = 7 × 10-8) for immune deficiency or suppression. Seventy-eight percent of cases and 52% of controls had at least one listed condition (51% of cases and 11% of controls under age 40). Severe disease was associated with encashment of at least one prescription in the past 9 months and with at least one hospital admission in the past 5 years (rate ratios 3.10 [95% CI 2.59-3.71] and 2.75 [95% CI 2.53-2.99], respectively) even after adjusting for the listed conditions. In those without listed conditions, significant associations with severe disease were seen across many hospital diagnoses and drug categories. Age and sex provided 2.58 bits of information for discrimination. A model based on demographic variables, listed conditions, hospital diagnoses, and prescriptions provided an additional 1.07 bits (C-statistic 0.804). A limitation of this study is that records from primary care were not available. CONCLUSIONS: We have shown that, along with older age and male sex, severe COVID-19 is strongly associated with past medical history across all age groups. Many comorbidities beyond the risk conditions designated by public health agencies contribute to this. A risk classifier that uses all the information available in health records, rather than only a limited set of conditions, will more accurately discriminate between low-risk and high-risk individuals who may require shielding until the epidemic is over.


Assuntos
Infecções por Coronavirus/epidemiologia , Nível de Saúde , Hospitalização , Pneumonia Viral/epidemiologia , Índice de Gravidade de Doença , Adulto , Idoso , Idoso de 80 Anos ou mais , Betacoronavirus , Estudos de Casos e Controles , Comorbidade , Infecções por Coronavirus/virologia , Tratamento Farmacológico , Registros Eletrônicos de Saúde , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Pandemias , Pneumonia Viral/virologia , Fatores de Risco , Escócia/epidemiologia , Adulto Jovem
12.
Am J Psychiatry ; 177(10): 917-927, 2020 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-32998551

RESUMO

OBJECTIVE: Death by suicide is a highly preventable yet growing worldwide health crisis. To date, there has been a lack of adequately powered genomic studies of suicide, with no sizable suicide death cohorts available for analysis. To address this limitation, the authors conducted the first comprehensive genomic analysis of suicide death using previously unpublished genotype data from a large population-ascertained cohort. METHODS: The analysis sample comprised 3,413 population-ascertained case subjects of European ancestry and 14,810 ancestrally matched control subjects. Analytical methods included principal component analysis for ancestral matching and adjusting for population stratification, linear mixed model genome-wide association testing (conditional on genetic-relatedness matrix), gene and gene set-enrichment testing, and polygenic score analyses, as well as single-nucleotide polymorphism (SNP) heritability and genetic correlation estimation using linkage disequilibrium score regression. RESULTS: Genome-wide association analysis identified two genome-wide significant loci (involving six SNPs: rs34399104, rs35518298, rs34053895, rs66828456, rs35502061, and rs35256367). Gene-based analyses implicated 22 genes on chromosomes 13, 15, 16, 17, and 19 (q<0.05). Suicide death heritability was estimated at an h2SNP value of 0.25 (SE=0.04) and a value of 0.16 (SE=0.02) when converted to a liability scale. Notably, suicide polygenic scores were significantly predictive across training and test sets. Polygenic scores for several other psychiatric disorders and psychological traits were also predictive, particularly scores for behavioral disinhibition and major depressive disorder. CONCLUSIONS: Multiple genome-wide significant loci and genes were identified and polygenic score prediction of suicide death case-control status was demonstrated, adjusting for ancestry, in independent training and test sets. Additionally, the suicide death sample was found to have increased genetic risk for behavioral disinhibition, major depressive disorder, depressive symptoms, autism spectrum disorder, psychosis, and alcohol use disorder compared with the control sample.


Assuntos
Herança Multifatorial/genética , Suicídio Consumado/psicologia , Adulto , Estudos de Casos e Controles , Feminino , Genoma Humano/genética , Estudo de Associação Genômica Ampla , Técnicas de Genotipagem , Humanos , Desequilíbrio de Ligação/genética , Masculino , Polimorfismo de Nucleotídeo Único/genética , Análise de Componente Principal , Escócia/epidemiologia , Fatores Sexuais , Suicídio Consumado/prevenção & controle , Suicídio Consumado/estatística & dados numéricos , Utah/epidemiologia , Adulto Jovem
13.
Public Health ; 188: 4-7, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33039678

RESUMO

BACKGROUND: Governments and health policymakers are now looking for strategies to lift the COVID-19 lockdown, while reducing risk to the public. METHODS: We propose the population attributable risk (PAR) as an established epidemiological tool that could support decision-making through quickly estimating the main benefits and costs of various exit strategies. RESULTS: We demonstrate the feasibility of use of PAR using pandemic data, that were publicly available in mid-May 2020 from Scotland and the US, to estimate the proportion of COVID-19 hospital admissions which might be avoided, and the proportion of adverse labour market effects - for various scenarios - based on maintaining the lockdown for those of certain ages with and without comorbidities. CONCLUSION: These calculations could be refined and applied in different countries to inform important COVID-19 policy decisions, using routinely collected data.


