Risk of cancer in first seven years after metal-on-metal hip replacement compared with other bearings and general population: linkage study between the National Joint Registry of England and Wales and hospital episode statistics.

addresses: Musculosketal Research Unit, School of Clinical Sciences, University of Bristol, Avon Orthopaedic Centre, Bristol BS10 5NB, UK. [email protected]: PMCID: PMC3318111types: Journal Article; Research Support, Non-U.S. Gov'tCopyright © 2012 by the BMJ Publishing Group Ltd. This articles was first published in: BMJ, 2012, Vol. 344, pp. e2383 -To determine whether use of metal-on-metal bearing surfaces is associated with an increased risk of a diagnosis of cancer in the early years after total hip replacement and specifically with an increase in malignant melanoma and haematological, prostate, and renal tract cancers

How do sectoral policies support climate compatible development? An empirical analysis focusing on southern Africa

Promoting inclusive and sustainable economic and social development whilst simultaneously adapting to climate change impacts and mitigating greenhouse gas emissions – Climate Compatible Development (CCD) – requires coherent policy approaches that span multiple sectors. This paper develops and applies a qualitative content analysis to assess national sector policies of ten southern African countries to determine their approaches for water, agriculture, forestry and energy and their compatibility with the aims of the three dimensions of CCD (development, climate adaptation and climate mitigation). Results indicate that sector policies currently only partially support shifts towards CCD, with approaches that both complement and detract from CCD being prioritized by national governments. Agriculture offers the greatest number of potentially viable approaches capable of achieving the development, adaptation and mitigation aims inherent in CCD, while energy the least. National governments should focus on developing coherent, cross-sector approaches that deliver such potential triple wins in order to promote new forms of inclusive and sustainable economic and social development, whilst facilitating adaptation to climate change impacts and supporting mitigation activities. Doing so will also go a long way towards ensuring the progress needed for achieving the Sustainable Development Goals (SDGs) and Nationally Determined Contributions (NDCs) to the Paris Climate Agreement

The role of rewilding in mitigating hydrological extremes: State of the evidence

Landscape rewilding has the potential to help mitigate hydrological extremes by allowing natural processes to function. Our systematic review assessed the evidence base for rewilding-driven mitigation of high and low flows. The review uncovers a lack of research directly addressing rewilding, but highlights research in analogue contexts which can, with caution, indicate the nature of change. There is a lack of before-after studies that enable deeper examination of temporal trajectories and legacy effects, and a lack of research on the scrub and shrubland habitats common in rewilding projects. Over twice as much evidence is available for high flows compared to low flows, and fewer than one third of studies address high and low flows simultaneously, limiting our understanding of co-benefits and contrasting effects. Flow magnitude variables are better represented within the literature than flow timing variables, and there is greater emphasis on modeling for high flows, and on direct measurement for low flows. Most high flow studies report a mitigating effect, but with variability in the magnitude of effect, and some exceptions. The nature of change for low flows is more complex and suggests a higher potential for increased low flow risks associated with certain trajectories but is based on a very narrow evidence base. We recommend that future research aims to: capture effects on both high and low flow extremes for a given type of change; analyze both magnitude and timing characteristics of flow extremes; and examine temporal trajectories (before and after data) ideally using a full before-after-control-impact design. This article is categorized under: Human Water > Value of Water Science of Water > Hydrological Processes Science of Water > Water Extremes Water and Life > Conservation, Management, and Awareness

Evaluation of stability of directly standardized rates for sparse data using simulation methods.

Background Directly standardized rates (DSRs) adjust for different age distributions in different populations and enable, say, the rates of disease between the populations to be directly compared. They are routinely published but there is concern that a DSR is not valid when it is based on a “small” number of events. The aim of this study was to determine the value at which a DSR should not be published when analyzing real data in England. Methods Standard Monte Carlo simulation techniques were used assuming the number of events in 19 age groups (i.e., 0–4, 5–9, ... 90+ years) follow independent Poisson distributions. The total number of events, age specific risks, and the population sizes in each age group were varied. For each of 10,000 simulations the DSR (using the 2013 European Standard Population weights), together with the coverage of three different methods (normal approximation, Dobson, and Tiwari modified gamma) of estimating the 95% confidence intervals (CIs), were calculated. Results The normal approximation was, as expected, not suitable for use when fewer than 100 events occurred. The Tiwari method and the Dobson method of calculating confidence intervals produced similar estimates and either was suitable when the expected or observed numbers of events were 10 or greater. The accuracy of the CIs was not influenced by the distribution of the events across categories (i.e., the degree of clustering, the age distributions of the sampling populations, and the number of categories with no events occurring in them). Conclusions DSRs should not be given when the total observed number of events is less than 10. The Dobson method might be considered the preferred method due to the formulae being simpler than that of the Tiwari method and the coverage being slightly more accurate

