Measles control in the urbanising environment

The relationship between urbanisation and measles control is examined. In urban settings in developing regions measles is a disease of particular importance, since it tends to affect children at a younger age and with greater severity than in rural settings. A further finding in urban areas, especially peri-urban slums, is the lower measles vaccination coverage rates compared with rural regions. Factors identified as determinants of measles vaccination coverage among children under 2 years of age in urban areas include: home delivery; being born outside the urban setting; and length of stay in the city. These factors are probably related to the low socioeconomic status and lack of social integration experienced by new urban immigrants. A number of additional obstacles such as distance, economic and cultural barriers, and inconvenient clinic hours all prevent parents from gaining easy access to vaccination services. In order to address the problems of measles control in expanding urban settings, a regional approach - with full integration of curative and preventive services - is called for. A more effective use of existing services will probably go a long way towards improving urban vaccination coverage with resultant measles control

Therapeutic Drug Monitoring of Antiepileptic Drugs in Epilepsy: A 2018 Update

Background: Antiepileptic drugs (AEDs) are the mainstay of epilepsy treatment. Since 1989, 18 new AEDs have been licensed for clinical use and there are now 27 licensed AEDs in total for the treatment of patients with epilepsy. Furthermore, several AEDs are also used for the management of other medical conditions, for example, pain and bipolar disorder. This has led to an increasingly widespread application of therapeutic drug monitoring (TDM) of AEDs, making AEDs among the most common medications for which TDM is performed. The aim of this review is to provide an overview of the indications for AED TDM, to provide key information for each individual AED in terms of the drug's prescribing indications, key pharmacokinetic characteristics, associated drug–drug pharmacokinetic interactions, and the value and the intricacies of TDM for each AED. The concept of the reference range is discussed as well as practical issues such as choice of sample types (total versus free concentrations in blood versus saliva) and sample collection and processing. / Methods: The present review is based on published articles and searches in PubMed and Google Scholar, last searched in March 2018, in addition to references from relevant articles. / Results: In total, 171 relevant references were identified and used to prepare this review. / Conclusions: TDM provides a pragmatic approach to epilepsy care, in that bespoke dose adjustments are undertaken based on drug concentrations so as to optimize clinical outcome. For the older first-generation AEDs (carbamazepine, ethosuximide, phenobarbital, phenytoin, primidone, and valproic acid), much data have accumulated in this regard. However, this is occurring increasingly for the new AEDs (brivaracetam, eslicarbazepine acetate, felbamate, gabapentin, lacosamide, lamotrigine, levetiracetam, oxcarbazepine, perampanel, piracetam, pregabalin, rufinamide, stiripentol, sulthiame, tiagabine, topiramate, vigabatrin, and zonisamide)

An evaluation of the national measles vaccination campaign in the new shanty areas of Khayelitsha

A local component of the national measles vaccination campaign was evaluated in an area undergoing rapid urbanisation near Cape Town. Four serial cross-sectional cluster samples were used. Proven vaccination coverage before the campaign was 55,8% (95% confidence interval (Cl) 46 - 66%), immediately afterwards it was 71,1% (95% Cl 65 - 77%), and 6 months later 73,6% (95% Cl 67 - 80%). The increase was not sustained among Transkei-born children. Significant determinants of vaccination coverage were: place of birth (X2 = 9,7; 2 df; P = 0,008); ≤6 months stay in Cape Town (odds ratio (OR) 2,22; 95% Cl 1,2 - 4,0%); and home birth (OR 3,21; 95% Cl 1,2 - 8,4%). The value of campaigns in controlling measles, as well as the role of a comprehensive health care service are discussed

Analysing the association of vitamin D status on selected cardiovascular risk markers using seasonal and genetic variations.

