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1.
Bone Joint J ; 101-B(9): 1063-1070, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31474149

RESUMO

AIMS: The primary aim of the study was to perform an analysis to identify the cost per quality-adjusted life-year (QALY) of robot-assisted unicompartmental knee arthroplasty (rUKA) relative to manual total knee arthroplasty (TKA) and unicompartmental knee arthroplasty (UKA) for patients with isolated medial compartment osteoarthritis (OA) of the knee. Secondary aims were to assess how case volume and length of hospital stay influenced the relative cost per QALY. PATIENTS AND METHODS: A Markov decision analysis was performed, using known parameters for costs, outcomes, implant survival, and mortality, to assess the cost-effectiveness of rUKA relative to manual TKA and UKA for patients with isolated medial compartment OA of the knee with a mean age of 65 years. The influence of case volume and shorter hospital stay were assessed. RESULTS: Using a model with an annual case volume of 100 patients, the cost per QALY of rUKA was £1395 and £1170 relative to TKA and UKA, respectively. The cost per QALY was influenced by case volume: a low-volume centre performing ten cases per year would achieve a cost per QALY of £7170 and £8604 relative to TKA and UKA. For a high-volume centre performing 200 rUKAs per year with a mean two-day length of stay, the cost per QALY would be £648; if performed as day-cases, the cost would be reduced to £364 relative to TKA. For a high-volume centre performing 200 rUKAs per year with a shorter length of stay of one day relative to manual UKA, the cost per QALY would be £574. CONCLUSION: rUKA is a cost-effective alternative to manual TKA and UKA for patients with isolated medial compartment OA of the knee. The cost per QALY of rUKA decreased with reducing length of hospital stay and with increasing case volume, compared with TKA and UKA. Cite this article: Bone Joint J 2019;101-B:1063-1070.


Assuntos
Artroplastia do Joelho/economia , Artroplastia do Joelho/métodos , Osteoartrite do Joelho/cirurgia , Idoso , Artroplastia do Joelho/estatística & dados numéricos , Análise Custo-Benefício , Feminino , Humanos , Tempo de Internação/economia , Tempo de Internação/estatística & dados numéricos , Masculino , Cadeias de Markov , Osteoartrite do Joelho/economia , Osteoartrite do Joelho/epidemiologia , Qualidade de Vida , Procedimentos Cirúrgicos Robóticos/economia , Procedimentos Cirúrgicos Robóticos/métodos , Procedimentos Cirúrgicos Robóticos/estatística & dados numéricos , Reino Unido/epidemiologia
2.
BMJ ; 366: l4786, 2019 09 04.
Artigo em Inglês | MEDLINE | ID: mdl-31484641

RESUMO

OBJECTIVE: To estimate the potential impact on body mass index (BMI) and prevalence of obesity of a 20% price increase in high sugar snacks. DESIGN: Modelling study. SETTING: General adult population of the United Kingdom. PARTICIPANTS: 36 324 households with data on product level household expenditure from UK Kantar FMCG (fast moving consumer goods) panel for January 2012 to December 2013. Data were used to estimate changes in energy (kcal, 1 kcal=4.18 kJ=0.00418 MJ) purchase associated with a 20% price increase in high sugar snacks. Data for 2544 adults from waves 5 to 8 of the National Diet and Nutrition Survey (2012-16) were used to estimate resulting changes in BMI and prevalence of obesity. MAIN OUTCOME MEASURES: The effect on per person take home energy purchases of a 20% price increase for three categories of high sugar snacks: confectionery (including chocolate), biscuits, and cakes. Health outcomes resulting from the price increase were measured as changes in weight, BMI (not overweight (BMI <25), overweight (BMI ≥25 and <30), and obese (BMI ≥30)), and prevalence of obesity. Results were stratified by household income and BMI. RESULTS: For income groups combined, the average reduction in energy consumption for a 20% price increase in high sugar snacks was estimated to be 8.9×103 kcal (95% confidence interval -13.1×103 to -4.2×103 kcal). Using a static weight loss model, BMI was estimated to decrease by 0.53 (95% confidence interval -1.01 to -0.06) on average across all categories and income groups. This change could reduce the UK prevalence of obesity by 2.7 percentage points (95% confidence interval -3.7 to -1.7 percentage points) after one year. The impact of a 20% price increase in high sugar snacks on energy purchase was largest in low income households classified as obese and smallest in high income households classified as not overweight. CONCLUSIONS: Increasing the price of high sugar snacks by 20% could reduce energy intake, BMI, and prevalence of obesity. This finding was in a UK context and was double that modelled for a similar price increase in sugar sweetened beverages.


