RESUMEN
Weather and climate patterns play an intrinsic role in societal health, yet a comprehensive synthesis of specific hazard-mortality causes does not currently exist. Country-level health burdens are thus highly uncertain, but harnessing collective expert knowledge can reduce this uncertainty, and help assess diverse mortality causes beyond what is explicitly quantified. Here, surveying 30 experts, we provide the first structured expert judgement of how weather and climate directly impact mortality, using the UK as an example. Current weather-related mortality is dominated by short-term exposure to hot and cold temperatures leading to cardiovascular and respiratory failure. We find additional underappreciated health outcomes, especially related to long-exposure hazards, including heat-related renal disease, cold-related musculoskeletal health, and infectious diseases from compound hazards. We show potential future worsening of cause-specific mortality, including mental health from flooding or heat, and changes in infectious diseases. Ultimately, this work could serve to develop an expert-based understanding of the climate-related health burden in other countries.
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Cambio Climático , Reino Unido/epidemiología , Humanos , Mortalidad/tendencias , Tiempo (Meteorología) , Clima , Testimonio de ExpertoRESUMEN
INTRODUCTION: The study investigates the relationship between work-related injuries, psychological distress, and the influence of perceived job control on healthcare workers, using Bakker and Demerouti's (2007) job demands-resources model as theoretical grounding. METHOD: We analyzed data from 610 healthcare workers (81.1% female) at a northern UK hospital, incorporating both self-reported and organizationally recorded work injury incidents over the three years preceding the survey, along with measures of psychological distress and perceived job control. RESULTS: Unexpectedly, we found that the occurrence of work-related injuries, irrespective of the method of reporting, is not related to lower psychological distress among those employees who report a high level of job control. This relationship holds even when adjusting for various demographic and occupational variables. CONCLUSIONS AND PRACTICAL APPLICATIONS: Given the prevalence of work injuries in the healthcare sector, our findings suggest a need for a deeper exploration into how job characteristics might interact to offset the consequences of work injuries, challenging existing assumptions and opening new avenues for research into the psychology of workplace safety.
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Personal de Salud , Traumatismos Ocupacionales , Humanos , Femenino , Masculino , Adulto , Traumatismos Ocupacionales/psicología , Traumatismos Ocupacionales/epidemiología , Persona de Mediana Edad , Personal de Salud/psicología , Personal de Salud/estadística & datos numéricos , Distrés Psicológico , Reino Unido/epidemiología , Estrés Psicológico/psicología , Estrés Psicológico/epidemiología , Encuestas y CuestionariosRESUMEN
Shiga-toxin producing Escherichia coli (STEC) O157 is a food-borne pathogen which causes gastrointestinal illness in humans. Ruminants are considered the main reservoir of infection, and STEC exceedance has been associated with heavy rainfall. In September 2022, a large outbreak of STEC O157:H7 was identified in the United Kingdom (UK). A national-level investigation was undertaken to identify the source of the outbreak and inform risk mitigation strategies. Whole genome sequencing (WGS) was used to identify outbreak cases. Overall, 259 cases with illness onset dates between 5 August and 12 October 2022, were confirmed across the UK. Epidemiological investigations supported a UK grown, nationally distributed, short shelf-life food item as the source of the outbreak. Analytical epidemiology and food chain analysis suggested lettuce as the likely vehicle of infection. Food supply chain tracing identified Grower X as the likely implicated producer. Independent of the food chain investigations, a novel geospatial analysis triangulating meteorological, flood risk, animal density and land use data was developed, also identifying Grower X as the likely source. Novel geospatial analysis and One Health approaches are potential tools for upstream data analysis to predict and prevent contamination events before they occur and to support evidence generation in outbreak investigations.
