Impact of Recent Evidence on Use of Hormone Therapy in the South African Private Sector (2001-2005)

Background: The release of the results of the oestrogen plus progesterone therapy (EPT) arm of the Women\'s Health Initiative (WHI) in July 2002 started a worldwide process of reconsideration of the rationale behind hormone therapy (HT). This process was accelerated after the release of the results from the oestrogen-only (ET) arm of the same study. The results of the WHI reinforced the indications of HT to alleviate vasomotor symptoms and to prevent bone loss associated with early menopause, but refuted the possibility of cardioprotective effects and raised uncertainty around the risk of breast cancer for long-term users. In response, new guidelines and position statements were developed to aid healthcare practitioners and patients in various countries, including South Africa. The dissemination and penetration of all this information has been assessed in a number of countries, but the extent of its effect on the South African market is as yet unknown. Accordingly, the aim of this study was to assess the use of HT in the South African private sector from 2001 to 2005. Methods: Monthly HT sales data for January 2001 to October 2005 were obtained from IMS Health (SA). Three successive periods were compared: (1) January 2001 to June 2002 (discontinuation of the WHI oestrogen plus progestogen arm), (2) July 2002 to February 2004 (termination of the WHI oestrogen only arm) and (3) March 2004 to October 2005. Results: Overall, sales of HT fell 6.9% between periods 1 and 2 and 14.6% between periods 2 and 3. The total sales of ET predominated; they were more than double those of EPT. For ET, the sale of conjugated equine oestrogen (CEE) preparations exceeded those of non-CEE ET preparations, while for EPT preparations the reverse was true. The decline in ET sales was mostly accounted for by the fall in sales of CEE, by 9.8% and 20.6% for the two periods respectively. There was an increase in sales of both low-dose CEE and non-CEE, although the magnitude of increase in the case of the latter was much greater. Throughout the entire study period, CEE 0.625 mg tablets were found to account for the greatest sales volumes. Private sector sales represented 74.4% of total national HT sales over this period. Conclusion: The release of the WHI findings resulted in a modest decrease in HT sales in South Africa, although it was less dramatic than sales reported elsewhere. The change in prescribing cannot be attributed to any single factor. Factors such as publicity, adherence to new guidelines, and pharmaceutical marketing may all have contributed. Guidelines need to be updated as the results of new research continue to be published. There is also a need to periodically review prescribing trends, and to assess compliance with evidence-based guidelines, in order to improve the quality of medicines use. The majority of prescriptions for HT in South Africa are written by general practitioners, rather than by specialists. It is thus imperative that guidelines be appropriately framed for this market, as well as interpreted and applied. Keywords: hormone therapy (HT), South Africa, Women's Health Initiative South African Family Practice Vol. 50 (6) 2008: pp. 42-42

New light on the ‘Drummer of Tedworth’: conflicting narratives of witchcraft in Restoration England

This paper presents a definitive text of hitherto little-known early documents concerning ‘The Drummer of Tedworth’, a poltergeist case that occurred in 1662-3 and became famous not least due to its promotion by Joseph Glanvill in his demonological work, Saducismus Triumphatus. On the basis of these and other sources, it is shown how responses to the events at Tedworth evolved from anxious piety on the part of their victim, John Mompesson, to confident apologetic by Glanvill, before they were further affected by the emergence of articulate scepticism about the case

Essays in anarchism and religion: Volume 1

Essays in anarchism and religion: Volume

External data required timely response by the Trial Steering-Data Monitoring Committee for the NALoxone InVEstigation (N-ALIVE) pilot trial

The prison-based N-ALIVE pilot trial had undertaken to notify the Research Ethics Committee and participants if we had reason to believe that the N-ALIVE pilot trial would not proceed to the main trial. In this paper, we describe how external data for the third year of before/after evaluation from Scotland's National Naloxone Programme, a related public health policy, were anticipated by eliciting prior opinion about the Scottish results in the month prior to their release as official statistics. We summarise how deliberations by the N-ALIVE Trial Steering-Data Monitoring Committee (TS-DMC) on N-ALIVE's own interim data, together with those on naloxone-on-release (NOR) from Scotland, led to the decision to cease randomization in the N-ALIVE pilot trial and recommend to local Principal Investigators that NOR be offered to already-randomized prisoners who had not yet been released

Impact of comorbidities on the safety and effectiveness of hip and knee arthroplasty surgery: A national observational study