Assuntos
Comércio , Obesidade/epidemiologia , Lanches , Açúcares/efeitos adversos , Impostos , Adolescente , Adulto , Índice de Massa Corporal , Ingestão de Energia , Feminino , Humanos , Renda/estatística & dados numéricos , Masculino , Modelos Biológicos , Modelos Econômicos , Obesidade/etiologia , Obesidade/prevenção & controle , Prevalência , Reino Unido/epidemiologia , Adulto Jovem
3.
BMJ ; 366: l4897, 2019 09 04.
Artigo em Inglês | MEDLINE | ID: mdl-31484644

RESUMO

OBJECTIVE: To examine the associations of vegetarianism with risks of ischaemic heart disease and stroke. DESIGN: Prospective cohort study. SETTING: The EPIC-Oxford study, a cohort in the United Kingdom with a large proportion of non-meat eaters, recruited across the country between 1993 and 2001. PARTICIPANTS: 48 188 participants with no history of ischaemic heart disease, stroke, or angina (or cardiovascular disease) were classified into three distinct diet groups: meat eaters (participants who consumed meat, regardless of whether they consumed fish, dairy, or eggs; n=24 428), fish eaters (consumed fish but no meat; n=7506), and vegetarians including vegans (n=16 254), based on dietary information collected at baseline, and subsequently around 2010 (n=28 364). MAIN OUTCOME MEASURES: Incident cases of ischaemic heart disease and stroke (including ischaemic and haemorrhagic types) identified through record linkage until 2016. RESULTS: Over 18.1 years of follow-up, 2820 cases of ischaemic heart disease and 1072 cases of total stroke (519 ischaemic stroke and 300 haemorrhagic stroke) were recorded. After adjusting for sociodemographic and lifestyle confounders, fish eaters and vegetarians had 13% (hazard ratio 0.87, 95% confidence interval 0.77 to 0.99) and 22% (0.78, 0.70 to 0.87) lower rates of ischaemic heart disease than meat eaters, respectively (P<0.001 for heterogeneity). This difference was equivalent to 10 fewer cases of ischaemic heart disease (95% confidence interval 6.7 to 13.1 fewer) in vegetarians than in meat eaters per 1000 population over 10 years. The associations for ischaemic heart disease were partly attenuated after adjustment for self reported high blood cholesterol, high blood pressure, diabetes, and body mass index (hazard ratio 0.90, 95% confidence interval 0.81 to 1.00 in vegetarians with all adjustments). By contrast, vegetarians had 20% higher rates of total stroke (hazard ratio 1.20, 95% confidence interval 1.02 to 1.40) than meat eaters, equivalent to three more cases of total stroke (95% confidence interval 0.8 to 5.4 more) per 1000 population over 10 years, mostly due to a higher rate of haemorrhagic stroke. The associations for stroke did not attenuate after further adjustment of disease risk factors. CONCLUSIONS: In this prospective cohort in the UK, fish eaters and vegetarians had lower rates of ischaemic heart disease than meat eaters, although vegetarians had higher rates of haemorrhagic and total stroke.


Assuntos
Dieta Vegetariana/efeitos adversos , Comportamento Alimentar , Carne/efeitos adversos , Isquemia Miocárdica/epidemiologia , Acidente Vascular Cerebral/epidemiologia , Adulto , Animais , Feminino , Peixes , Seguimentos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Isquemia Miocárdica/etiologia , Estudos Prospectivos , Medição de Risco , Alimentos Marinhos , Fatores Socioeconômicos , Acidente Vascular Cerebral/etiologia , Inquéritos e Questionários/estatística & dados numéricos , Reino Unido/epidemiologia , Vegetarianos/estatística & dados numéricos
4.
Orthop Clin North Am ; 50(4): 539-548, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31466669

RESUMO

End-stage ankle arthritis has a significant effect on function and quality of life. Total ankle arthroplasty continues to emerge as a safe and effective treatment of ankle arthritis. Ankle arthroplasty preserves motion at the ankle joint, while still achieving the primary goal of pain relief. With encouraging outcomes and improved implant longevity, there has been significant improvement on the results of first-generation implants. Further high-quality studies are required to clarify outcomes post ankle arthroplasty. This article reviews the latest data from national registries and the wider literature to evaluate the current status with outcomes of modern total ankle replacements.


Assuntos
Artrite/epidemiologia , Artrite/cirurgia , Artroplastia de Substituição do Tornozelo/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Artroplastia de Substituição do Tornozelo/instrumentação , Austrália/epidemiologia , Humanos , Pessoa de Meia-Idade , Nova Zelândia/epidemiologia , Noruega/epidemiologia , Medidas de Resultados Relatados pelo Paciente , Desenho de Prótese , Falha de Prótese , Sistema de Registros , Suécia/epidemiologia , Resultado do Tratamento , Reino Unido/epidemiologia , Adulto Jovem
5.
BMC Vet Res ; 15(1): 268, 2019 Jul 29.
Artigo em Inglês | MEDLINE | ID: mdl-31357996