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Cambio Climático , Brotes de Enfermedades , Infecciones por Escherichia coli , Escherichia coli O157 , Microbiología de Alimentos , Enfermedades Transmitidas por los Alimentos , Lactuca , Lactuca/microbiología , Humanos , Infecciones por Escherichia coli/epidemiología , Infecciones por Escherichia coli/microbiología , Infecciones por Escherichia coli/transmisión , Reino Unido/epidemiología , Escherichia coli O157/aislamiento & purificación , Escherichia coli O157/genética , Enfermedades Transmitidas por los Alimentos/epidemiología , Enfermedades Transmitidas por los Alimentos/microbiología , Secuenciación Completa del Genoma , Escherichia coli Shiga-Toxigénica/aislamiento & purificación , Escherichia coli Shiga-Toxigénica/genética , Adulto , Persona de Mediana Edad , Femenino , Masculino , Contaminación de Alimentos/análisis , Anciano , Animales , Adolescente , NiñoRESUMEN
BACKGROUND: Although healthy sleep patterns have been linked to a lower risk of cardiovascular disease in earlier research, it is unclear how beneficial they are for venous thromboembolism (VTE). AIM: This research aimed to examine the correlation between sleep patterns, genetic susceptibility, and VTE. METHODS: In the UK Biobank cohort, healthy sleep behaviors were defined as early chronotype, 7-8 hours of sleep each day, no snoring, infrequent insomnia, and infrequent daytime sleepiness. Each of the five criteria was given 1 point, creating a healthy sleep score ranging from 0 to 5. Cox proportional hazards regression models were utilized to examine the associations between genetic susceptibility, healthy sleep score and VTE. RESULTS: The UK Biobank study included 384,758 participants aged 56.6 ± 8.0 years. After a median of 11.9 years of follow-up, 8,885 (2.3%) participants were diagnosed with VTE. A healthy sleep score inversely affected VTE risk. For participants with a score of 5, the hazard ratio of VTE was 0.813 (95% confidence interval: 0.758-0.873, P<0.001) compared to those with a score ≤2. Early chronotype, sleeping 7-8 hours each day, infrequent insomnia, and infrequent daytime sleepiness were significantly associated with a 7.9%, 8.3%, 5.1%, and 20.7% lower risk of VTE, respectively. In addition, the correlation between sleep pattern and the incidence of VTE was consistent, regardless of genetic susceptibility (P for interaction = 0.366). CONCLUSIONS: Our secondary analysis of a large-scale prospectively gathered registry revealed that individuals with a healthy sleep pattern are significantly correlated with lower risk of developing VTE, irrespective of genetic susceptibility.
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Bancos de Muestras Biológicas , Predisposición Genética a la Enfermedad , Sueño , Tromboembolia Venosa , Humanos , Tromboembolia Venosa/genética , Tromboembolia Venosa/epidemiología , Persona de Mediana Edad , Masculino , Femenino , Reino Unido/epidemiología , Estudios Prospectivos , Sueño/genética , Sueño/fisiología , Anciano , Factores de Riesgo , Modelos de Riesgos Proporcionales , Adulto , Biobanco del Reino UnidoRESUMEN
Streptococcus mitis is a leading cause of infective endocarditis (IE). However, our understanding of the genomic epidemiology and pathogenicity of IE-associated S. mitis is hampered by low IE incidence. Here we use whole genome sequencing of 129 S. mitis bloodstream infection (BSI) isolates collected between 2001-2016 from clinically diagnosed IE cases in the UK to investigate genetic diversity, antimicrobial resistance, and pathogenicity. We show high genetic diversity of IE-associated S. mitis with virtually all isolates belonging to distinct lineages indicating no predominance of specific lineages. Additionally, we find a highly variable distribution of known pneumococcal virulence genes among the isolates, some of which are overrepresented in disease when compared to carriage strains. Our findings suggest that S. mitis in patients with clinically diagnosed IE is not primarily caused by specific hypervirulent or antimicrobial resistant lineages, highlighting the accidental pathogenic nature of S. mitis in patients with clinically diagnosed IE.
