Spatial epidemiology of indicators of male reproductive health in Scotland

BACKGROUND In recent years there are a number of reports showing a deterioration in male reproductive health, i.e. diminished semen quality and increases in the incidence of testicular cancer and the congenital malformations cryptorchidism and hypospadias. It is hypothesised that these changes have been caused by increasing in utero exposure to environmental oestrogens and/or anti-androgensOBJECTIVES (i) Describe the geographical distributions of three indicators of male reproductive health in Scotland (i.e. testicular cancer, cryptorchidism and hypospadias). (ii) Describe the conjoint geographical distribution of the three indicators specified in (i). (iii) Identify explanatory factors that might account for the geographical distribution of male reproductive health in Scotland.METHODS An epidemiology study modelling the geographical distributions using routinely collected data of the three indicators. The primary assessment of the geographical distribution of the indicators was by means of the relative risks at postcode sector level. If geographically varying risk factors (environmental or not) are associated with these conditions then would expect to see clustering of relative risks. Bayesian methods were used to estimate the relative risks so as to account for their variability due to areas with small number of cases. These Bayesian models were developed further by including potential covariates to assess if these area specific factors explain the spatial variation of the three indicators. In addition, Bayesian modelling of individual data pertaining to the cryptorchidism cases was also carried out to explore whether the spatial variation in risk might also be explained by the nature of the cases within each postcode sector rather than area specific covariates. Finally, a Bayesian model which combined all three indicators was developed to examine the spatial relationships between the three disease/conditions.RESULTS There are similarities in the spatial pattern of the cryptorchidism and hypospadias relative risks, with both conditions having clusters of high relative risks in the East and South-West of Scotland. The spatial variation of the testicular cancer relative risks is not similar to the other two conditions nor is it conclusive that it has a distinct spatial pattern. The relative risks of the postcode sectors for all the indicators are associated with radon measurements and the rural/urban indicator. The spatial analysis of individual information concerning the cryptorchidism cases indicate that the spatial variation of the relative risks might also be explained by individual information; namely maternal age and co-morbidity with hypospadias.CONCLUSIONS There does appear to be geographically varying risk factors associated with these three conditions. Furthermore, as the spatial variation of cryptorchidism and hypospadias is similar it is likely that they have some common aetiology. As the same risk factors were found to be associated with testicular cancer and the congenital malformations, then this carcinoma appears to share some aetiology with cryptorchidism and hypospadias. Therefore there are geographically varying risk factors whose exposure occurs in utero, that are associated with all three conditions, providing some evidence to support the proposed hypothesis. Flowever, the common aetiology of these conditions could not only to be environmental but also due to genetic and life-style factors, that could pertain to the individual cases rather than the specific area. Therefore, further studies are required to investigate the associations between all the disease/conditions of male reproductive heath and the various potential risk factors

Prevalence, Nature, Severity and Risk Factors for Prescribing Errors in Hospital Inpatients : Prospective Study in 20 UK Hospitals

Funding This study was funded by the General Medical Council (GMC). The study funders had no role in the study design, in the collection, analysis, and interpretation of data, in the writing of this manuscript or in the decision to submit the article for publication. Acknowledgements The EQUIP team would like to thank the following people: Members of the Expert Reference Group (Graham Buckley, Gary Cook, Dianne Parker, Lesley Pugsley and Mike Scott); Members of the Error Validation Group (Lindsay Harper, Katy Mellor, Steven Williams, Keith Harkins, Steve McGlynn, Ray George, Tim Dornan, Penny Lewis); Tribal Consulting Ltd. (Heather Heathfield, Emma Carter) for database design; Study co-ordinators at hospitals (Linda Aldred, Deborah Armstrong, Isam Badhawi, Kathryn Ball, Neil Caldwell, Vanya Fidling, Nicholas Fong, Heather Ford, Andrea Gill, Lindsay Harper, Jean Holmes, Sally James, Christopher Poole, Sally Shaw, Heather Smith, Julie Street, Atia Rifat, David Thornton, Tracey Thornton, Jane Warren, Steven Williams), and all pharmacists at the study sites who collected data for this study.Peer reviewedPublisher PD