RESUMO

BACKGROUND: This study investigated changes over time in the epidemiology of extended-spectrum ß-lactamase (ESBL) producing Escherichia coli within a single equine referral hospital in the UK. Faecal samples were collected from hospitalised horses in 2008 and 2017, processed using selective media and standard susceptibility laboratory methods. A novel real-time PCR with high resolution melt analysis was used to distinguish blaCTX-M-1 and blaCTX-M-15 within CTX-M-1 group. RESULTS: In 2008, 457 faecal samples from 103 horses were collected, with ESBL-producing E. coli identified in 131 samples (28.7, 95% CI 24.6-33.1). In 2017, 314 faecal samples were collected from 74 horses with ESBL-producing E. coli identified in 157 samples (50.0, 95% CI 44.5-55.5). There were 135 and 187 non-duplicate ESBL-producing isolates from 2008 and 2017, respectively. In 2008, 12.6% of isolates belonged to CTX-M-1 group, all carrying blaCTX-M-1, whilst in 2017, 94.1% of isolates were CTX-M-1 group positive and of these 39.2 and 60.8% of isolates carried blaCTX-M-1 and blaCTX-M-15, respectively. In addition, the prevalence of doxycycline, gentamicin and 3rd generation cephalosporin resistance increased significantly from 2008 to 2017 while a decreased prevalence of phenotypic resistance to potentiated sulphonamides was observed. CONCLUSIONS: The real-time PCR proved a reliable and high throughput method to distinguish between blaCTX-M-1 and blaCTX-M-15. Furthermore, its use in this study demonstrated the emergence of faecal carriage of CTX-M-15 in hospitalised horses, with an increase in prevalence of ESBL-producing E. coli as well as increased antimicrobial resistance to frequently used antimicrobials.


Assuntos
Infecções por Escherichia coli/veterinária , Fezes/microbiologia , Doenças dos Cavalos/epidemiologia , Doenças dos Cavalos/microbiologia , beta-Lactamases/metabolismo , Animais , Antibacterianos/farmacologia , Farmacorresistência Bacteriana , Escherichia coli/efeitos dos fármacos , Escherichia coli/enzimologia , Escherichia coli/genética , Infecções por Escherichia coli/epidemiologia , Infecções por Escherichia coli/microbiologia , Cavalos , Hospitais Veterinários/estatística & dados numéricos , Prevalência , Reino Unido/epidemiologia , beta-Lactamases/genética
6.
BMJ ; 365: l2327, 2019 Jun 26.
Artigo em Inglês | MEDLINE | ID: mdl-31243001

RESUMO

OBJECTIVE: To examine whether sleep traits have a causal effect on risk of breast cancer. DESIGN: Mendelian randomisation study. SETTING: UK Biobank prospective cohort study and Breast Cancer Association Consortium (BCAC) case-control genome-wide association study. PARTICIPANTS: 156 848 women in the multivariable regression and one sample mendelian randomisation (MR) analysis in UK Biobank (7784 with a breast cancer diagnosis) and 122 977 breast cancer cases and 105 974 controls from BCAC in the two sample MR analysis. EXPOSURES: Self reported chronotype (morning or evening preference), insomnia symptoms, and sleep duration in multivariable regression, and genetic variants robustly associated with these sleep traits. MAIN OUTCOME MEASURE: Breast cancer diagnosis. RESULTS: In multivariable regression analysis using UK Biobank data on breast cancer incidence, morning preference was inversely associated with breast cancer (hazard ratio 0.95, 95% confidence interval 0.93 to 0.98 per category increase), whereas there was little evidence for an association between sleep duration and insomnia symptoms. Using 341 single nucleotide polymorphisms (SNPs) associated with chronotype, 91 SNPs associated with sleep duration, and 57 SNPs associated with insomnia symptoms, one sample MR analysis in UK Biobank provided some supportive evidence for a protective effect of morning preference on breast cancer risk (0.85, 0.70, 1.03 per category increase) but imprecise estimates for sleep duration and insomnia symptoms. Two sample MR using data from BCAC supported findings for a protective effect of morning preference (inverse variance weighted odds ratio 0.88, 95% confidence interval 0.82 to 0.93 per category increase) and adverse effect of increased sleep duration (1.19, 1.02 to 1.39 per hour increase) on breast cancer risk (both oestrogen receptor positive and oestrogen receptor negative), whereas evidence for insomnia symptoms was inconsistent. Results were largely robust to sensitivity analyses accounting for horizontal pleiotropy. CONCLUSIONS: Findings showed consistent evidence for a protective effect of morning preference and suggestive evidence for an adverse effect of increased sleep duration on breast cancer risk.


Assuntos
Neoplasias da Mama/epidemiologia , Neoplasias da Mama/etiologia , Sono , Adulto , Idoso , Estudos de Casos e Controles , Ritmo Circadiano , Comorbidade , Fatores de Confusão (Epidemiologia) , Feminino , Estudo de Associação Genômica Ampla , Humanos , Incidência , Análise da Randomização Mendeliana , Pessoa de Meia-Idade , Análise Multivariada , Estudos Prospectivos , Fatores de Risco , Distúrbios do Início e da Manutenção do Sono/epidemiologia , Fatores de Tempo , Reino Unido/epidemiologia
7.
BMJ ; 365: l2323, 2019 Jun 26.
Artigo em Inglês | MEDLINE | ID: mdl-31243014

