National data opt out programme: consequences for maternity services in England

Electronic health records offer great potential for individual care, service improvement and, when collated, the health of the wider population. Datasets composed of these types of records have been invaluable to our understanding of risk factors for maternal and infant ill-health. However, a potential barrier to data quality in England is emerging where patients choose to opt out of sharing their information beyond the NHS. Focussing on maternity statistics, we will present the importance of population level health data for monitoring NHS services, and the potential consequences for patients of opting out. Evidencing the success of similar systems in Nordic countries, we argue that the English population must be better informed of the implications of opting out of sharing NHS data for research and the safeguards in place to protect patient information

Does adiposity mediate the relationship between socioeconomic position and non-allergic asthma in childhood?

BACKGROUND: Despite its high prevalence, early onset and chronic nature, the causes of asthma are not clearly established. The present study examined a plausible but untested relationship in the development of non-allergic asthma; an asthma phenotype closely linked to deprivation and other preventable risk factors. Our aim was to determine the mediating role of adiposity in the relationship between socioeconomic position in infancy and non-allergic asthma emergence in mid-childhood. METHODS: To estimate the causal indirect effect of adiposity we applied the parametric g-computational procedure to 6203 singleton children from the UK Millennium Cohort Study. Adiposity was measured at age 7 by body mass index, waist circumference and waist circumference-to-height ratio. Children who developed non-allergic asthma between the age of 7 and 14 were compared with children without allergies or allergic asthma at these ages. RESULTS: We found no evidence to suggest that adiposity is a mediator in the relationship between socioeconomic position and the development of non-allergic asthma in mid-childhood. After adjustment for risk factors, the direct effect of socioeconomic position remained; children in the lowest tertile of socioeconomic position had a 43% (OR 1.43, 95% CI 1.38 to 1.49) greater odds of developing non-allergic asthma compared with the highest tertile. CONCLUSIONS: Adiposity at age 7 does not mediate the relationship between socioeconomic position and non-allergic asthma. The results suggest that improving socioeconomic conditions and promoting healthy weight are both important in reducing the development of non-allergic asthma in early to mid-childhood

Geospatial and seasonal variation of bronchiolitis in England: a cohort study using hospital episode statistics

BACKGROUND Rates of hospital admissions for bronchiolitis vary seasonally and geographically across England; however, seasonal differences by area remain unexplored. We sought to describe spatial variation in the seasonality of hospital admissions for bronchiolitis and its association with local demographic characteristics. METHODS Singleton children born in English National Health Service hospitals between 2011 and 2016 (n=3 727 013) were followed up for 1 year. Poisson regression models with harmonic functions to model seasonal variations were used to calculate weekly incidence rates and peak timing of bronchiolitis admissions across English regions and clinical commissioning groups (CCGs). Linear regression was used to estimate the joint association of population density and deprivation with incidence and peak timing of bronchiolitis admissions at the CCG level. RESULTS Bronchiolitis admission rates ranged from 30.9 per 1000 infant-years (95% CI 30.4 to 31.3) in London to 68.7 per 1000 (95% CI 67.9 to 69.5) in the North West. Across CCGs, there was a 5.3-fold variation in incidence rates and the epidemic peak ranged from week 49.3 to 52.2. Admission rates were positively associated with area-level deprivation. CCGs with earlier peak epidemics had higher population densities, and both high and low levels of deprivation were associated with earlier peak timing. CONCLUSIONS Approximately one quarter of the variation in admission rates and two-fifths of the variation in peak timing of hospital admissions for bronchiolitis were explained by local demographic characteristics. Implementation of an early warning system could help to prepare hospitals for peak activity and to time public health messages

Skin bleaching: A neglected form of injury and threat to global skin

Skin bleaching is the use of creams, gels, or soaps to lighten the skin and is known to cause a number of injuries, many of which are potentially life-threatening. Despite the growing body of research identifying the harmful effects of skin bleaching, this topic has received little attention in the field of public health. This study provides a literature review of the current research documenting health risks associated with skin bleaching. Articles pertaining to skin bleaching practices and their health consequences were extracted from databases that publish research in the biomedical, public health, and social science literatures. Twenty-two articles that met search criteria were analysed and thematically coded using a priori research questions examining: (1) harms caused by skin bleaching, (2) alignment with accepted definitions of injury, and (3) suggestions for prevention and intervention. Results indicate skin bleaching poses a serious public health risk and threat to skin safety. Researchers have called for increased governmental and individual/community intervention to address this growing problem. Limitations of the study include the small number of scholarly publications on the topic, limited epidemiological study of the topic, and various selection biases in individual articles that may skew results. Keywords: skin safety, skin bleaching, skin lightening, injury prevention, literature review, public healt

