Under-reporting of foetal alcohol spectrum disorders: an analysis of hospital episode statistics

<p>Abstract</p> <p>Background</p> <p>Internationally, 0.97 per 1,000 live births are affected by foetal alcohol syndrome (FAS). However, prevalence intelligence has been limited in the UK, hindering the development of appropriate services. This analysis compares hospital admissions over time, between regions and with alcohol-related admissions for adult females to assess whether established patterns (such as the North experiencing elevated harms) can be identified.</p> <p>Methods</p> <p>A retrospective analysis of hospital admissions data (April 2002 to March 2008) for foetal alcohol spectrum disorder (FASD)-related conditions: foetal alcohol syndrome (dysmorphic) (n = 457); foetus and newborn affected by maternal use of alcohol (n = 157); maternal care for (suspected) damage to foetus from alcohol (n = 285); and 322,161 women admitted due to alcohol-related conditions.</p> <p>Results</p> <p>Whilst the rate of admission for alcohol-related conditions in women aged 15-44 years increased significantly by 41% between 2002/03 and 2007/08 (p < 0.0001), no such increases were seen in the numbers of FASD-related conditions (all p < 0.05). Established regional rates of admission for alcohol-related conditions in women aged 15-44 years old were not associated with admission for FASD-related conditions.</p> <p>Conclusions</p> <p>It would be expected that the North West and North East regions, known to have higher levels of alcohol harm would have higher levels of FASD-related conditions. However, this was not reflected in the incidence of such conditions, suggesting under-reporting. With incomplete datasets, intelligence systems are severely limited, hampering efforts to develop targeted interventions. Improvements to intelligence systems, practitioner awareness and screening are essential in tackling this.</p

Ten-year mortality, disease progression, and treatment-related side effects in men with localised prostate cancer from the ProtecT randomised controlled trial according to treatment received

Background The ProtecT trial reported intention-to-treat analysis of men with localised prostate cancer randomly allocated to active monitoring (AM), radical prostatectomy, and external beam radiotherapy. Objective To report outcomes according to treatment received in men in randomised and treatment choice cohorts. Design, setting, and participants This study focuses on secondary care. Men with clinically localised prostate cancer at one of nine UK centres were invited to participate in the treatment trial comparing AM, radical prostatectomy, and radiotherapy. Intervention Two cohorts included 1643 men who agreed to be randomised and 997 who declined randomisation and chose treatment. Outcome measurements and statistical analysis Analysis was carried out to assess mortality, metastasis and progression and health-related quality of life impacts on urinary, bowel, and sexual function using patient-reported outcome measures. Analysis was based on comparisons between groups defined by treatment received for both randomised and treatment choice cohorts in turn, with pooled estimates of intervention effect obtained using meta-analysis. Differences were estimated with adjustment for known prognostic factors using propensity scores. Results and limitations According to treatment received, more men receiving AM died of PCa (AM 1.85%, surgery 0.67%, radiotherapy 0.73%), whilst this difference remained consistent with chance in the randomised cohort (p = 0.08); stronger evidence was found in the exploratory analyses (randomised plus choice cohort) when AM was compared with the combined radical treatment group (p = 0.003). There was also strong evidence that metastasis (AM 5.6%, surgery 2.4%, radiotherapy 2.7%) and disease progression (AM 20.35%, surgery 5.87%, radiotherapy 6.62%) were more common in the AM group. Compared with AM, there were higher risks of sexual dysfunction (95% at 6 mo) and urinary incontinence (55% at 6 mo) after surgery, and of sexual dysfunction (88% at 6 mo) and bowel dysfunction (5% at 6 mo) after radiotherapy. The key limitations are the potential for bias when comparing groups defined by treatment received and changes in the protocol for AM during the lengthy follow-up required in trials of screen-detected PCa. Conclusions Analyses according to treatment received showed increased rates of disease-related events and lower rates of patient-reported harms in men managed by AM compared with men managed by radical treatment, and stronger evidence of greater PCa mortality in the AM group. Patient summary More than 95 out of every 100 men with low or intermediate risk localised prostate cancer do not die of prostate cancer within 10 yr, irrespective of whether treatment is by means of monitoring, surgery, or radiotherapy. Side effects on sexual and bladder function are better after active monitoring, but the risks of spreading of prostate cancer are more common

Functional and quality of life outcomes of localised prostate cancer treatments (prostate testing for cancer and treatment [ProtecT] study)

Objective To investigate the functional and quality of life (QoL) outcomes of treatments for localised prostate cancer and inform treatment decision-making. Patients and Methods Men aged 50–69 years diagnosed with localised prostate cancer by prostate-specific antigen testing and biopsies at nine UK centres in the Prostate Testing for Cancer and Treatment (ProtecT) trial were randomised to, or chose one of, three treatments. Of 2565 participants, 1135 men received active monitoring (AM), 750 a radical prostatectomy (RP), 603 external-beam radiotherapy (EBRT) with concurrent androgen-deprivation therapy (ADT) and 77 low-dose-rate brachytherapy (BT, not a randomised treatment). Patient-reported outcome measures (PROMs) completed annually for 6 years were analysed by initial treatment and censored for subsequent treatments. Mixed effects models were adjusted for baseline characteristics using propensity scores. Results Treatment-received analyses revealed different impacts of treatments over 6 years. Men remaining on AM experienced gradual declines in sexual and urinary function with age (e.g., increases in erectile dysfunction from 35% of men at baseline to 53% at 6 years and nocturia similarly from 20% to 38%). Radical treatment impacts were immediate and continued over 6 years. After RP, 95% of men reported erectile dysfunction persisting for 85% at 6 years, and after EBRT this was reported by 69% and 74%, respectively (P < 0.001 compared with AM). After RP, 36% of men reported urinary leakage requiring at least 1 pad/day, persisting for 20% at 6 years, compared with no change in men receiving EBRT or AM (P < 0.001). Worse bowel function and bother (e.g., bloody stools 6% at 6 years and faecal incontinence 10%) was experienced by men after EBRT than after RP or AM (P < 0.001) with lesser effects after BT. No treatment affected mental or physical QoL. Conclusion Treatment decision-making for localised prostate cancer can be informed by these 6-year functional and QoL outcomes

Contributions of alcohol use to teenage pregnancy: an initial examination of geographical and evidence based associations.