RESUMO

OBJECTIVE: To assess the prospective associations of baseline and long term trajectories of physical activity on mortality from all causes, cardiovascular disease, and cancer. DESIGN: Population based cohort study. SETTING: Adults from the general population in the UK. PARTICIPANTS: 14 599 men and women (aged 40 to 79) from the European Prospective Investigation into Cancer and Nutrition-Norfolk cohort, assessed at baseline (1993 to 1997) up to 2004 for lifestyle and other risk factors; then followed to 2016 for mortality (median of 12.5 years of follow-up, after the last exposure assessment). MAIN EXPOSURE: Physical activity energy expenditure (PAEE) derived from questionnaires, calibrated against combined movement and heart rate monitoring. MAIN OUTCOME MEASURES: Mortality from all causes, cardiovascular disease, and cancer. Multivariable proportional hazards regression models were adjusted for age, sex, sociodemographics, and changes in medical history, overall diet quality, body mass index, blood pressure, triglycerides, and cholesterol levels. RESULTS: During 171 277 person years of follow-up, 3148 deaths occurred. Long term increases in PAEE were inversely associated with mortality, independent of baseline PAEE. For each 1 kJ/kg/day per year increase in PAEE (equivalent to a trajectory of being inactive at baseline and gradually, over five years, meeting the World Health Organization minimum physical activity guidelines of 150 minutes/week of moderate-intensity physical activity), hazard ratios were: 0.76 (95% confidence interval 0.71 to 0.82) for all cause mortality, 0.71 (0.62 to 0.82) for cardiovascular disease mortality, and 0.89 (0.79 to 0.99) for cancer mortality, adjusted for baseline PAEE, and established risk factors. Similar results were observed when analyses were stratified by medical history of cardiovascular disease and cancer. Joint analyses with baseline and trajectories of physical activity show that, compared with consistently inactive individuals, those with increasing physical activity trajectories over time experienced lower risks of mortality from all causes, with hazard ratios of 0.76 (0.65 to 0.88), 0.62 (0.53 to 0.72), and 0.58 (0.43 to 0.78) at low, medium, and high baseline physical activity, respectively. At the population level, meeting and maintaining at least the minimum physical activity recommendations would potentially prevent 46% of deaths associated with physical inactivity. CONCLUSIONS: Middle aged and older adults, including those with cardiovascular disease and cancer, can gain substantial longevity benefits by becoming more physically active, irrespective of past physical activity levels and established risk factors. Considerable population health impacts can be attained with consistent engagement in physical activity during mid to late life.


Assuntos
Exercício , Mortalidade , Adulto , Idoso , Doenças Cardiovasculares/mortalidade , Causas de Morte , Metabolismo Energético , Feminino , Estilo de Vida Saudável , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Neoplasias/mortalidade , Vigilância da População , Estudos Prospectivos , Fatores de Risco , Reino Unido/epidemiologia
9.
BMC Public Health ; 19(1): 748, 2019 Jun 13.
Artigo em Inglês | MEDLINE | ID: mdl-31196050

RESUMO

BACKGROUND: Universal childhood vaccination programmes form a core component of child health policies in most countries, including the UK. Achieving high coverage rates of vaccines is critical for establishing 'herd immunity' and preventing disease outbreaks. Evidence from the UK has identified several groups of children who are at risk of not being fully immunised. Our aim was to determine whether children with intellectual disabilities constitute one such group. METHODS: Secondary analysis of parental report data on child vaccination collected in the UK's Millennium Cohort Study when the children were 9 months, 3 years, 5 years and 14 years old. RESULTS: With one exception (MMR coverage at age 5) vaccination coverage rates were lower for children with intellectual disabilities (when compared to children without intellectual disability) for all vaccinations at all ages. Complete coverage rates were significantly lower for children with intellectual disabilities at ages 9 months (unadjusted PRR non-vaccination = 2.03 (1.14-3.60), p < 0.05) and 3 years (unadjusted PRR = 2.16 (1.06-4.43), p < 0.05), but not at age 5 years (unadjusted PRR = 1.91 (0.67-5.49)). HPV vaccination was lower (but not significantly so) at age 14 (PRR = 1.83 (0.99-3.37), p = 0.054). Adjusting PRRs for between group differences in family socio-economic position and other factors associated with coverage reduced the strength of association between intellectual disability and coverage at all ages. However, incomplete vaccination remained significantly elevated for children with intellectual disabilities at ages 9 months and 3 years. There were no statistically significant differences between parents of children with/without intellectual disability regarding the reasons given for non-vaccination. CONCLUSIONS: Children with intellectual disabilities in the UK are at increased risk of vaccine preventable diseases. This may jeopardise their own health, the health of younger siblings and may also compromise herd immunity.


Assuntos
Crianças com Deficiência/estatística & dados numéricos , Deficiência Intelectual/epidemiologia , Cobertura Vacinal/estatística & dados numéricos , Adolescente , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Lactente , Masculino , Reino Unido/epidemiologia
10.
BMC Infect Dis ; 19(1): 552, 2019 Jun 24.
Artigo em Inglês | MEDLINE | ID: mdl-31234784