The quality of prison primary care: cross-sectional cluster-level analyses of prison healthcare data in the North of England

Background Prisoners have significant health needs, are relatively high users of healthcare, and often die prematurely. Strong primary care systems are associated with better population health outcomes. We investigated the quality of primary care delivered to prisoners. Methods We assessed achievement against 30 quality indicators spanning different domains of care in 13 prisons in the North of England. We conducted repeated cross-sectional analyses of routinely recorded data from electronic health records over 2017–20. Multi-level mixed effects logistic regression models explored associations between indicator achievement and prison and prisoner characteristics. Findings Achievement varied markedly between indicators, prisons and over time. Achieved processes of care ranged from 1% for annual epilepsy reviews to 94% for blood pressure checks in diabetes. Intermediate outcomes of care ranged from only 0.2% of people with epilepsy being seizure-free in the preceding year to 34% with diabetes having sufficient blood pressure control. Achievement improved over three years for 11 indicators and worsened for six, including declining antipsychotic monitoring and rising opioid prescribing. Achievement varied between prisons, e.g., 1.93-fold for gabapentinoid prescribing without coded neuropathic pain (odds ratio [OR] range 0.67–1.29) and 169-fold for dried blood spot testing (OR range 0.05–8.45). Shorter lengths of stay were frequently associated with lower achievement. Ethnicity was associated with some indicators achievement, although the associations differed (both positive and negative) with indicators. Interpretation We found substantial scope for improvement and marked variations in quality, which were largely unaltered after adjustment for prison and prisoner characteristics. Funding National Institute for Health and Care Research Health and Social Care and Delivery Research Programme: 17/05/26

The Quality of Prison Primary Care: Cross-Sectional Analyses of Prison Healthcare Data in England

Background: Prisoners have significant health needs, are relatively high users of healthcare and often die prematurely. Strong primary care systems are associated with better population health outcomes. We investigated the quality of primary care delivered to prisoners.Methods: We assessed achievement against 30 quality indicators spanning different domains of care in 13 prisons in the North of England. We conducted repeated cross-sectional analyses of routinely recorded data from electronic health records over 2017-20. Multi-level mixed effects logistic regression models explored associations between indicator achievement and prison and prisoner characteristics.Findings: We found marked variations in achievement between indicators and between prisons. Achievement ranged from 0·2% of people with epilepsy coded as seizure-free to 93·8% of people with diabetes having blood pressure checks over the preceding year. Achievement improved over three years for 11 indicators and worsened for six, including declining antipsychotic monitoring and rising opioid prescribing. Achievement varied between prisons, e.g. 1·93-fold for gabapentinoid prescribing without coded neuropathic pain (odds ratio [OR] range 0·67 to 1·29) and 169-fold for dried blood spot testing (OR range 0·05 to 8·45). Shorter lengths of stay were frequently associated with lower achievement. Ethnicity was associated with some indicators achievement, although the associations differed with indicators.Interpretation: We found substantial scope for improvement and marked variations in quality, which were largely unaltered after adjustment for prison and prisoner characteristics

Mechanism-based urinary biomarkers to identify the potential for aminoglycoside-induced nephrotoxicity in premature neonates: a proof-of-concept study.

Premature infants are frequently exposed to aminoglycoside antibiotics. Novel urinary biomarkers may provide a non-invasive means for the early identification of aminoglycoside-related proximal tubule renal toxicity, to enable adjustment of treatment and identification of infants at risk of long-term renal impairment. In this proof-of-concept study, urine samples were collected from 41 premature neonates (≤ 32 weeks gestation) at least once per week, and daily during courses of gentamicin, and for 3 days afterwards. Significant increases were observed in the three urinary biomarkers measured (Kidney Injury Molecule-1 (KIM-1), Neutrophil Gelatinase-associated Lipocalin (NGAL), and N-acetyl-β-D-glucosaminidase (NAG)) during treatment with multiple courses of gentamicin. When adjusted for potential confounders, the treatment effect of gentamicin remained significant only for KIM-1 (mean difference from not treated, 1.35 ng/mg urinary creatinine; 95% CI 0.05-2.65). Our study shows that (a) it is possible to collect serial urine samples from premature neonates, and that (b) proximal tubule specific urinary biomarkers can act as indicators of aminoglycoside-associated nephrotoxicity in this age group. Further studies to investigate the clinical utility of novel urinary biomarkers in comparison to serum creatinine need to be undertaken