Assuntos
Infecções por Coronavirus/prevenção & controle , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Política Pública , Medição de Risco/métodos , Adulto , Idoso , Infecções por Coronavirus/epidemiologia , Emprego/economia , Estudos de Viabilidade , Hospitalização/estatística & dados numéricos , Humanos , Pessoa de Meia-Idade , Pneumonia Viral/epidemiologia , Quarentena/legislação & jurisprudência , Escócia/epidemiologia , Estados Unidos/epidemiologia , Adulto Jovem
14.
Euro Surveill ; 25(42)2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-33094713

RESUMO

BackgroundThe progression and geographical distribution of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in the United Kingdom (UK) and elsewhere is unknown because typically only symptomatic individuals are diagnosed. We performed a serological study of blood donors in Scotland in the spring of 2020 to detect neutralising antibodies to SARS-CoV-2 as a marker of past infection and epidemic progression.AimOur objective was to determine if sera from blood bank donors can be used to track the emergence and progression of the SARS-CoV-2 epidemic.MethodsA pseudotyped SARS-CoV-2 virus microneutralisation assay was used to detect neutralising antibodies to SARS-CoV-2. The study comprised samples from 3,500 blood donors collected in Scotland between 17 March and 18 May 2020. Controls were collected from 100 donors in Scotland during 2019.ResultsAll samples collected on 17 March 2020 (n = 500) were negative in the pseudotyped SARS-CoV-2 virus microneutralisation assay. Neutralising antibodies were detected in six of 500 donors from 23 to 26 March. The number of samples containing neutralising antibodies did not significantly rise after 5-6 April until the end of the study on 18 May. We found that infections were concentrated in certain postcodes, indicating that outbreaks of infection were extremely localised. In contrast, other areas remained comparatively untouched by the epidemic.ConclusionAlthough blood donors are not representative of the overall population, we demonstrated that serosurveys of blood banks can serve as a useful tool for tracking the emergence and progression of an epidemic such as the SARS-CoV-2 outbreak.


Assuntos
Anticorpos Neutralizantes/sangue , Anticorpos Antivirais/sangue , Betacoronavirus/imunologia , Doadores de Sangue , Infecções por Coronavirus/epidemiologia , Pandemias , Pneumonia Viral/epidemiologia , Vigilância da População , Adulto , Análise por Conglomerados , Infecções por Coronavirus/sangue , Ensaio de Imunoadsorção Enzimática , Feminino , Geografia Médica , Humanos , Concentração Inibidora 50 , Masculino , Modelos Imunológicos , Testes de Neutralização , Pneumonia Viral/sangue , Prevalência , Escócia/epidemiologia , Sensibilidade e Especificidade , Estudos Soroepidemiológicos , População Urbana
15.
Mar Environ Res ; 162: 105196, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33126111

RESUMO

There is a pressing need to quantify the risks of renewable energy developments such as offshore wind farms for protected populations. However, assessments are often based on incomplete data, or fail to consider variation in risk between sexes and at different times of year. We tracked northern gannets foraging from the world's largest colony (Bass Rock, Scotland) across five consecutive breeding seasons. We examine how seasonal and sex differences in behaviour affect the collision risk from planned and operational wind farms within their foraging range and assess the likely consequences for long-term population viability. Both sexes made shorter trips during chick-rearing than prior to chick-hatching, spent a greater proportion of time within wind farm sites and had an eight times greater potential collision risk during chick-rearing. Females made longer trips than males at both these times of year, flew higher and spent more time within wind farm sites, leading to three times greater collision risk for females. After accounting for the potential additional mortality from collisions, and assuming that the death of a parent also led to the loss of its offspring, the breeding population was projected to increase by 3.57% (95% CI: 2.16-5.15%) per year, compared with 6.56% (95% CI: 4.59-8.73%) in the absence of turbines, suggesting a negligible effect on population viability. However, additional mortality could result in greater immigration from neighbouring colonies, potentially affecting their viability and highlighting a need for research within a metapopulation framework to assess the impacts of offshore wind developments on vulnerable species across multiple connected sites.