RESUMO

BACKGROUND: Human papillomavirus (HPV) is the most widespread sexually transmitted infection worldwide. It causes several health consequences, in particular accounting for the majority of cervical cancer cases in women. In the United Kingdom, a vaccination campaign targeting 12-year-old girls started in 2008; this campaign has been successful, with high uptake and reduced HPV prevalence observed in vaccinated cohorts. Recently, attention has focused on vaccinating both sexes, due to HPV-related diseases in males (particularly for high-risk men who have sex with men) and an equity argument over equalising levels of protection. METHODS: We constructed an epidemiological model for HPV transmission in the UK, accounting for nine of the most common HPV strains. We complemented this with an economic model to determine the likely health outcomes (healthcare costs and quality-adjusted life years) for individuals from the epidemiological model. We then tested vaccination with the three HPV vaccines currently available, vaccinating either girls alone or both sexes. For each strategy we calculated the threshold price per vaccine dose, i.e. the maximum amount paid for the added health benefits of vaccination to be worth the cost of each vaccine dose. We calculated results at 3.5% discounting, and also 1.5%, to consider the long-term health effects of HPV infection. RESULTS: At 3.5% discounting, continuing to vaccinate girls remains highly cost-effective compared to halting vaccination, with threshold dose prices of £56-£108. Vaccination of girls and boys is less cost-effective (£25-£53). Compared to vaccinating girls only, adding boys to the programme is not cost-effective, with negative threshold prices (-£6 to -£3) due to the costs of administration. All threshold prices increase when using 1.5% discounting, and adding boys becomes cost-effective (£36-£47). These results are contingent on the UK's high vaccine uptake; for lower uptake rates, adding boys (at the same uptake rate) becomes more cost effective. CONCLUSIONS: Vaccinating girls is extremely cost-effective compared with no vaccination, vaccinating both sexes is less so. Adding boys to an already successful girls-only programme has a low cost-effectiveness, as males have high protection through herd immunity. If future health effects are weighted more heavily, threshold prices increase and vaccination becomes cost-effective.


Assuntos
Análise Custo-Benefício , Modelos Econômicos , Infecções por Papillomavirus/prevenção & controle , Vacinas contra Papillomavirus/imunologia , Vacinação/economia , Adolescente , Feminino , Custos de Cuidados de Saúde , Humanos , Imunidade Coletiva , Masculino , Papillomaviridae/imunologia , Infecções por Papillomavirus/epidemiologia , Infecções por Papillomavirus/imunologia , Vacinas contra Papillomavirus/administração & dosagem , Anos de Vida Ajustados por Qualidade de Vida , Reino Unido/epidemiologia , Neoplasias do Colo do Útero/prevenção & controle
11.
Value Health ; 22(6): 669-676, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31198184

RESUMO

OBJECTIVES: To estimate the impact of cures for chronic hepatitis C (CHC) infection on organ donation in the United Kingdom. Curing CHC infection reduces the need for liver transplants and enables cured individuals to donate organs of all types. METHODS: We adapted a double-queuing model of organ allocation to estimate the effects of CHC infection cures on liver, lung, heart, and kidney transplants in the United Kingdom. We assumed that cured individuals would donate organs at similar rates as the general population and no longer require liver transplants because of CHC infection. We estimated how curing CHC infection influences waitlist lengths for each organ and the annual net present value to society on the basis of quality-adjusted life-years gained through additional transplants under opt-in and opt-out organ donation policies. RESULTS: Curing CHC generates the most value for patients on the liver waitlist, because it increases the number of transplantable livers and reduces the need for transplants. Under the current opt-in policy, liver waitlist length falls by 24%, generating £34.3 million of annual net present value. Growth in the number of uninfected lungs, hearts, and kidneys generates an additional £19.2 million annually, with £18.7 million from kidneys. Implementing the opt-out policy, liver waitlist length would decrease by 75%, implying that treating CHC eliminates one-third of the excess liver waitlist due to an opt-in policy. CONCLUSIONS: Treating CHC has large positive spillovers to uninfected individuals by reducing the need for liver transplants and allowing cured individuals to donate organs. These spillovers have not been included in traditional value assessments of CHC treatment.


Assuntos
Hepatite C Crônica/terapia , Transplantes/estatística & dados numéricos , Coração , Hepatite C Crônica/epidemiologia , Humanos , Rim , Fígado , Pulmão , Obtenção de Tecidos e Órgãos/estatística & dados numéricos , Reino Unido/epidemiologia , Listas de Espera
12.
N Z Vet J ; 67(5): 270-276, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31234729

RESUMO

AIMS: To report the clinical outcomes and complications after the use of 3.5 mm/2.7 mm locking compression plates (LCP) with additional internal fixation for pancarpal arthrodesis (PCA) in dogs. METHODS: This was a retrospective study using medical records from a single orthopaedic referral hospital between December 2015 and April 2018. The inclusion criteria were the use of a dorsally applied LCP for PCA in dogs with a minimum follow-up period of 12 months. Additional crossed 2.7 or 3.5 mm cortical screws or Kirschner wires were placed in all limbs to further stabilise the joints. A light dressing without external coaptation was applied postoperatively to all limbs. Postoperative lameness assessment was recorded at the last clinical evaluation. RESULTS: Twelve dogs with 13 arthrodesed limbs were included, with carpal hyperextension injury being the most common indication for surgery (4/13; 31%). One dog was recorded with a minor complication, which was a metacarpal fracture distal to the bone plate. Major complications were observed in 4/13 (31%) limbs, with surgical site infection being recorded in all four limbs and screw loosening in one limb. No implant failure was reported. At the final clinical evaluation (43-437 days after surgery), none or mechanical lameness was recorded in 9/13 (69%) limbs, mild lameness in 3/13 (23%) limbs, and moderate lameness in one 1/13 (8%) limb. CONCLUSIONS AND CLINICAL RELEVANCE: Locking plate and screw fixation with additional internal fixation resulted in comparable complication and infection rates in canine PCA to previous published studies using hybrid dynamic compression plates. No implant failure was reported for any of the limbs despite the use of a light dressing without external coaptation.