Injecting drug use in prison:Prevalence and implications for needle exchange policy

Purpose – The purpose of this paper is to explore prison drug injecting prevalence, identify any changes in injecting prevalence and practice during imprisonment and explore views on prison needle exchange. Design/methodology/approach – An empirical prospective cohort survey conducted between 2006 and 2008. The study involved a random sample of 267 remand and sentenced prisoners from a large male category B prison in England where no prison needle exchange operates. Questionnaires were administered with prisoners on reception and, where possible, at one, three and six months during their sentence. Findings – In total, 64 per cent were injecting until admission into prison. The majority intended to stop injecting in prison (93 per cent), almost a quarter due to the lack of needle exchange (23 per cent). Yet when hypothetically asked if they would continue injecting in prison if needle exchange was freely available, a third of participants (33 per cent) believed that they would. Injecting cessation happened on prison entry and appeared to be maintained during the sentence. Research limitations/implications – Not providing sterile needles may increase risks associated with injecting for prisoners who continue to inject. However, providing such equipment may prolong injecting for other prisoners who currently cease injecting on account of needle exchange programmes (NEPs) not being provided in the UK prison setting. Practical implications – Not providing sterile needles may increase risks associated with injecting for prisoners who continue to inject. However, providing such equipment may prolong injecting for other prisoners who currently cease injecting on account of NEPs not being provided in the UK prison setting. Originality/value – This survey is the first to question specifically regarding the timing of injecting cessation amongst male prisoners and explore alongside intention to inject should needle exchange facilities be provided in prison. </jats:sec

Years of Life Lost to COVID-19 in 20 countries

BACKGROUND: Although the highest burden of COVID-19 mortality is in older age groups, there is considerable burden of premature mortality, including within older age groups who have died as a result of the novel disease. The aim of this work was to calculate years of life lost (YLL) to COVID-19 for countries with age and sex specific COVID-19 death data available and investigate the burden of premature mortality amongst the included countries. A secondary aim was to investigate the underestimation of YLL when using country specific life expectancies instead of global life expectancies. METHODS: This study calculates YLL to COVID-19 for 20 countries to investigate the burden of premature mortality and underestimation of YLL when using country specific life expectancies compared to global. Population statistics and cumulative COVID-19 death data were extracted from the National Institute for Demographic Studies’ Demography of COVID-19 Deaths database. Overall YLL, YLL per 1000, cumulative YLL with age, and peak deaths per 1000 were calculated. RESULTS: USA has the highest overall YLL with 10 289 624 compared to Norway with the lowest YLL of 10 771. When taking into account population size, South Korea has the lowest YLL at 0.55 per 1000 people, with Moldova having the highest at 49.63 per 1000 people. In terms of COVID-19 deaths per 1000 people, South Korea again has the lowest (0.04), but England & Wales have the highest (2.39). The USA, Ukraine, Moldova and Romania have a larger burden of YLL in younger ages. England and Wales had the highest loss to a population category, with 5.78% of those aged 90+ dying of COVID-19. When using local life expectancy instead of global estimates, the burden of YLL was underestimated by as much as 47.9%. CONCLUSIONS: This study highlights that although the higher burden of YLL is with older age groups, some countries have a high burden of YLL in younger age groups that should not be ignored. It also demonstrates that life should be valued across all age groups and geographies, and when making decisions locally, there is value in decision makers comparing local lives to globally optimal values