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Bacteriemia , Infecciones Estreptocócicas , Streptococcus mitis , Humanos , Streptococcus mitis/genética , Streptococcus mitis/aislamiento & purificación , Reino Unido/epidemiología , Infecciones Estreptocócicas/microbiología , Infecciones Estreptocócicas/epidemiología , Irlanda/epidemiología , Bacteriemia/microbiología , Bacteriemia/epidemiología , Endocarditis/microbiología , Endocarditis/epidemiología , Genoma Bacteriano/genética , Secuenciación Completa del Genoma , Masculino , Femenino , Variación Genética , Genómica , Anciano , Filogenia , Persona de Mediana Edad , Farmacorresistencia Bacteriana/genética , Endocarditis Bacteriana/microbiología , Endocarditis Bacteriana/epidemiología , Adulto , Factores de Virulencia/genética , Antibacterianos/farmacología , Antibacterianos/uso terapéutico , Virulencia/genéticaRESUMEN
BACKGROUND: Sex disparity between metabolic-obesity (defined by body mass index, BMI) phenotypes and obesity-related cancer (ORC) remains unknown. Considering BMI reflecting overall obesity but not fat distribution, we aimed to systematically assess the association of our newly proposed metabolic-anthropometric phenotypes with risk of overall and site-specific ORC by sex. METHODS: A total of 141,579 men (mean age: 56.37 years, mean follow-up time: 12.04 years) and 131,047 women (mean age: 56.22 years, mean follow up time: 11.82 years) from the UK Biobank was included, and designated as metabolic-anthropometric phenotypes based on metabolic status (metabolically healthy/unhealthy), BMI (non-obesity/obesity) and body shape (pear/slim/apple/wide). The sex-specific association of different phenotypes with overall and site-specific ORC was assessed by hazard ratios (HRs) and 95% confidence intervals (CIs) using Cox proportional hazards regression models. RESULTS: We found metabolically unhealthy and/or obesity phenotypes conveyed a higher risk in men than in women for overall ORC and colorectal cancer compared with metabolically healthy non-obesity phenotype (Pinteraction < 0.05). Of note, metabolically healthy obesity phenotype contributed to increased risks of most ORC in men (HRs: 1.58 ~ 2.91), but only correlated with higher risks of endometrial (HR = 1.89, 95% CI: 1.54-2.32) and postmenopausal breast cancers (HR = 1.17, 95% CI: 1.05-1.31) in women. Similarly, even under metabolically healthy, men carrying apple and wide shapes phenotypes (metabolically healthy apple/wide and metabolically healthy non-obesity apple/wide) suffered an increased risk of ORC (mainly colorectal, liver, gastric cardia, and renal cancers, HRs: 1.20 ~ 3.81) in comparison with pear shape or non-obesity pear shape. CONCLUSIONS: There was a significant sex disparity between metabolic-anthropometric phenotypes and ORC risk. We advised future ORC prevention and control worth taking body shape and sex disparity into account.
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Neoplasias , Obesidad , Fenotipo , Humanos , Masculino , Femenino , Persona de Mediana Edad , Obesidad/epidemiología , Obesidad/complicaciones , Estudios Prospectivos , Neoplasias/epidemiología , Índice de Masa Corporal , Anciano , Reino Unido/epidemiología , Factores Sexuales , Factores de Riesgo , Antropometría , AdultoRESUMEN
The Epidemic Diseases Act (EDA) was enacted in February 1897 by the Government of India to prevent and control the spread of the plague. Since then, the Act has become a key legal tool for the control of epidemics/pandemics in India. We attempted to understand the international and domestic pressures that led to the adoption of the EDA in three ways. First, we analyse the legislative structure (Bombay Municipal Act of 1888, Indian Railways Act of 1890, and Act I of 1870) that dealt with infectious or contagious diseases in colonial India before the EDA came into force. Second, we focus on the linkages between international and domestic pressures that necessitated the adoption of the EDA. Third, we analyse the discussions of the Council of the Governor General of India on the bill titled 'A Bill to Provide for the better prevention of the spread of Dangerous Epidemic Diseases', which later became the Epidemic Diseases Act No. III of 1897. We situate the EDA in an international context of International Sanitary Conferences, quarantine, trade concerns, and pilgrimage to Mecca in order to understand the pressures that impacted British epidemic policy formation in colonial India.
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Epidemias , India/epidemiología , Humanos , Epidemias/historia , Epidemias/prevención & control , Epidemias/legislación & jurisprudencia , Reino Unido/epidemiología , Política de Salud/historia , Política de Salud/legislación & jurisprudencia , Historia del Siglo XIX , Control de Enfermedades Transmisibles/legislación & jurisprudencia , Control de Enfermedades Transmisibles/historia , Formulación de PolíticasAsunto(s)
Infecciones por Parvoviridae , Parvovirus B19 Humano , Humanos , Reino Unido/epidemiología , Parvovirus B19 Humano/aislamiento & purificación , Infecciones por Parvoviridae/epidemiología , Infecciones por Parvoviridae/virología , Adulto , Masculino , Femenino , Adolescente , Adulto Joven , Niño , Persona de Mediana Edad , Preescolar , Enfermedad Aguda/epidemiologíaRESUMEN
OBJECTIVE: Colorectal cancer (CRC) is the fourth most common cancer in the UK. Patients with symptoms suggestive of CRC should be referred for urgent investigation. However, gastrointestinal symptoms are often non-specific and there is a need for suitable triage tools to enable prioritisation of investigations. In this study, the performance of the faecal immunochemical test (FIT), anaemia and the artificial intelligence algorithm ColonFlag were retrospectively examined and evaluated for their potential clinical benefits in patients who had been referred on an urgent lower gastrointestinal cancer pathway. DESIGN: All patients aged over 40 years referred in a 12-month period were included. After 6 months, clinical outcomes were determined and the performance of the triage tests was evaluated. RESULTS: A total of 3822 patients completed investigations and received a diagnosis. 143 had CRC, 126 high-risk adenomas (HRA). ColonFlag would have missed 27 CRC and 29 HRA. Faecal haemoglobin (f-Hb) at a cut-off of 10 µg/g would have missed 10 CRC and 26 HRA; f-Hb in combination with anaemia would have missed 2 CRC and 14 HRA. Using f-Hb in combination with ColonFlag would have missed only 1 CRC and 5 HRA and would have reduced the need for urgent referral by over 400 patients. CONCLUSION: ColonFlag has potential to assist detection of CRC and HRA, alone where no faecal sample is present and in combination with FIT and to reduce the need for urgent referral.