Assuntos
Artrodese/veterinária , Ossos do Carpo/cirurgia , Doenças do Cão/cirurgia , Coxeadura Animal/cirurgia , Animais , Artrodese/métodos , Placas Ósseas , Parafusos Ósseos , Doenças do Cão/etiologia , Cães/lesões , Feminino , Fraturas Ósseas/cirurgia , Fraturas Ósseas/veterinária , Coxeadura Animal/etiologia , Masculino , Estudos Retrospectivos , Infecção da Ferida Cirúrgica/epidemiologia , Infecção da Ferida Cirúrgica/veterinária , Resultado do Tratamento , Reino Unido/epidemiologia
13.
Bone Joint J ; 101-B(6): 708-714, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31154849

RESUMO

AIMS: This study sought to determine the proportion of older adults with hip fractures captured by a multicentre prospective cohort, the World Hip Trauma Evaluation (WHiTE), whether there was evidence of selection bias during WHiTE recruitment, and the extent to which the WHiTE cohort is representative of the broader population of older adults with hip fractures. PATIENTS AND METHODS: The characteristics of patients recruited into the WHiTE cohort study were compared with those treated at WHiTE hospitals during the same timeframe and submitted to the National Hip Fracture Database (NHFD). RESULTS: Patients recruited to WHiTE were more likely to be admitted from their own home (83.5% vs 80.2%; p < 0.001) and to have a higher median Abbreviated Mental Test Score (AMTS) (9 (interquartile range (IQR) 6 to 10) vs 9 (IQR 5 to 10); p < 0.001) than those who were not recruited. In terms of WHiTE cohort generalizability, participating hospitals included a greater proportion of Major Trauma Centres (47.8% vs 7.8%) and large hospitals (997 (IQR 873 to 1290) vs 707 (459 to 903) beds) with high-volume Emergency Departments (median annual attendances of 43 981 (IQR 37 147 to 54 385) vs 35 964 (IQR 26 229 to 50 551)). However, there were few differences in baseline characteristics between patients in the WHiTE cohort and those recorded in the NHFD. CONCLUSION: There is evidence of a weak selection bias towards recruiting fitter patients within the WHiTE cohort, which will help to put into context the findings of future studies. We conclude that the patients within the WHiTE cohort are representative of the national population of older adults with hip fractures throughout England, Wales, and Northern Ireland. Cite this article: Bone Joint J 2019;101-B:708-714.


Assuntos
Fraturas do Quadril/epidemiologia , Idoso de 80 Anos ou mais , Bases de Dados Factuais , Feminino , Humanos , Masculino , Estudos Prospectivos , Reino Unido/epidemiologia
14.
Nat Med ; 25(6): 909-910, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31160814

RESUMO

We use the genotyping and death register information of 409,693 individuals of British ancestry to investigate fitness effects of the CCR5-∆32 mutation. We estimate a 21% increase in the all-cause mortality rate in individuals who are homozygous for the ∆32 allele. A deleterious effect of the ∆32/∆32 mutation is also independently supported by a significant deviation from the Hardy-Weinberg equilibrium (HWE) due to a deficiency of ∆32/∆32 individuals at the time of recruitment.


Assuntos
Homozigoto , Mutação , Receptores CCR5/genética , Adulto , Idoso , Bases de Dados Genéticas/estatística & dados numéricos , Feminino , Aptidão Genética , Infecções por HIV/prevenção & controle , Humanos , Expectativa de Vida , Masculino , Pessoa de Meia-Idade , Mortalidade , Sistema de Registros/estatística & dados numéricos , Taxa de Sobrevida , Reino Unido/epidemiologia
15.
Ann R Coll Surg Engl ; 101(7): 495-500, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31219318

RESUMO

INTRODUCTION: Early detection and treatment of anastomotic leak may mitigate its consequences. Within an enhanced recovery setting, the subtle signs of a leak can be more apparent. There are multiple treatment options for anastomotic leak following anterior resection. This study aimed to determine when leaks are diagnosed in enhanced recovery, and whether the choice of intervention affects outcomes. MATERIALS AND METHODS: We conducted a retrospective study of a prospectively maintained database of complications of anterior resections for rectal cancer in a district general hospital in the UK. Data were extracted on day of leak diagnosis, length of stay, intensive care admission, mortality and ileostomy reversal rate. Statistical analysis was performed using Student's t, Mann-Whitney U and chi square tests. RESULTS: A total of 323 patients underwent anterior resection for colorectal cancer between 1 January 2007 and 1 October 2015. The leak rate was 10.8% (35/323). Patients were diagnosed in hospital with leaks on median day 4 compared with day 11 for patients diagnosed with leaks after readmission from home (P < 0.001). Defunctioned patients diagnosed with a leak had a longer median length of stay (24 vs 18.0 days, P = 0.31) but were more frequently managed non-operatively (100% vs 19.0%, P < 0.001) and had a lower admission rate to intensive care (9.5% vs 42.9%, P = 0.02) than patients who were not defunctioned at time of resection. Overall mortality from anastomotic leak was 2.9% (1/35). Ileostomies were reversed in 73.5% of patients (25/34). DISCUSSION: Enhanced recovery enables early diagnosis of leaks following anterior resection. Defunctioning of patients with anastomotic leak lowers mortality.


