Associations between selected immune-mediated diseases and tuberculosis: record-linkage studies

PMCID: PMC3616814This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited

The specialty choices of graduates from Brighton and Sussex Medical School: a longitudinal cohort study

BACKGROUND Since 2007 junior doctors in the UK have had to make major career decisions at a point when previously many had not yet chosen a specialty. This study examined when doctors in this new system make specialty choices, which factors influence choices, and whether doctors who choose a specialty they were interested in at medical school are more confident in their choice than those doctors whose interests change post-graduation. METHODS Two cohorts of students in their penultimate year at one medical school (n = 227/239) were asked which specialty interested them as a career. Two years later, 210/227 were sent a questionnaire measuring actual specialty chosen, confidence, influence of perceptions of the specialty and experiences on choice, satisfaction with medicine, personality, self-efficacy, and demographics. Medical school and post-graduation choices in the same category were deemed 'stable'. Predictors of stability, and of not having chosen a specialty, were calculated using bootstrapped logistic regression. Differences between specialties on questionnaire factors were analysed. RESULTS 50% responded (n = 105/277; 44% of the 239 Year 4 students). 65% specialty choices were 'stable'. Factors univariately associated with stability were specialty chosen, having enjoyed the specialty at medical school or since starting work, having first considered the specialty earlier. A regression found doctors who chose psychiatry were more likely to have changed choice than those who chose general practice. Confidence in the choice was not associated with stability. Those who chose general practice valued lifestyle factors. A psychiatry choice was associated with needing a job and using one's intellect to help others. The decision to choose surgical training tended to be made early. Not having applied for specialty training was associated with being lower on agreeableness and conscientiousness. CONCLUSION Medical school experiences are important in specialty choice but experiences post-graduation remain significant, particularly in some specialties (psychiatry in our sample). Career guidance is important at medical school and should be continued post-graduation, with senior clinicians supported in advising juniors. Careers advice in the first year post-graduation may be particularly important, especially for specialties which have difficulty recruiting or are poorly represented at medical school

On the Access of Blood-Borne Dyes to Various Tumour Regions

THE degree of blood supply in vital and non-vital tumour regions has long been of interest in tumour biology in its various aspects. In this paper evidence is presented that many tumours contain substantial regions which cannot readily be reached by blood-borne substances, and that these regions contain living cells capable of starting tumours when transplanted into new hosts. These regions were easily mapped out by changing the colour of the systemic blood with a harmless dye which, in addition, coloured the interstitial fluid, but did not enter the living cells (Goldacre, 1955, unpublished data; Goldacre and Sylven, 1959; Holmberg, 1961). Preliminary data (Goldacre and Sylven, 1959) indicated that in some tumours in rats and mice the only region presenting an open connection with the systemic circulation was a thin peripheral zone varying from a few millmetres to a tenth of a millimetre in thickness or less. Somewhat similar observations were made by Owen (1960) in spontaneous tumours of cats and dogs, using the same method. The blood, often visible in the regions unreached by the dye, was blocked off from the general circulation. In the present communication mor

Hospital admissions for vitamin D related conditions and subsequent immune-mediated disease: record-linkage studies

PMCID: PMC3729414The electronic version of this article is the complete one and can be found online at: http://www.biomedcentral.com/1741-7015/11/171. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited

Perinatal factors associated with subsequent diabetes mellitus in the child: record linkage study

WSTĘP. W niniejszej pracy przedstawiono raport dotyczący związku między czynnikami okołoporodowymi a późniejszą cukrzycą u potomstwa przed ukończeniem 30. roku życia. MATERIAŁ I METODY. Analizie poddano sprzężone szpitalne dane statystyczne, porównując czynniki okołoporodowe u 518 osób przyjętych do szpitala z powodu cukrzycy z takimi samymi czynnikami u 292 845 innych chorych w określonej populacji, w południowej Anglii w latach 1963-1999. WYNIKI. Cukrzyca występowała znacznie częściej u dzieci matek chorych na cukrzycę niż u innych (OR: 6,42; 95% CI: 4,18-9,86). Nie stwierdzono znamiennego związku z masą urodzeniową lub wiekiem ciążowym oddzielnie. Cukrzyca występowała częściej u osób w wyższym kwintylu masy urodzeniowej dla wieku ciążowego w porównaniu z połączonymi najniższymi 4 kwintylami (OR: 1,33; 95% CI: 1,08-1,64), jednak nie stwierdzono zgodnego gradientu rosnącej częstości występowania cukrzycy w najniższych 4 kwintylach. Nie dowiedziono znamiennego związku między cukrzycą a wiekiem matki, liczbą porodów, statusem społecznym, paleniem tytoniu w ciąży, sposobem porodu lub jakimkolwiek innym badanym czynnikiem okołoporodowym. Wszystkie wyniki były podobne, gdy analizę ograniczono do chorych na cukrzycę w wieku poniżej 15 lat. WNIOSKI. Wykazano silny związek między występowaniem cukrzycy u dzieci - głównie, jeśli nie całkowicie, typu 1 - a stwierdzeniem tej choroby u matek. Cukrzyca występowała nieznacznie częściej w najcięższym kwintylu masy urodzeniowej dla wieku ciążowego niż w innych kwintylach. Nie zaobserwowano znamiennego związku między występowaniem cukrzycy a innymi badanymi czynnikami okołoporodowymi.AIMS. To report on associations between perinatal factors and the subsequent development of diabetes mellitus under the age of 30 years in the offspring. METHODS. Analysis of linked hospital statistical records, comparing perinatal factors relating to the birth of 518 people admitted to hospital for diabetes with the same factors in 292 845 others, in a defined population in southern England from 1963 to 1999. RESULTS. Diabetes mellitus was much more common in children of mothers with diabetes than in others (OR: 6.42; 95% CI: 4.18&#8211;9.86). There was no significant association with birthweight or gestational age separately. Diabetes was more common in those in the highest quintile of 'birthweight for gestational age' compared with the lowest four quintiles combined (OR: 1.33; 95% CI: 1.08-1.64), but there was no consistent gradient of increasing frequency of diabetes across the lowest four quintiles. There were no significant associations between diabetes and mothers' age, parity, social class, or smoking during pregnancy, or between babies' mode of delivery or any other perinatal factors investigated. All results were similar when the analysis was confined to diabetes in people aged < 15 years. CONCLUSIONS. We found a strong association between diabetes in the child - mainly, if not entirely type 1 diabetes - and maternal diabetes. Diabetes was slightly more common in the heaviest quintile of birthweight for gestational age than in other quintiles. There were no significant associations between diabetes and the other perinatal factors studied