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Anemia , Inteligencia Artificial , Neoplasias Colorrectales , Detección Precoz del Cáncer , Hemoglobinas , Sangre Oculta , Humanos , Femenino , Masculino , Estudios Retrospectivos , Persona de Mediana Edad , Anciano , Neoplasias Colorrectales/diagnóstico , Anemia/diagnóstico , Detección Precoz del Cáncer/métodos , Hemoglobinas/análisis , Algoritmos , Adulto , Heces/química , Triaje/métodos , Adenoma/diagnóstico , Adenoma/patología , Reino Unido/epidemiología , Derivación y Consulta/estadística & datos numéricos , Anciano de 80 o más AñosRESUMEN
The relationship between psoriasis and site-specific cancers remains unclear. Here, we aim to investigate whether psoriasis is causally associated with site-specific cancers. We use observational and genetic data from the UK Biobank, obtaining GWAS summary data, eQTL analysis data, TCGA data, and GTEx data from public datasets. We perform PheWAS, polygenic risk score analysis, and one-sample and two-sample Mendelian randomization analyses to investigate the potential causal associations between psoriasis and cancers. In the unselected PheWAS analysis, psoriasis is associated with higher risks of 16 types of cancer. Using one-sample Mendelian randomization analyses, it is found that genetically predicted psoriasis is associated with higher risks of anal canal cancer, breast cancer, follicular non-Hodgkin's lymphoma and nonmelanoma skin cancer in women; and lung cancer and kidney cancer in men. Our two-sample Mendelian randomization analysis indicates that psoriasis is causally associated with breast cancer and lung cancer. Gene annotation shows that psoriasis-related genes, such as ERAP1, are significantly different in lung and breast cancer tissues. Taken together, clinical attention to lung cancer and breast cancer may be warranted among patients with psoriasis.
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Predisposición Genética a la Enfermedad , Estudio de Asociación del Genoma Completo , Análisis de la Aleatorización Mendeliana , Psoriasis , Humanos , Psoriasis/genética , Psoriasis/epidemiología , Femenino , Masculino , Neoplasias/genética , Neoplasias/epidemiología , Polimorfismo de Nucleótido Simple , Factores de Riesgo , Neoplasias de la Mama/genética , Neoplasias de la Mama/epidemiología , Reino Unido/epidemiología , Neoplasias Pulmonares/genética , Neoplasias Pulmonares/epidemiología , Persona de Mediana Edad , Sitios de Carácter Cuantitativo , Herencia Multifactorial/genéticaRESUMEN
Many studies use a reductionist approach to isolate the influence of one factor in childhood on multimorbidity rather than consider the combined effect of wider determinants. We explored how potential multiple early life determinants of multimorbidity can be characterised across three UK cohort studies. We used the National Child Development Study (NCDS), the 1970 British Cohort Study (BCS70), and the Aberdeen Children of the 1950s Study (ACONF) to identified early life variables that fit into 12 conceptualised domains of early life determinants of multimorbidity. Variables were assigned into 12 domains; principal component analysis reduced the dimensionality of the data and structured variables into subgroups. The data audit identified 7 domains in ACONF, 10 domains in NCDS and 12 domains in BCS70. Dominant components included maternal fertility histories within the prenatal, antenatal and birth domain, long-term illnesses within the child health domain, educational ability within the child education and health literacy domain, ethnicity within the demography domain, parental health behaviours within the transgenerational domain, housing within the socioeconomic domain and parental-child interactions within the parental-family domain. We demonstrated that if multiple large scale longitudinal studies are used, there is enough data available for researchers to consider conceptualising early life risk factors of multimorbidity across groups or domains. Such conceptualisation can help challenge the existing understanding of disease aetiology and develop new ideas for prevention of multimorbidity.