Assuntos
Fístula Anastomótica/diagnóstico , Ileostomia/estatística & dados numéricos , Assistência Perioperatória/métodos , Neoplasias Retais/cirurgia , Reoperação/estatística & dados numéricos , Idoso , Anastomose Cirúrgica/efeitos adversos , Anastomose Cirúrgica/métodos , Fístula Anastomótica/etiologia , Fístula Anastomótica/mortalidade , Feminino , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Assistência Perioperatória/estatística & dados numéricos , Estudos Prospectivos , Reto/cirurgia , Estudos Retrospectivos , Taxa de Sobrevida , Resultado do Tratamento , Reino Unido/epidemiologia
16.
BJOG ; 126(11): 1390-1398, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31240854

RESUMO

OBJECTIVE: To calculate the cost-effectiveness of implementing PlGF testing alongside a clinical management algorithm in maternity services in the UK, compared with current standard care. DESIGN: Cost-effectiveness analysis. SETTING: Eleven maternity units participating in the PARROT stepped-wedge cluster-randomised controlled trial. POPULATION: Women presenting with suspected pre-eclampsia between 20+0 and 36+6  weeks' gestation. METHODS: Monte Carlo simulation utilising resource use data and maternal adverse outcomes. MAIN OUTCOME MEASURES: Cost per maternal adverse outcome prevented. RESULTS: Clinical care with PlGF testing costs less than current standard practice and resulted in fewer maternal adverse outcomes. There is a total cost-saving of UK£149 per patient tested, when including the cost of the test. This represents a potential cost-saving of UK£2,891,196 each year across the NHS in England. CONCLUSIONS: Clinical care with PlGF testing is associated with the potential for cost-savings per participant tested when compared with current practice via a reduction in outpatient attendances, and improves maternal outcomes. This economic analysis supports a role for implementation of PlGF testing in antenatal services for the assessment of women with suspected pre-eclampsia. TWEETABLE ABSTRACT: Placental growth factor testing for suspected pre-eclampsia is cost-saving and improves maternal outcomes.


Assuntos
Técnicas de Diagnóstico Obstétrico e Ginecológico/economia , Fator de Crescimento Placentário/sangue , Pré-Eclâmpsia/sangue , Pré-Eclâmpsia/diagnóstico , Complicações na Gravidez/sangue , Complicações na Gravidez/diagnóstico , Adulto , Biomarcadores/sangue , Análise por Conglomerados , Análise Custo-Benefício , Feminino , Idade Gestacional , Humanos , Modelos Econômicos , Pré-Eclâmpsia/epidemiologia , Pré-Eclâmpsia/fisiopatologia , Gravidez , Complicações na Gravidez/epidemiologia , Complicações na Gravidez/fisiopatologia , Resultado da Gravidez , Reino Unido/epidemiologia
17.
Eur J Epidemiol ; 34(9): 863-870, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31187313

RESUMO

There are known short-term benefits in breastfed infants versus bottle-fed infants in terms of lower risks of infection and obesity in infancy and childhood, but the long-term effect on the risk of adult cancers is unclear. In a cohort of 1 in 4 UK women born in 1935-1950 we report the incidence of adult cancers in relation to having been breastfed in infancy. In median year 2001 (interquartile range 2000-2003) 548,741 women without prior cancer reported whether they had been breastfed. There was 81% agreement between women's report of having been breastfed and information on breastfeeding recorded when they were 2 years old. Participants were followed by record-linkage to national cancer registration, hospital admission and death databases. Cox regression yielded adjusted relative risks (RRs) and 95% confidence intervals (CI) by having been breastfed or not for eight cancer sites with > 2000 incident cases and for related conditions, where appropriate. Of the eight cancers examined here one association was highly statistically significant: an increase in colorectal cancer incidence among women who had been breastfed versus not (RR 1.18, 95% CI 1.12-1.24, n = 8651). To investigate further the findings for colorectal cancer, we studied eight other gastro-intestinal conditions, and found increased risks in women who had been breastfed versus not for benign colorectal polyps (RR 1.09, 95% CI 1.05-1.13, n = 17,677) and for appendicitis (RR 1.19, 95% CI 1.07-1.31, n = 2108). The greater risks of adult colorectal cancer, colorectal polyps and appendicitis associated with having been breastfed in infancy suggest possible long-term effects of infant feeding practices on the gastrointestinal tract. Further studies are required to clarify this novel association.