1. Key points and recommendations • From the data analyses: a. Alcohol-related hospital admissions in young people (aged 15-17 years) have been used here as a proxy measure of alcohol misuse in these age groups1, and have been compared with teenage conceptions (in females aged under 182). b. At both lower tier local authority and ward levels there is a significant positive relationship between teenage conceptions and alcohol-related hospital admissions in young people. This relationship is independent of deprivation. c. After taking deprivation3 at ward level into account, the teenage conception rate was 34 per 1000 females (aged 15-17 years) in wards with the lowest levels of alcohol-related hospital admissions, compared with 41 per 1000 females in wards with the highest levels of alcoholrelated hospital admissions. d. Local authorities that have seen increases in teenage conceptions between 2006 and 2007 have also seen disproportionate annual increases in teenage alcohol-related hospital admissions. e. While England as a whole saw a 0.8% increase in alcohol-related hospital admissions in young people, local authorities which documented increases in teenage conceptions saw a five-fold greater increase (5.2%). • From the evidence review: a. A rapid evidence review, although not a full structured systematic review, was conducted to provide an overview of some of the key studies examining associations between alcohol consumption and sexual behaviours. b. Early regular alcohol consumption is associated with early onset of sexual activity. c. Any amount of current drinking by teenagers is associated with being sexually active, especially binge drinking and drinking in greater quantities. d. Alcohol use at first sex is associated with lower levels of condom use at first intercourse. e. Beginning to drink alcohol at an early age is strongly associated with having a higher (or multiple) number of sexual partners. Those drinking more and at higher frequencies are at greater risk of having multiple partners. f. Evidence of a routine association between non-condom use and alcohol consumption is equivocal. However, there is better evidence to support higher levels of non-condom use in those who binge drink or have alcohol problems. g. In young people there is some evidence of an association between the misuse of alcohol and sex without any contraception. However, the relationship between risk and increasing levels of consumption is unclear. h. Alcohol consumption, and especially binge drinking and drinking greater quantities, is associated with an increased risk of becoming pregnant in females and getting someone pregnant in males. i. There is good evidence to suggest that alcohol consumption in young people contributes to levels of regretted sex and that increasing consumption is associated with a greater probability of having experienced regretted sex. j. There is good evidence to suggest an association between drinking in young people, especially binge drinking, and increased risk of forced sex. • Suggested further steps a. Better intelligence on the relationships between alcohol and teenage pregnancy could be developed from existing data sets. Comprehensive analyses of the relationships between alcohol-related hospital admissions and teenage conceptions should be undertaken once new data are available.4 b. Additional data sets are likely to provide a more comprehensive picture of the relationships between alcohol consumption, teenage conceptions, and also other key sexual health issues. Use of the National Drug Treatment Monitoring Data5 may improve understanding of links. For some parts of the country, accident and emergency department data relating to alcohol can also be utilised. Such analyses should examine relationships with alcohol and levels of terminations, and with sexually transmitted infections (including Chlamydia) as well as with teenage conceptions. c. We would suggest that this combination of data sets (on sexual heath and substance use such as alcohol and drugs) is used to create a model of youth (i.e. under 18 year olds) behaviour at ward, local authority and NHS/primary care trust levels across England. Unlike typical analyses on single issues this could help inform strategies for delivering holistic support for young people. d. A model using sexual health, alcohol and drugs data could also be used to examine the match of service need to service provision for young people at local levels. e. Research studies on the relationships between alcohol and sexual health issues in England are relatively few and far between. High quality research on understanding how these issues are linked in England is urgently needed. f. Adequate evidence is already available to suggest strong links between alcohol, teenage conceptions and other sexual health issues. Future developments in both alcohol and sexual health services should examine how prevention messages and initiatives can be delivered to address both issues together. g. Services dealing with sexual health or substance misuse should be encouraged to provide seamless support for young people who may present with either a sexual health or an alcohol problem, recognising they will often have problems with both

Contents Executive Summary.................................................................................................................6

Indicator 1: Synthetic estimates of binge drinking..............................................................9 Indicator 2: Hospitalised admission for alcohol specific conditions..................................1

The Complementary Relationship between Financial and Non-Financial Information in the Biotechnology Industry and the Degree of Investor Sophistication

We examine whether financial and non-financial variables, separately and in tandem, are value relevant in explaining market returns, equity values and the degree of investment by sophisticated investors for a sample of drug development companies. Patent counts, number of collaborations and probability-adjusted portfolios of drugs under development are the non-financial information metrics used in this study. Earnings are the main financial information variable. We show that news about these non-financial measures is significantly associated with abnormal returns. We also find that earnings are value relevant in explaining cumulative abnormal returns and equity prices around earnings announcement dates despite the fact that R&D expenditures are large and usually expensed as incurred. We further show that non-financial information is value relevant in explaining annual returns, equity prices and degree of investment by (long-horizon) sophisticated investors. Moreover, non-financial variables are value relevant after controlling for financial variables suggesting that the two types of variables are complements