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Multimorbilidad , Humanos , Reino Unido/epidemiología , Estudios Longitudinales , Femenino , Masculino , Factores de Riesgo , Niño , Adulto , Factores Socioeconómicos , Preescolar , AdolescenteRESUMEN
The metabolomic profile of aging is complex. Here, we analyse 325 nuclear magnetic resonance (NMR) biomarkers from 250,341 UK Biobank participants, identifying 54 representative aging-related biomarkers associated with all-cause mortality. We conduct genome-wide association studies (GWAS) for these 325 biomarkers using whole-genome sequencing (WGS) data from 95,372 individuals and perform multivariable Mendelian randomization (MVMR) analyses, discovering 439 candidate "biomarker - disease" causal pairs at the nominal significance level. We develop a metabolomic aging score that outperforms other aging metrics in predicting short-term mortality risk and exhibits strong potential for discriminating aging-accelerated populations and improving disease risk prediction. A longitudinal analysis of 13,263 individuals enables us to calculate a metabolomic aging rate which provides more refined aging assessments and to identify candidate anti-aging and pro-aging NMR biomarkers. Taken together, our study has presented a comprehensive aging-related metabolomic profile and highlighted its potential for personalized aging monitoring and early disease intervention.
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Envejecimiento , Bancos de Muestras Biológicas , Biomarcadores , Estudio de Asociación del Genoma Completo , Metabolómica , Humanos , Envejecimiento/genética , Envejecimiento/metabolismo , Reino Unido/epidemiología , Masculino , Femenino , Metabolómica/métodos , Anciano , Persona de Mediana Edad , Biomarcadores/metabolismo , Análisis de la Aleatorización Mendeliana , Espectroscopía de Resonancia Magnética , Metaboloma , Estudios Longitudinales , Secuenciación Completa del Genoma , Adulto , Anciano de 80 o más Años , Biobanco del Reino UnidoRESUMEN
OBJECTIVE: The chronic pain syndromes (CPS) include syndromes such as chronic widespread pain (CWP), dry eye disease (DED) and irritable bowel syndrome (IBS). Highly prevalent and lacking pathognomonic biomarkers, the CPS are known to cluster in individuals in part due to their genetic overlap, but patient diagnosis can be difficult. The success of quantitative sensory testing (QST) and inflammatory biomarkers as phenotyping tools in conditions such as painful neuropathies warrant their investigation in CPS. We aimed to examine whether individual QST modalities and candidate inflammatory markers were associated with CWP, DED or IBS in a large, highly phenotyped population sample. DESIGN: Cross-sectional study. SETTING: Community-dwelling cohort. PARTICIPANTS: Twins from the TwinsUK cohort PRIMARY AND SECONDARY OUTCOME MEASURES: We compared 10 QST modalities, measured in participants with and without a CWP diagnosis between 2007 and 2012. We investigated whether inflammatory markers measured by Olink were associated with CWP, including interleukin-6 (IL-6), IL-8, IL-10, monocyte chemoattractant protein-1 and tumour necrosis factor. All analyses were repeated in DED and IBS with correction for multiple testing. RESULTS: In N=3022 twins (95.8% women), no association was identified between individual QST modalities and CPS diagnoses (CWP, DED and IBS). Analyses of candidate inflammatory marker levels and CPS diagnoses in n=1368 twins also failed to meet statistical significance. CONCLUSION: Our findings in a large population cohort suggest a lack of true association between singular QST modalities or candidate inflammatory markers and CPS.
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Dolor Crónico , Síndromes de Ojo Seco , Síndrome del Colon Irritable , Humanos , Estudios Transversales , Masculino , Femenino , Dolor Crónico/diagnóstico , Persona de Mediana Edad , Síndrome del Colon Irritable/diagnóstico , Adulto , Síndromes de Ojo Seco/diagnóstico , Anciano , Biomarcadores/sangre , Interleucina-6/sangre , Interleucina-8/sangre , Factor de Necrosis Tumoral alfa/sangre , Quimiocina CCL2/sangre , Reino Unido/epidemiología , Interleucina-10/sangre , Dimensión del Dolor/métodosRESUMEN
BACKGROUND: Despite persistent concerns about only children's disadvantage relative to individuals with siblings, existing health-related evidence is inconsistent. Recent evidence from Nordic countries about only children having poorer health outcomes may not apply elsewhere because selection processes differ across contexts. We investigate the midlife health of only children in the UK where one-child families tend to be socio-economically advantaged relative to large families. METHODS: Using the 1946, 1958 and 1970 British birth cohort studies, we examine various biomarkers and self-reported measures of chronic disease by sibship size when respondents are aged in their mid-40s, mid-50s and mid-60s. We estimate separate linear probability models for each cohort, age and outcome, adjusting for childhood and early adulthood circumstances. RESULTS: We found no evidence of only children differing from those with one, two or three or more siblings, at any age, in any of the cohorts, on: heart problems, hypertension, high triglycerides, high glycated haemoglobin or high C-reactive protein. However, compared with only children, the probability for cancer (0.019, 95% confidence interval [CI]: 0.002, 0.035; age 46/1970) and poor general health (0.060, CI: 0.015, 0.127; age 55/1958; and 0.110, CI: 0.052, 0.168; age 63/1946) was higher among those with three or more siblings. CONCLUSIONS: There is no consistent pattern of only child health disadvantage for midlife chronic disease outcomes across ages or cohorts in the UK. Research should focus on better understanding how sibship size differentials are contingent on context.