Anterior interosseous nerve syndrome: retrospective analysis of 14 patients

Introduction: The anterior interosseous nerve (AIN) is a only motor nerve innervating the deep muscles of the forearm. Its compression is rare. We present a retrospective analysis of 14 patients with an AIN syndrome with a variety of clinical manifestations who underwent operative and conservative treatment. Patients and methods: Fourteen patients (six female, eight male, mean age 48 ± 9 years) were included. In six patients, the right limb was affected, and in eight patients the left limb. Conservative treatment was started for every patient. If no signs of recovery appeared within 3 months, operative exploration was performed. Final assessment was performed between 2 and 9 years after the onset of paralysis (mean duration of follow-up 46 ± 11 months). Patients were examined clinically for return of power, range of motion, pinch and grip strengths. Also the disability of the arm, shoulder, and hand (DASH) score was calculated. Results: Seven of our 14 patients had incomplete AIN palsy with isolated total loss of function of flexor pollicis longus (FPL), five of FPL and flexor digitorum profundus (FDP)1 simultaneously, and two of FDP1. Weakness of FDP2 could be seen in four patients. Pronator teres was paralysed in two patients. Pain in the forearm was present in nine patients. Four patients had predisposing factors. Eight patients treated conservatively exhibited spontaneous recovery from their paralysis during 3-12 months after the onset. In six patients, the AIN was explored 12 weeks after the initial symptoms and released from compressing structures. Thirteen patients showed good limb function. In one patient with poor result a tendon transfer was necessary. The DASH score of patients treated conservatively and operatively presented no significant difference. Conclusion: AIN syndrome can have different clinical manifestations. If no signs of spontaneous recovery appear within 12 weeks, operative treatment should be performed

Facemums 2018: final report

Continuity of care and easy access to reliable information during pregnancy is essential to the health and wellbeing of pregnant women. In recent years widespread use of the internet has fundamentally changed the way people obtain health information and communicate with health providers. Pregnant women have been found to be a group who are particularly motivated to look for information and support online. In 2015 a pilot study was conducted to explore the feasibility of using professionally moderated social media groups to provide additional antenatal support for pregnant mothers. The intervention called Facemums proved to be extremely popular with users and in addition to improving access to reliable information and support it was found that involvement in a group greatly enhanced relational continuity o one of the key aims underpinning NHS antenatal care. Following the success of the original pilot study in April 2019 a full-scale intervention was rolled out across 7 NHS Trusts and 8 Maternity Hospitals in 3 Sustainable Transformation Partnerships (ST1s) (Wave 1). A further 5 NHS Trusts became involved in November 2019 (Wave 2). These two waves supported over 500 pregnant women (AFacemums’) and have involved training over 60 NHS midwifes to act as group moderators (AFacewives’). The Facemums programme has been hugely successful meeting the information and support needs of pregnant women and newly delivered mothers improving continuity of care providing professional access to midwives and facilitating peer support in a safe and manageable way

Neurobehavioral consequences of chronic intrauterine opioid exposure in infants and preschool children: a systematic review and meta-analysis

<b>Background</b><p></p> It is assumed within the accumulated literature that children born of pregnant opioid dependent mothers have impaired neurobehavioral function as a consequence of chronic intrauterine opioid use.<p></p> <b>Methods</b><p></p> Quantitative and systematic review of the literature on the consequences of chronic maternal opioid use during pregnancy on neurobehavioral function of children was conducted using the Meta-analysis of Observational Studies in Epidemiology (MOOSE) and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. We searched Cinahl, EMBASE, PsychINFO and MEDLINE between the periods of January 1995 to January 2012.<p></p> <b>Results</b><p></p> There were only 5 studies out of the 200 identified that quantitatively reported on neurobehavioral function of children after maternal opioid use during pregnancy. All 5 were case control studies with the number of exposed subjects within the studies ranging from 33–143 and 45–85 for the controls. This meta-analysis showed no significant impairments, at a non-conservative significance level of p < 0.05, for cognitive, psychomotor or observed behavioural outcomes for chronic intra-uterine exposed infants and pre-school children compared to non-exposed infants and children. However, all domains suggested a trend to poor outcomes in infants/children of opioid using mothers. The magnitude of all possible effects was small according to Cohen’s benchmark criteria.<p></p> <b>Conclusions</b><p></p> Chronic intra-uterine opioid exposed infants and pre-school children experienced no significant impairment in neurobehavioral outcomes when compared to non-exposed peers, although in all domains there was a trend to poorer outcomes. The findings of this review are limited by the small number of studies analysed, the heterogenous populations and small numbers within the individual studies. Longitudinal studies are needed to determine if any neuropsychological impairments appear after the age of 5 years and to help investigate further the role of environmental risk factors on the effect of ‘core’ phenotypes

Diabetic Neuropathy and Axon Reflex-Mediated Neurogenic Vasodilatation in Type 1 Diabetes

Objective: Axon reflex-mediated neurogenic vasodilatation in response to cutaneous heating may reflect early, pre-clinical small fibre dysfunction. We aimed to evaluate the distribution of the vascular flare area measured by laser doppler imaging (‘‘LDI FLARE area’’) in type 1 diabetes and in healthy volunteers. Research and Methods: Concurrent with clinical and electrophysiological examination to classify diabetic sensorimotor polyneuropathy (DSP), LDIFLARE area (cm 2) was determined in 89 type 1 diabetes subjects matched to 64 healthy volunteers. We examined the association and diagnostic performance of LDI with clinical and subclinical measures of DSP and its severity. Results: Compared to the 64 healthy volunteers, the 56 diabetes controls without DSP had significantly lower LDIFLARE area (p = 0.006). The 33 diabetes cases with DSP had substantially lower LDIFLARE area as compared to controls without DSP (p = 0.002). There was considerable overlap in LDIFLARE area between all groups such that the ROC curve had an AUC of 0.72 and optimal sensitivity of 70 % for the detection of clinical DSP. Use of a subclinical definition for DSP, according to subclinical sural nerve impairment, was associated with improved AUC of 0.75 and sensitivity of 79%. In multivariate analysis higher HbA1c and body mass index had independent associations with smaller LDIFLARE area. Conclusions: Axon reflex-mediated neurogenic vasodilatation in response to cutaneous heating is a biomarker of earl