Assuntos
Aleitamento Materno , Neoplasias Colorretais/epidemiologia , Gastroenteropatias/epidemiologia , Obesidade/epidemiologia , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Comportamento Alimentar , Feminino , Humanos , Incidência , Lactente , Registro Médico Coordenado , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Risco , Reino Unido/epidemiologia
18.
Public Health ; 171: 66-75, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31103615

RESUMO

OBJECTIVES: Over a quarter of UK births are to women who were born outside of the UK. Black and Minority Ethnic (BME) women are disproportionately affected by poor mental health and inequitable access to mental health care in the perinatal period, yet the influence of the migrant status (mothers' UK vs. non-UK birth) is poorly understood. This study aimed to explore the relationship between ethnicity, migration and mental health indicators among mothers participating in a large nationally representative cohort study. STUDY DESIGN: This is a secondary analysis of data from the Millennium Cohort Study. METHODS: Logistic regression quantified the crude and adjusted effects of self-reported ethnicity and migrant status on prevalence of psychological distress and treatment for anxiety/depression at 9-month and 5-year postpartum. RESULTS: We found substantial variation in the prevalence of distress according to ethnicity and migrant status, with Indian and Pakistani women at greatest risk. Despite equal or greater risk, BME and migrant women were less likely to report treatment for anxiety/depression. Mutually adjusted analyses showed ethnicity to be a stronger predictor of both outcomes than migrant status; however, at 5 years, being a migrant independently predicted lower odds of treatment, for a statistically similar level of distress. CONCLUSIONS: Migrant women are likely to be at high risk of poor mental health in the perinatal period and beyond, yet may face significant barriers to accessing mental health care. A better understanding of ethnicity and migration as interrelated risk factors for perinatal mental ill-health is needed to help National Health Service organisations develop policy and practice that is flexible and responsive to diversity.


Assuntos
Grupo com Ancestrais do Continente Africano/psicologia , Grupos Étnicos/psicologia , Transtornos Mentais/epidemiologia , Transtornos Mentais/terapia , Grupos Minoritários/psicologia , Mães/psicologia , Migrantes/psicologia , Adulto , Grupo com Ancestrais do Continente Africano/estatística & dados numéricos , Ansiedade/epidemiologia , Ansiedade/etnologia , Ansiedade/terapia , Estudos de Coortes , Depressão/epidemiologia , Depressão/etnologia , Depressão/terapia , Grupos Étnicos/estatística & dados numéricos , Feminino , Acesso aos Serviços de Saúde , Humanos , Transtornos Mentais/etnologia , Serviços de Saúde Mental , Grupos Minoritários/estatística & dados numéricos , Mães/estatística & dados numéricos , Período Pós-Parto , Gravidez , Prevalência , Fatores de Risco , Autorrelato , Migrantes/estatística & dados numéricos , Reino Unido/epidemiologia
20.
BMC Gastroenterol ; 19(1): 68, 2019 May 02.
Artigo em Inglês | MEDLINE | ID: mdl-31046685

RESUMO

BACKGROUND: Before diagnosis, people with coeliac disease suffer reduced quality of life, which improves substantially after the disease has been diagnosed. Delayed diagnosis is common. The aim of this study was to assess changes over time in prevalence of coeliac disease symptoms/associated medical conditions, time to diagnosis, quality of life and its determinants before and after diagnosis in the United Kingdom. METHODS: A postal questionnaire was designed in 2015 and sent to 4000 individuals with diagnosed coeliac disease, requesting information on respondents' socio-demographic and clinical characteristics, and their quality of life pre- and post-diagnosis using the EQ-5D instrument. Data were analysed and compared with results from a survey conducted in 2006 using descriptive analyses, univariate and multivariable regression methods. RESULTS: The survey response rate was 40%. Sixty-five percent of respondents reported at least 4 symptoms pre-diagnosis, a significant reduction by 13 percentage points (95% CI: -16.9, - 9.4; p-value: < 0.001) compared to 2006. Pre-diagnosis mean duration of symptoms was 12.8 years (SD: 15.3), a non-significant reduction of 0.6 years (95% CI: -2, 0.8; p-value: 0.426) compared to 2006. There was a significant improvement of 0.20 (95% CI: 0.18, 0.22; p-value: < 0.001) in quality of life from pre- (0.65) to post-diagnosis (0.85). Pre-diagnosis values were significantly higher by 0.09 (95% CI: 0.06, 0.12; p-value: < 0.001) than in 2006. Number of symptoms and low income were associated with decreased quality of life. CONCLUSIONS: Undiagnosed coeliac disease is associated with a substantial decrement in quality of life. Time to diagnosis has not significantly shortened over the decade 2006-2015, but symptoms are less severe when diagnosis occurs. Harmonising clinical guidelines for intensified active case finding will help improve quality of life of people with coeliac disease.


Assuntos
Doença Celíaca/diagnóstico , Qualidade de Vida , Adolescente , Adulto , Idoso , Doença Celíaca/dietoterapia , Doença Celíaca/epidemiologia , Comorbidade , Diagnóstico Tardio , Dieta Livre de Glúten , Status Econômico , Feminino , Inquéritos Epidemiológicos , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Pobreza , Prevalência , Reino Unido/epidemiologia , Adulto Jovem
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