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Biomarcadores , Hermanos , Humanos , Masculino , Reino Unido/epidemiología , Femenino , Biomarcadores/sangre , Enfermedad Crónica/epidemiología , Persona de Mediana Edad , Adulto , Niño , Estado de Salud , Composición Familiar , Factores Socioeconómicos , Cohorte de Nacimiento , Estudios de CohortesRESUMEN
BACKGROUND: Psychological and trauma-related factors are associated with many diseases and mortality. However, a comprehensive assessment of the association between psycho-trauma exposures and aging acceleration is currently lacking. METHODS: Using data from 332,359 UK Biobank participants, we calculated biological aging acceleration, indexed by the presence of leukocyte telomere length (LTL) deviation (i.e., the difference between genetically determined and observed LTL > 0). The acceleration of facial aging (i.e., looking older than the chronological age) was assessed using a self-report question. Then, we estimated the associations of each psycho-trauma factor with biological and facial aging acceleration, using logistic regression models adjusted for multiple important covariates. Furthermore, restricted to 99,180 participants with complete psychological and trauma-related data, we identified clusters of individuals with distinct psycho-trauma patterns using the latent class analysis method and assessed their associations with aging acceleration using similar models. RESULTS: We observed most of the studied psycho-trauma factors were associated with biological and facial aging acceleration. Compared to the "Absence of trauma and psychopathology" cluster, the "adverse childhood experiences (ACEs) with psychopathology" cluster showed strong associations with those aging measurements (odds ratio [OR] = 1.13 [1.05 - 1.23] for biological and 1.52 [1.18 - 1.95] for facial aging acceleration), while no such association was observed for the "ACEs without psychopathology" cluster (1.04 [0.99 - 1.09] and 1.02 [0.84 - 1.24]. CONCLUSIONS: Our study demonstrated significant associations of psycho-trauma factors with both biological and facial aging acceleration. The differential aging consequences observed among ACEs exposed individuals with and without psychopathology prompt interventions aimed to improve individuals' psychological resilience to prevent aging acceleration.
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Envejecimiento , Humanos , Reino Unido/epidemiología , Masculino , Femenino , Persona de Mediana Edad , Envejecimiento/fisiología , Anciano , Bancos de Muestras Biológicas , Adulto , Cara , Leucocitos , Experiencias Adversas de la Infancia , Biobanco del Reino UnidoRESUMEN
Introduction: Hepatitis C virus (HCV) is not currently included in the United Kingdom routine antenatal screening program, but the latest guidelines from the Centers for Disease Control and Prevention, American Association for the Study of Liver Diseases, and Infectious Diseases Society of America recommend HCV screening for all pregnant women during each pregnancy. The aim of this study was to collect qualitative data on the feasibility and acceptability of antenatal HCV screening in pregnant women at the time of routine antenatal screening at 12 weeks, to estimate patient knowledge about HCV and identify the prevalence of HCV infection in antenatal women. Methods: This was a pilot study targeting a single hospital-based antenatal clinic in Birmingham, initially conducted for eight weeks with a further extension of the study period to enhance recruitment to meet the feasibility target of 500 patients. Data collected included demographic and epidemiological details. Pregnant women attending the antenatal unit were given information regarding HCV and antenatal screening for HCV prior to their initial antenatal visit. During the antenatal visit, research nurses provided further information about the study and HCV infection. Consent was obtained for taking part in the study and testing for HCV using blood samples taken at the same time as other routine antenatal screening blood tests. All women who agreed to participate in the study were asked to complete an acceptability and knowledge questionnaire. All women had HCV antibody testing as the primary screening assay. The test result was communicated in writing to the women and their general practitioner. Confirmatory positive antibody tests were followed up with quantitative HCV PCR and genotype analysis. The outcomes of testing were no evidence of HCV infection and evidence of past HCV infection or current HCV