Vitamin D deficiency is common and has been proposed as a risk factor for cardiovascular disease (CVD), but much of this evidence is inconsistent. The aim of the thesis was to explore the associations between vitamin D status (25(OH)D) and selected risk biomarkers of CVD, in participants of the British 1958 birth cohort free from CVD. Different methodologies were used in an attempt to avoid confounded associations. Mediation analysis was used to infer an association between 25(OH)D and biomarkers from seasonal variations. A genome-wide association study (GWAS) was done to find single nucleotide polymorphisms (SNPs) associated with 25(OH)D. SNPs found by the GWAS and SNPs in candidate genes were evaluated as proxy markers for 25(OH)D, and used in Mendelian randomisation (MR) analysis with the biomarkers. Higher 25(OH)D concentrations were associated with lower levels of tissue plasminogen activator (tPA), after adjusting for lifestyle, socio-economic and adiposity covariates. An association between 25(OH)D and tPA was inferred using mediation analysis. In the GWAS, SNPs from genes involved in the synthesis, hydroxylation and transportation of vitamin D were associated with 25(OH)D. SNPs passing evaluation as proxy markers for 25(OH)D were classified as “synthesis” and “metabolism” based on gene function, with the former considered to be a more robust proxy than the latter. Statistical power to detect an association was limited in MR analysis. However, there was some evidence that 25(OH)D had a protective association with tPA, when metabolism SNPs were used as proxy for 25(OH)D in MR analysis. Findings from the different analyses were inconsistent for CRP, D-dimer and fibrinogen. In conclusion, the findings tentatively suggest that vitamin D has a beneficial influence on CVD through the mechanism of fibrinolysis. However, more evidence is required from large MR studies and randomised controlled trials before the role of vitamin D in CVD is conclusively understood

Evaluation of genetic markers as instruments for Mendelian randomization studies on vitamin D.

Mendelian randomization (MR) studies use genetic variants mimicking the influence of a modifiable exposure to assess and quantify a causal association with an outcome, with an aim to avoid problems with confounding and reverse causality affecting other types of observational studies

Estimating the influence of body mass index (BMI) on mortality using offspring BMI as an instrumental variable

Objective: High body mass index (BMI) is an important predictor of mortality but estimating underlying causality is hampered by confounding and pre-existing disease. Here, we use information from the offspring to approximate parental BMIs, with an aim to avoid biased estimation of mortality risk caused by reverse causality. / Methods: The analyses were based on information on 9674 offspring–mother and 9096 offspring–father pairs obtained from the 1958 British birth cohort. Parental BMI–mortality associations were analysed using conventional methods and using offspring BMI as a proxy, or instrument, for their parents’ BMI. / Results: In the conventional analysis, associations between parental BMI and all-cause mortality were U-shaped (Pcurvature  0.46). Curvature was particularly pronounced for mortality from respiratory diseases and from lung cancer. Instrumental variable analyses suggested a positive association between BMI and mortality from all causes [mothers: HR per SD of BMI 1.43 (95% CI 1.21–1.69), fathers: HR 1.17 (1.00–1.36)] and from coronary heart disease [mothers: HR 1.65 (1.15–2.36), fathers: HR 1.51 (1.17–1.97)]. These were larger than HR from the equivalent conventional analyses, despite some attenuation by adjustment for social indicators and smoking. / Conclusions: Analyses using offspring BMI as a proxy for parental BMI suggest that the apparent adverse consequences of low BMI are considerably overestimated and adverse consequences of overweight are underestimated in conventional epidemiological studies

A web-based resource for the assessment of language skills in English and Welsh-speaking adults with neurological deficits