AIMS: Access to joint replacement is being restricted for patients with comorbidities in a number of high-income countries. However, there is little evidence on the impact of comorbidities on outcomes. The purpose of this study was to determine the safety and effectiveness of hip and knee arthroplasty in patients with and without comorbidities. METHODS: In total, 312,079 hip arthroplasty and 328,753 knee arthroplasty patients were included. A total of 11 common comorbidities were identified in administrative hospital records. Safety risks were measured by assessing length of hospital stay (LOS) and 30-day emergency readmissions and mortality. Effectiveness outcomes were changes in Oxford Hip or Knee Scores (OHS/OKS) (scale from 0 (worst) to 48 (best)) and in health-related quality of life (EQ-5D) (scale from 0 (death) to 1 (full health)) from immediately before, to six months after, surgery. Regression analysis was used to estimate adjusted mean differences (LOS, change in OHS/OKS/EQ-5D) and risk differences (readmissions and mortality). RESULTS: Patients with comorbidities had a longer LOS and higher readmission and mortality rates than patients without. In hip arthroplasty patients with heart disease, for example, LOS was 1.20 days (95% confidence interval (CI) 1.15 to 1.25) longer and readmission rate was 1.52% (95% CI 1.34% to 1.71%) and mortality 0.19% (95% CI 0.15% to 0.23%) higher. Similar patterns were observed for knee arthroplasty patients. Patients without comorbidities reported large improvements in function (mean improvement OHS 21.3 (SD 9.91) and OKS 15.9 (SD 10.0)). Patients with comorbidities reported only slightly smaller improvements. In patients with heart disease, mean improvement in OHS was 0.39 (95% CI 0.27 to 0.51) and in OKS 0.56 (95% CI 0.45 to 0.67) less than in patients without comorbidities. There were no significant differences in EQ-5D improvement. CONCLUSION: Comorbidities were associated with small increases in adverse safety risks but they have little impact on pain or function in patients undergoing hip or knee arthroplasty. These results do not support restricting access to hip and knee arthroplasty for patients with common comorbidities. Cite this article: Bone Joint J 2021;103-B(1):56-64

WPA position statement on prisoner mental and public health care

As a group, prisoners have a tendency not to engage effectively with healthcare services while they are in the community because they have so many other competing priorities. Other priorities may include access to adequate finance, finding a place to sleep that is dry and safe, having sufficient food for themselves and their families, or the need to meet existing addictions. However, as a group, they present with high levels of health morbidity across domains of physical and mental health and addictions. It is widely established that screening people for healthcare conditions at the point when they are received into prison can assist in identifying a range of medical conditions. Although the process has limitations, the practice of screening is recommended internationally. After screening has taken place, healthcare services are meant to be provided in prisons to the same extent and quality as would be available in the community, yet across the world, there have often been problems in ensuring the adequacy of prison healthcare systems. Prison healthcare departments have often lagged behind regarding funding, and many countries have reported problems with the quality and consistency of delivery. Also, issues with training and continuous professional development are often cited as problematic in this area. This curriculum has been prepared to assist countries in ensuring that systems are in place for the effective training and continuous professional development of staff. It is meant to assist those who design such programs for local use

Replication and Characterization of Association between ABO SNPs and Red Blood Cell Traits by Meta-Analysis in Europeans.

Red blood cell (RBC) traits are routinely measured in clinical practice as important markers of health. Deviations from the physiological ranges are usually a sign of disease, although variation between healthy individuals also occurs, at least partly due to genetic factors. Recent large scale genetic studies identified loci associated with one or more of these traits; further characterization of known loci and identification of new loci is necessary to better understand their role in health and disease and to identify potential molecular mechanisms. We performed meta-analysis of Metabochip association results for six RBC traits-hemoglobin concentration (Hb), hematocrit (Hct), mean corpuscular hemoglobin (MCH), mean corpuscular hemoglobin concentration (MCHC), mean corpuscular volume (MCV) and red blood cell count (RCC)-in 11 093 Europeans from seven studies of the UCL-LSHTM-Edinburgh-Bristol (UCLEB) Consortium. We identified 394 non-overlapping SNPs in five loci at genome-wide significance: 6p22.1-6p21.33 (with HFE among others), 6q23.2 (with HBS1L among others), 6q23.3 (contains no genes), 9q34.3 (only ABO gene) and 22q13.1 (with TMPRSS6 among others), replicating previous findings of association with RBC traits at these loci and extending them by imputation to 1000 Genomes. We further characterized associations between ABO SNPs and three traits: hemoglobin, hematocrit and red blood cell count, replicating them in an independent cohort. Conditional analyses indicated the independent association of each of these traits with ABO SNPs and a role for blood group O in mediating the association. The 15 most significant RBC-associated ABO SNPs were also associated with five cardiometabolic traits, with discordance in the direction of effect between groups of traits, suggesting that ABO may act through more than one mechanism to influence cardiometabolic risk.British Heart Foundation (Grant ID: RG/10/12/28456, RG/08/013/25942, RG/13/16/30528, RG/98002, RG/07/008/23674); Medical Research Council (Grant ID: G0000934, G0500877, MC_UU_12019/1, K013351); Wellcome Trust (Grant ID: 068545/Z/02, 097451/Z/11/Z); European Commission Framework Programme 6 (Grant ID: 018996); French Ministry of Research; Department of Health Policy Research Programme (England); Chief Scientist Office of Scotland (Grant ID: CZB/4/672, CZQ/1/38); National Institute on Ageing (NIA) (Grant ID: AG1764406S1, 5RO1AG13196); Pfizer plc (Unrestricted Investigator Led Grant); Diabetes UK (Clinical Research Fellowship 10/0003985); Stroke Association; National Heart Lung and Blood Institute (5RO1HL036310); Agency for Health Care Policy Research (HS06516); John D. and Catherine T. MacArthur Foundation Research Networks on Successful Midlife Development and Socio-economic Status and Health; Swiss National Science Foundation (33CSCO-122661); GlaxoSmithKline. Faculty of Biology and Medicine of Lausanne,Switzerland.This is the final version of the article. It first appeared from Public Library of Science (PLOS) via http://dx.doi.org/10.1371/journal.pone.015691