infection. Results: Five hundred and forty-nine women were approached in the antenatal clinic; 30 women refused consent while 29 women were excluded from the study (blood tests not performed after consenting, age less than 18 years, and consent form lost). Four hundred and ninety women were included in the study. The median age of the study population was 29 years (range, 18-46). Knowledge about blood-borne viruses was limited; 75% of women had some understanding about antenatal hepatitis B (HBV) and human immunodeficiency virus (HIV) testing. Previous awareness about hepatitis C was reported by 55%. Ninety-one percent of women found the information they were given about hepatitis C helpful. Ninety-six percent of the women included in this study found the counselling they received about HCV useful and felt that the delivery of this information was carried out in an acceptable manner. Once given information about HCV, 99% felt that universal screening for HCV should be implemented. HCV antibody was negative in 489 women. One patient with a positive HCV antibody (prevalence: 0.2%) had a negative HCV PCR. Conclusion: Routine antenatal screening for HCV is not currently recommended in the UK. Our study suggests that antenatal HCV screening would be both feasible and acceptable to most pregnant women attending antenatal clinics. Though the awareness of HCV was low, with appropriate counselling and communication, 99% of pregnant women were in favor of antenatal screening for HCV. Antenatal screening would identify HCV-positive mothers and allow follow-up of their infants so that any infected mothers and infants could be offered effective curative therapy and prevent the progression of liver disease. The inclusion of HCV antenatal screening would complete the blood-borne virus profile and enhance the WHO target to eliminate HCV in the UK.
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Estudios de Factibilidad , Conocimientos, Actitudes y Práctica en Salud , Hepatitis C , Tamizaje Masivo , Aceptación de la Atención de Salud , Complicaciones Infecciosas del Embarazo , Humanos , Femenino , Embarazo , Proyectos Piloto , Adulto , Complicaciones Infecciosas del Embarazo/diagnóstico , Complicaciones Infecciosas del Embarazo/epidemiología , Hepatitis C/diagnóstico , Hepatitis C/epidemiología , Aceptación de la Atención de Salud/estadística & datos numéricos , Tamizaje Masivo/métodos , Reino Unido/epidemiología , Diagnóstico Prenatal/métodos , Diagnóstico Prenatal/estadística & datos numéricos , Atención Prenatal/métodos , Hepacivirus/aislamiento & purificación , Hepacivirus/genética , Adulto Joven , Prevalencia , Encuestas y CuestionariosRESUMEN
The incidence of mental health problems is increasing in the United Kingdom and may be associated with lower dietary quality. Food expenditure is a marker of food insecurity with potential implications for mental health. This analysis considers data collected as part of the United Kingdom Household Longitudinal Survey (UKHLS), also known as 'Understanding Society' (2009-2021) (N = 388,944) to determine the extent to which food expenditure within and outside the household, is associated with mental health, whilst controlling for demographic factors. Mental health was measured using the General Health Questionnaire (GHQ-12) for which responses were on a 4-point scale and reverse-scored so that a higher score represented more favourable mental health. Household food expenditure and food expenditure outside the home were the outcomes. Controlling for socioeconomic and demographic factors, fixed-effects models indicated that better mental health was associated with greater household food expenditure and with greater food expenditure outside the home and that this association persisted post-lockdown. Among those on lower incomes better mental health was associated with lower food expenditure. When people who identified as white and non-white were modelled separately, better mental health was associated with lower food expenditure within and beyond the household only in those who identified as white. These findings imply that the mental health of people residing in the UK, particularly those on lower incomes and those who identify as white, may benefit from spending less of the household budget on food. In achieving United Nations General Assembly (2012) Sustainable Development Goals related to poverty, hunger and in promoting mental health, policies are needed to render food more affordable and to reduce other aspects of expenditure that impact upon food budgeting.