We will present a new web-based resource for the assessment of language disorders in English monolinguals and Welsh/English bilingual adults with neurological deficits. Although both languages are typically affected in bilinguals, few valid tools are available to accurately and comprehensively assess both languages, and none in Welsh-English speakers. This impedes both accurate diagnosis and therapeutic efforts. The goal of this work was to provide a secure user-friendly platform to allow clinicians to administer and score tests on-line or offline. The battery includes 16 different tests developed to measure the same abilities in Welsh and in English and to be of comparable difficulty in the two languages. These tests assess a range of language skills: spoken word production (picture naming, naming to definition, translation, repetition), reading (reading aloud, lexical decision, paragraph reading) and written production (spelling to dictation, delayed copy, written picture description). The tests manipulate and/or control for key psycholinguistic variables (e.g., word frequency, length, concreteness, Welsh-English similarity, grammatical class, lexicality). In the on-line version, all tests are programmed to allow automatic and standardized presentation of auditory or visual stimuli. The program also records oral or written responses and response times for each stimulus, and provide summary scores broken down by stimulus category. Each test package includes: a) an introductory section explaining the test aims and rationale, b) instructions on how to administer the test, c) scoring instructions and scoring sheets and d) performance indicators (e.g., Z-score) based on control data from 120 neurologically healthy participants (40 English monolinguals and 80 Welsh-English bilinguals, broken down by age, language and educational level. The presentation will include demos of the interface and of computerized test administration and scoring. Note that this new resource is suitable for the assessment of both English monolingual and Welsh-English bilingual adults.ESRC/MRC; Bangor ESRC Impact Acceleration Accoun

Experimental Measurement of the Berry Curvature from Anomalous Transport

Geometrical properties of energy bands underlie fascinating phenomena in a wide-range of systems, including solid-state materials, ultracold gases and photonics. Most famously, local geometrical characteristics like the Berry curvature can be related to global topological invariants such as those classifying quantum Hall states or topological insulators. Regardless of the band topology, however, any non-zero Berry curvature can have important consequences, such as in the semi-classical evolution of a wave packet. Here, we experimentally demonstrate for the first time that wave packet dynamics can be used to directly map out the Berry curvature. To this end, we use optical pulses in two coupled fibre loops to study the discrete time-evolution of a wave packet in a 1D geometrical "charge" pump, where the Berry curvature leads to an anomalous displacement of the wave packet under pumping. This is both the first direct observation of Berry curvature effects in an optical system, and, more generally, the proof-of-principle demonstration that semi-classical dynamics can serve as a high-resolution tool for mapping out geometrical properties

UK survey of occupational therapist’s and physiotherapist’s experiences and attitudes towards hip replacement precautions and equipment

Background: Total hip replacement (THR) is one of the most common orthopaedic procedures in the United Kingdom (UK). Historically, people following THR have been provided with hip precautions and equipment such as: raised toilet seats and furniture rises, in order to reduce the risks of dislocation post-operation. The purpose of this study was to determine current practices in the provision of these interventions in the UK for people following primary THR. Methods: A 27-question, self-administered online survey was developed and distributed to UK physiotherapists and occupational therapists involved in the management of people following primary THR (target respondents). The survey included questions regarding the current practices in the provision of equipment and hip precautions for THR patients, and physiotherapist’s and occupational therapist’s attitudes towards these practices. The survey was disseminated through print and web-based/social media channels. Results: 170 health professionals (87 physiotherapists and 83 occupational therapists), responded to the survey. Commonly prescribed equipment in respondent’s health trusts were raised toilet seats (95%), toilet frames and rails (88%), furniture raises (79%), helping hands/grabbers (77%), perching stools (75%) and long-handled shoe horns (75%). Hip precautions were routinely prescribed by 97% of respondents. Hip precautions were most frequently taught in a pre-operative group (52% of respondents). Similarly equipment was most frequently provided pre-operatively (61% respondents), and most commonly by occupational therapists (74% respondents). There was variability in the advice provided on the duration of hip precautions and equipment from up to six weeks post-operatively to life-time usage. Conclusions: Current practice on hip precautions and provision of equipment is not full representative of clinician’s perceptions of best care after THR. Future research is warranted to determine whether and to whom hip precautions and equipment should be prescribed post-THR as opposed to the current ‘blanket’ provision of equipment and movement restriction provided in UK practice