Assuntos
Fontes Geradoras de Energia , Vento , Animais , Demografia , Feminino , Masculino , Escócia , Estações do Ano
16.
J Glob Health ; 10(2): 020103, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33110502

RESUMO

The COVID-19 pandemic has put health systems, economies and societies under unprecedented strain, calling for innovative approaches. Scotland's government, like those elsewhere, is facing difficult decisions about how to deploy digital technologies and data to help contain, control and manage the disease, while also respecting citizens' rights. This paper explores the ethical challenges presented by these methods, with particular emphasis on mobile apps associated with contact tracing. Drawing on UK and international experiences, it examines issues such as public trust, data privacy and technology design; how changing disease threats and contextual factors can affect the balance between public benefits and risks; and the importance of transparency, accountability and stakeholder participation for the trustworthiness and good-governance of digital systems and strategies. Analysis of recent technology debates, controversial programmes and emerging outcomes in comparable countries implementing contact tracing apps, reveals sociotechnical complexities and unexpected paradoxes that warrant further study and underlines the need for holistic, inclusive and adaptive strategies. The paper also considers the potential role of these apps as Scotland transitions to the 'new normal', outlines challenges and opportunities for public engagement, and poses a set of ethical questions to inform decision-making at multiple levels, from software design to institutional governance.


Assuntos
Busca de Comunicante/ética , Transmissão de Doença Infecciosa/ética , Direitos Humanos/ética , Aplicativos Móveis/ética , Pandemias/ética , Betacoronavirus , Busca de Comunicante/métodos , Infecções por Coronavirus/prevenção & controle , Transmissão de Doença Infecciosa/prevenção & controle , Governo , Humanos , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Escócia/epidemiologia , Participação dos Interessados , Tecnologia/ética
17.
BMJ ; 371: m3582, 2020 10 28.
Artigo em Inglês | MEDLINE | ID: mdl-33115726

RESUMO

OBJECTIVE: To assess the risk of hospital admission for coronavirus disease 2019 (covid-19) among patient facing and non-patient facing healthcare workers and their household members. DESIGN: Nationwide linkage cohort study. SETTING: Scotland, UK, 1 March to 6 June 2020. PARTICIPANTS: Healthcare workers aged 18-65 years, their households, and other members of the general population. MAIN OUTCOME MEASURE: Admission to hospital with covid-19. RESULTS: The cohort comprised 158 445 healthcare workers, most of them (90 733; 57.3%) being patient facing, and 229 905 household members. Of all hospital admissions for covid-19 in the working age population (18-65 year olds), 17.2% (360/2097) were in healthcare workers or their households. After adjustment for age, sex, ethnicity, socioeconomic deprivation, and comorbidity, the risk of admission due to covid-19 in non-patient facing healthcare workers and their households was similar to the risk in the general population (hazard ratio 0.81 (95% confidence interval 0.52 to 1.26) and 0.86 (0.49 to 1.51), respectively). In models adjusting for the same covariates, however, patient facing healthcare workers, compared with non-patient facing healthcare workers, were at higher risk (hazard ratio 3.30, 2.13 to 5.13), as were household members of patient facing healthcare workers (1.79, 1.10 to 2.91). After sub-division of patient facing healthcare workers into those who worked in "front door," intensive care, and non-intensive care aerosol generating settings and other, those in front door roles were at higher risk (hazard ratio 2.09, 1.49 to 2.94). For most patient facing healthcare workers and their households, the estimated absolute risk of hospital admission with covid-19 was less than 0.5%, but it was 1% and above in older men with comorbidity. CONCLUSIONS: Healthcare workers and their households contributed a sixth of covid-19 cases admitted to hospital. Although the absolute risk of admission was low overall, patient facing healthcare workers and their household members had threefold and twofold increased risks of admission with covid-19.


Assuntos
Infecções por Coronavirus/epidemiologia , Família , Pessoal de Saúde/estatística & dados numéricos , Hospitalização/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Adolescente , Adulto , Idoso , Betacoronavirus , Estudos de Coortes , Comorbidade , Feminino , Pessoal de Saúde/classificação , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Fatores de Risco , Escócia/epidemiologia , Adulto Jovem
18.
BMC Nephrol ; 21(1): 419, 2020 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-33004002