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Composición Familiar , Renta , Salud Mental , Humanos , Reino Unido/epidemiología , Salud Mental/estadística & datos numéricos , Estudios Longitudinales , Femenino , Masculino , Renta/estadística & datos numéricos , Adulto , Persona de Mediana Edad , Inseguridad Alimentaria/economía , Factores Socioeconómicos , Adulto Joven , Encuestas y Cuestionarios , AdolescenteRESUMEN
INTRODUCTION: Posterior native hip dislocations (NHD) are high-energy injuries. Thompson-Epstein Type I dislocations describe those without significant associated femoral or acetabular fracture. The aim of this study was to compare the clinical and radiological outcomes of patients with Type I NHDs. We also evaluate the association between radiological indicators of femoroacetabular impingement (FAI) and NHD. PATIENTS AND METHODS: A retrospective study from January 2012 to May 2021 compared skeletally mature patients (⩾16 years) with Type I posterior NHD to age and gender-matched controls with Type II-V posterior NHD. Patient demographics, mechanism of injury, complications and patient-reported outcome measures (PROMs) are presented. Post reduction radiographs and computed tomography were used to assess for FAI. Univariate analyses were performed to evaluate radiological outcomes. RESULTS: 13 patients (77% male) with Type I posterior NHD were compared to a control group of 40 patients (80% male) with Type II-V posterior NHD. 11 patients in the study group and 14 in the control group experienced isolated injuries (p = 0.01). Post-reduction complications were similar. The study group had significantly lower post-injury osteoarthritis incidence (n = 0) compared to controls (n = 18, p = 0.0083). Patients reported a mean Oxford Hip Score of 43.5 ± 2.2 and EQ-5D-VAS score of 87.1 ± 7.4, with 6 patients indicating minimal symptoms across all EQ-5D-5L domains. Radiological femoroacetabular impingement (FAI) was prevalent in both groups, especially among males. CONCLUSIONS: Patients who underwent emergent closed reduction of Type I NHD demonstrated good short to medium term outcomes. Our radiological findings suggest a high prevalence of FAI. Future work should aim to quantify longer term outcomes following this injury. We call for further comparative studies of patients who suffer NHD with and without fractures to aid our understanding of risk factors. Given the rarity of this injury, multicentre efforts will be required to capture large numbers of patients.
Asunto(s)
Pinzamiento Femoroacetabular , Luxación de la Cadera , Centros Traumatológicos , Humanos , Masculino , Femenino , Estudios Retrospectivos , Adulto , Reino Unido/epidemiología , Luxación de la Cadera/diagnóstico por imagen , Luxación de la Cadera/epidemiología , Persona de Mediana Edad , Pinzamiento Femoroacetabular/diagnóstico por imagen , Pinzamiento Femoroacetabular/epidemiología , Adulto Joven , Medición de Resultados Informados por el Paciente , Acetábulo/lesiones , Acetábulo/diagnóstico por imagen , Tomografía Computarizada por Rayos X/métodos , Fracturas del Fémur/diagnóstico por imagen , Fracturas del Fémur/epidemiología , Anciano , AdolescenteRESUMEN
BACKGROUND: Many disease processes are influenced by circadian clocks and display ~24-hour rhythms. Whether disruptions to these rhythms increase stroke risk is unclear. We evaluated the association between 24-hour rest-activity rhythms, stroke risk, and major poststroke adverse outcomes. METHODS AND RESULTS: We examined ~100 000 participants from the UK Biobank (aged 44-79 years; ~57% women) assessed with actigraphy (6-7 days) and 5-year median follow-up. We derived (1) most active 10-hour activity counts across the 24-hour cycle and the timing of its midpoint timing; (2) the least active 5-hour count and its midpoint; (3) relative amplitude; (4) interdaily stability; and (5) intradaily variability, for stability and fragmentation of the rhythm. Cox proportional hazard models were constructed for time to (1) incident stroke (n=1652) and (2) poststroke adverse outcomes (dementia, depression, disability, or death). Suppressed relative amplitude (lowest quartile [quartile 1] versus the top quartile [quartile 4]) was associated with stroke risk (hazard ratio [HR], 1.61 [95% CI, 1.35-1.92]; P<0.001) after adjusting for demographics. Later most active 10-hour activity count midpoint timing (14:00-15:26; HR, 1.26 [95% CI, 1.07-1.49]; P=0.007) also had higher stroke risk than earlier (12:17-13:10) participants. A fragmented rhythm (intradaily variability) was also associated with higher stroke risk (quartile 4 versus quartile 1; HR, 1.26 [95% CI, 1.06-1.49]; P=0.008). Suppressed relative amplitude was associated with risk for poststroke adverse outcomes (quartile 1 versus quartile 4; HR, 2.02 [95% CI, 1.46-2.48]; P<0.001). All associations were independent of age, sex, race, obesity, sleep disorders, cardiovascular diseases or risks, and other comorbidity burdens. CONCLUSIONS: Suppressed 24-hour rest-activity rhythm may be a risk factor for stroke and an early indicator of major poststroke adverse outcomes.