Pharmaceutical companies' policies on access to trial data, results, and methods: audit study.

Objectives To identify the policies of major pharmaceutical companies on transparency of trials, to extract structured data detailing each companies' commitments, and to assess concordance with ethical and professional guidance.Design Structured audit.Setting Pharmaceutical companies, worldwide.Participants 42 pharmaceutical companies.Main outcome measures Companies' commitments on sharing summary results, clinical study reports (CSRs), individual patient data (IPD), and trial registration, for prospective and retrospective trials.Results Policies were highly variable. Of 23 companies eligible from the top 25 companies by revenue, 21 (91%) committed to register all trials and 22 (96%) committed to share summary results; however, policies commonly lacked timelines for disclosure, and trials on unlicensed medicines and off-label uses were only included in six (26%). 17 companies (74%) committed to share the summary results of past trials. The median start date for this commitment was 2005. 22 companies (96%) had a policy on sharing CSRs, mostly on request: two committed to share only synopses and only two policies included unlicensed treatments. 22 companies (96%) had a policy to share IPD; 14 included phase IV trials (one included trials on unlicensed medicines and off-label uses). Policies in the exploratory group of smaller companies made fewer transparency commitments. Two companies fell short of industry body commitments on registration, three on summary results. Examples of contradictory and ambiguous language were documented and summarised by theme. 23/42 companies (55%) responded to feedback; 7/1806 scored policy elements were revised in light of feedback from companies (0.4%). Several companies committed to changing policy; some made changes immediately.Conclusions The commitments made by companies to transparency of trials were highly variable. Other than journal submission for all trials within 12 months, all elements of best practice were met by at least one company, showing that these commitments are realistic targets

A mobile ecology of resources for Covid-19 learning

Mobile devices and a vast array of accompanying applications offer significant affordances to create, consume, share, collaborate and communicate—affordances that could be easily leveraged to facilitate meaningful learning. A positive disruption arising from Covid-19 that aligns with the affordances of mobile learning is the uncoupling of time and space in the learning process. Traditionally formal learning is a process that is predominately viewed as an experience that is ‘timetabled’— scheduled to eventuate at a ‘place’—lecture or a tutorial (or similar) in a room or lecture theatre. In this concise paper, an ecology of resources is discussed along with guiding principles for designing and facilitating uncoupled authentic and student-determined learning post the emergency remote teaching phase

Beyond the toxic trio : exploring demand typologies in children’s social care

Demand for children’s social care is often conflated with rates of intervention and associated with a limited constellation of parental risk factors. This article reports on a more comprehensive picture of demand obtained through a quantitative study of child welfare interventions in England. Longitudinal child-level data were combined from children’s social care services in six English local authorities over a four-year period (2015–2018). Latent class analysis was undertaken for a random sample of child episodes where an assessment was undertaken (n = 15,000). The results were tested for consistency across LAs and to identify the most appropriate number of classes. Conditional probabilities were used to interpret the demand represented by each class, and to explore the relationship between typologies and child characteristics such as age, gender and ethnicity. The analysis found seven classes, or typologies of demand, to be present in factors at assessment across all the LAs, which were linked to certain child characteristics and intervention pathways. The findings go beyond the ‘toxic trio’ terminology often used to profile risks to children and support the innovative use of administrative data to provide insight into patterns of demand. Implications are discussed for strategic responses to child welfare problems and the multi-agency context of prevention