RESUMO

BACKGROUND: Infection with the severe acute respiratory coronavirus 2 (SARS-CoV-2) has led to a worldwide pandemic with coronavirus disease 2019 (COVID-19), the disease caused by SARS-CoV-2, overwhelming healthcare systems globally. Preliminary reports suggest a high incidence of infection and mortality with SARS-CoV-2 in patients receiving kidney replacement therapy (KRT). The aims of this study are to report characteristics, rates and outcomes of all patients affected by infection with SARS-CoV-2 undergoing KRT in Scotland. METHODS: Study design was an observational cohort study. Data were linked between the Scottish Renal Registry, Health Protection Scotland and the Scottish Intensive Care Society Audit Group national data sets using a unique patient identifier (Community Health Index (CHI)) for each individual by the Public Health and Intelligence unit of Public Health, Scotland. Descriptive statistics and survival analyses were performed. RESULTS: During the period 1st March 2020 to 31st May 2020, 110 patients receiving KRT tested positive for SARS-CoV-2 amounting to 2% of the prevalent KRT population. Of those affected, 86 were receiving haemodialysis or peritoneal dialysis and 24 had a renal transplant. Patients who tested positive were older and more likely to reside in more deprived postcodes. Mortality was high at 26.7% in the dialysis patients and 29.2% in the transplant patients. CONCLUSION: The rate of detected SARS-CoV-2 in people receiving KRT in Scotland was relatively low but with a high mortality for those demonstrating infection. Although impossible to confirm, it appears that the measures taken within dialysis units coupled with the national shielding policy, have been effective in protecting this population from infection.


Assuntos
Betacoronavirus/isolamento & purificação , Controle de Doenças Transmissíveis/organização & administração , Infecções por Coronavirus , Falência Renal Crônica , Transplante de Rim/estatística & dados numéricos , Pandemias , Pneumonia Viral , Terapia de Substituição Renal , Comorbidade , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Feminino , Humanos , Falência Renal Crônica/epidemiologia , Falência Renal Crônica/cirurgia , Falência Renal Crônica/terapia , Masculino , Pessoa de Meia-Idade , Mortalidade , Avaliação de Processos e Resultados em Cuidados de Saúde , Pandemias/prevenção & controle , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Saúde Pública/métodos , Sistema de Registros/estatística & dados numéricos , Terapia de Substituição Renal/métodos , Terapia de Substituição Renal/estatística & dados numéricos , Escócia/epidemiologia
19.
Waste Manag ; 118: 463-470, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32977306

RESUMO

Packaging waste production, especially single-use containers, is exerting detrimental effects on terrestrial and aquatic ecosystems, including human health. To internalise the externalities associated with single-use containers, different instruments, including a deposit refund scheme (DRS), have been operationalised in many countries. Therefore, DRS is introduced in Scotland to reduce plastic litters by increasing recycling rates and incentivising pro-environmental behavioural change. This study addresses the complexity of single-use plastic containers by analysing consumers' perceptions regarding the introduction of DRS in Scotland. Using 940 comments from the BBC "Have Your Say" messageboard, this study adopts sentiment analysis to understand consumers' opinions about the introduction and implementation of DRS in Scotland. Findings suggest that a UK-wide scheme that is similar in terms of operations and structure is required for DRS to be successful. While consumers' knowledge and opinions about DRS are mixed, the efficacy of DRS including its relevance is questioned and raises doubts about its contribution to sustainability. The findings imply the need for UK countries to negotiate and collaborate on appropriate and attractive interventions in addressing post-consumer single-use plastic containers. The implications of the findings for policy and practice, especially in improving the operations of DRS are further discussed.


Assuntos
Ecossistema , Embalagem de Produtos , Comportamento do Consumidor , Humanos , Plásticos , Reciclagem , Escócia
20.
J Environ Radioact ; 223-224: 106400, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32937266

RESUMO

Soil erosion has been associated with various negative environmental impacts foremost of which is the potential pressure it could impose on global food security. The poor conditions of our agricultural soil can be attributed to years of unsustainable farming practices occurring throughout history that has placed significant pressure on the environment. Moreover, climate change scenarios indicate further intensification which is likely making prediction and assessment of erosion processes critical for long term agricultural sustainability. This study demonstrates the potential of mobile gamma-ray spectrometry with large volume NaI(Tl) detectors to identify, at high spatial resolution, changes in 137Cs soil concentration within the ploughed layer of soil and enabling the soil erosion processes to be quantified. This technique represents a significant advantage over conventional spatially-isolated point measurements such as soil sampling as it offers real time mapping at the field scale. However, spectral signal derived from measurements in the field are highly dependent on the calibration procedure used and are particularly sensitive to source-detector changes such as the presence of a vehicle, ground curvature and soil moisture content. Conventional calibration procedures tend to not consider these potential sources of uncertainty potentially leaving the system vulnerable to systematic uncertainties, especially when 137Cs concentrations are low. This study used Monte Carlo simulations to investigate such changes utilising additional information including a high-resolution digital terrain model. The method was demonstrated on a ploughed site in Scotland, revealing a mixture of tillage and water erosion patterns supported by soil core data. Findings showed that the sites topography had relatively little effect (<10%) on calculated erosion rates, but moisture content could be the determining factor, albeit very difficult to measure reliably throughout a survey.


Assuntos
Monitoramento de Radiação , Solo , Agricultura , Radioisótopos de Césio , Escócia
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