Gastrointestinal Safety of Aspirin for a High-Dose, Multiple-Day Treatment Regimen: A Meta-Analysis of Three Randomized Controlled Trials

Background and Aim: Aspirin is a commonly used over-the-counter (OTC) agent for the symptomatic treatment of acute pain, fever, or the common cold, but data regarding safety in this context are limited. In order to characterize the safety of aspirin beyond single-dose or long-term use data, we conducted a meta-analysis of multiple-dose, multiple-day studies of OTC aspirin at a label-approved dosage. Methods: We conducted a meta-analysis of individual patient data from three Bayer-sponsored studies. The meta-analysis was performed in 2015; the individual studies were conducted between 2008 and 2012 and were of a randomized, parallel-group, placebo-controlled design. Patients received a minimum dosage of aspirin of 2000 mg/day over at least 3 days. The endpoints were patient-reported adverse events (AEs) with an emphasis on the system organ class gastrointestinal system. Event incidences were estimated and an analysis of the odds ratios (ORs) and risk differences (RDs) of aspirin versus placebo were performed. Results: Of the 819 patients included, 433 were treated with aspirin and 386 were treated with placebo. The majority of patients (85.7 %) received a median dose of aspirin of 3000 mg/day for 3 days. The incidence of the overall AEs was low and rates were comparable between the aspirin (10.9 %) and placebo (12.4 %) groups [OR: 0.86 (95 % confidence interval [CI] 0.56, 1.34); RD: -1.49 (95 % CI -6.01, 3.03)]. Gastrointestinal AEs were more common in subjects treated with aspirin (7.4 %) than with placebo (5.4 %), and although this difference did not reach statistical significance, a trend towards increased risk was observed with aspirin use [OR: 1.41 (95 % CI 0.78, 2.54); RD: 2.00 (95 % CI -1.35, 5.35)]. Nausea, upper abdominal pain, dyspepsia, and diarrhea were the most frequently reported gastrointestinal AEs. There were no reports of serious gastrointestinal complications such as bleeding, perforation, or ulceration.: Conclusions: The multiple-dose regimen of aspirin used for several days according to the OTC label is well-tolerated by otherwise healthy non-elderly subjects for short-term and symptomatic treatment of pain, fever, and the common cold. There were no reports of serious gastrointestinal complications in either of the groups

Measuring the productivity of residential long-term care in England: methods for quality adjustment and regional comparison

Productivity trend information is valuable in developing policy and for understanding changes in the ‘value for money’ of the care system. In this paper, we consider approaches to measuring productivity of adult social care (ASC), and particularly care home services. Productivity growth in the public sector is traditionally measured by comparing change in total output to change in total inputs, but has not accounted for changes in service quality and need. In this study, we propose a method to estimate ‘quality adjusted’ output based on indicators of the Adult Social Care Outcomes Toolkit (ASCOT), using data collected in the annual adult social care survey (ASCS). When combined with expenditure and activity data for 2010 to 2012, we found that this approach was feasible to implement with current data and that it altered the productivity results compared with non-adjusted productivity metrics. Overall, quality-adjusted productivity grew in most regions between 2010 and 2011 and remained unchanged for most regions from 2011 to 2012

Books

Brain work Brain Work and Mental Activity: Quantitative Studies with Radioactive Tracers. Ed. by N. A. Lassen, D. H. Ingvar, M. E. RaicWe and L. Friberg. Pp. 446. Illustrated. Copenhagen: Munksgaard. 1991.Neuroanatomy Neuroanatomy for Medical Students. 2nd ed. By ]. L. Wilkinson. pp. x + 307. illustrated. Oxford: Butterworth Heinemann. 1992.Atherosclerosis Molecular Biology of Atherosclerosis: Proceedings of the 57th European Atherosclerosis Society Meeting. Ed. by M. J. Halpern. Pp. xv + 662. Illustrated. £45. London: John libbey. 1992.Antibiotics Antibiotic Guidelines. By H. J. Koomhof and L. D. Liebowitz. pp. 122. Pretoria: JL van Schaik. 1991.Reproductive medicine Reproduction, Growth and Development. By A. Negro-Vilar and G. perez-Palacios. Pp. xv + 440. illustrated. $162,50. New York: Raven Press. 1991.Obesity research Progress in Obesity Research 1990. Ed. by Y. Oomura, S. Tarui, S. Inoue and T. Shimazu. Pp. xiii + 688. illustrated. £17,50. London: John Libbey. 1991.Epidemiology Fetal and Infant Origins of Adult Disease. Ed. by D.}. P. Barker. Pp. xv + 343. £30. London: BM}. 1992

When contact goes wrong: Negative intergroup contact promotes generalized outgroup avoidance

This paper broadens our understanding of the consequences of negative intergroup contact. Study 1 reports cross-sectional evidence that negative contact with European immigrants in Britain is not only associated with increased prejudice, but also the avoidance of future contact with this group. Studies 2A and 2B provided an experimental replication in a different intergroup context. A negative encounter with an outgroup member, but not an ingroup member, was found to reduce intentions to engage in contact with the outgroup in the future. Study 3 went on to demonstrate that the effect of negative contact on outgroup avoidance is not limited to the contacted outgroup, but is indirectly associated with reduced intentions to engage with other, secondary outgroups—an effect we refer to as avoidance generalization effect. Negative contact was also associated with lower general contact self-efficacy. Together, findings suggest that negative contact is damaging not just because it increases prejudice but also because it compromises future engagement with diversity

Rigorous Formulation of Duality in Gravitational Theories

In this paper we evince a rigorous formulation of duality in gravitational theories where an Einstein like equation is valid, by providing the conditions under which the Hodge duals (with respect to the metric tensor g) of T^a and R_b^a may be considered as the torsion and curvature 2-forms associated with a connection D', part of a Riemann-Cartan structure (M,g',D'), in the cases g = g' and g does not equal g', once T^a and R_b^a are the torsion and curvature 2-forms associated with a connection D part of a Riemann-Cartan structure (M,g,D). A new form for the Einstein equation involving the dual of the Riemann tensor of D is also provided, and the result is compared with others appearing in the literature.Comment: 15 page

Dutch translation and cross-cultural validation of the Adult Social Care Outcomes Toolkit (ASCOT)

Background: The Adult Social Care Outcomes Toolkit was developed to measure outcomes of social care in England. In this study, we translated the four level self-completion version (SCT-4) of the ASCOT for use in the Netherlands and performed a cross-cultural validation. Methods: The ASCOT SCT-4 was translated into Dutch following international guidelines, including two forward and back translations. The resulting version was pilot tested among frail older adults using think-aloud interviews. Furthermore, using a subsample of the Dutch ACT-study, we investigated test-retest reliability and construct validity and compared response distributions with data from a comparable English study. Results: The pilot tests showed that translated items were in general understood as intended, that most items were reliable, and that the response distributions of the Dutch translation and associations with other measures were comparable to the original English version. Based on the results of the pilot tests, some small modifications and a revision of the Dignity items were proposed for the final translation, which were approved by the ASCOT development team. The complete original English version and the final Dutch translation can be obtained after registration on the ASCOT website (http://www.pssru.ac.uk/ascot). Conclusions: This study provides preliminary evidence that the Dutch translation of the ASCOT is valid, reliable and comparable to the original English version. We recommend further research to confirm the validity of the modified Dutch ASCOT translation