Three-dimensional arrangement of elastic fibers in the human corneal stroma

This is the final version of the article. Available from the publisher via the DOI in this record.The cornea is the main refracting lens in the eye. As part of the outer tunic it has to be resilient, a property conferred by the organisation of the constituent collagen. It also has to be sufficiently elastic to regain its exact shape when deformed, in order not to distort the retinal image. The basis of this elasticity is not fully understood. The purpose of this study was to characterise in three dimensions the arrangement and distribution of elastic fibers in the human corneal stroma, using serial block face scanning electron microscopy. We have demonstrated that there exists a complex network of elastic fibers that appear to originate in the sclera or limbus. These appear as elastic sheets in the limbus and peripheral cornea immediately above the trabecular meshwork which itself appears to extend above Descemet's membrane in the peripheral stroma. From these sheets, elastic fibers extend into the cornea; moving centrally they bifurcate and trifurcate into narrower fibers and are concentrated in the posterior stroma immediately above Descemet's membrane. We contend that elastic sheets will play an important role in the biomechanical deformation and recovery of the peripheral cornea. The network may also have practical implications for understanding the structural basis behind a number of corneal surgeries.We would like to thank Dr Anthony Hayes and Mr Derek Scarborough for help with the histology presented in this study and Dr Sally Hayes for useful discussions concerning data interpretation. This work was funded by a Programme Grant (503626) from the Medical Research Council (to KMM) and an MRC studentship (to TW). We thank the CTC Eye Bank at Bristol, UK and the HDBR at Newcastle, UK, for supply of human corneas. The authors have no conflicts of interest to declare

Individuals' Long Term Use of Cognitive Behavioural Skills to Manage their Depression: A Qualitative Study

Background: Cognitive Behavioural Therapy (CBT) aims to teach people skills to help them self-manage their depression. Trial evidence shows that CBT is an effective treatment for depression and individuals may experience benefits long-term. However, there is little research about individuals’ continued use of CBT skills once treatment has finished. Aims: To explore whether individuals who had attended at least 12 sessions of CBT continued to use and value the CBT skills they had learnt during therapy. Method: Semi-structured interviews were held with participants from the CoBalT trial who had received CBT, approximately 4 years earlier. Interviews were audio-recorded, transcribed and analysed thematically. Results: 20 participants were interviewed. Analysis of the interviews suggested that individuals who viewed CBT as a learning process, at the time of treatment, recalled and used specific skills to manage their depression once treatment had finished. In contrast, individuals who viewed CBT only as an opportunity to talk about their problems did not appear to utilize any of the CBT skills they had been taught and reported struggling to manage their depression once treatment had ended. Conclusions: Our findings suggest individuals may value and use CBT skills if they engage with CBT as a learning opportunity at the time of treatment. Our findings underline the importance of the educational model in CBT and the need to emphasize this to individuals receiving treatment

Does a modified STarT Back Tool predict outcome with a broader group of musculoskeletal patients than back pain? A secondary analysis of cohort data.

OBJECTIVES: The STarT Back Tool has good predictive performance for non-specific low back pain in primary care. We therefore aimed to investigate whether a modified STarT Back Tool predicted outcome with a broader group of musculoskeletal patients, and assessed the consequences of using existing risk-group cut-points across different pain regions. SETTING: Secondary analysis of prospective data from 2 cohorts: (1) outpatient musculoskeletal physiotherapy services (PhysioDirect trial n=1887) and (2) musculoskeletal primary-secondary care interface services (SAMBA study n=1082). PARTICIPANTS: Patients with back, neck, upper limb, lower limb or multisite pain with a completed modified STarT Back Tool (baseline) and 6-month physical health outcome (Short Form 36 (SF-36)). OUTCOMES: Area under the receiving operator curve (AUCs) tested discriminative abilities of the tool's baseline score for identifying poor 6-month outcome (SF-36 lower tertile Physical Component Score). Risk-group cut-points were tested using sensitivity and specificity for identifying poor outcome using (1) Youden's J statistic and (2) a clinically determined rule that specificity should not fall below 0.7 (false-positive rate <30%). RESULTS: In PhysioDirect and SAMBA, poor 6-month physical health was 18.5% and 28.2%, respectively. Modified STarT Back Tool score AUCs for predicting outcome in back pain were 0.72 and 0.79, neck 0.82 and 0.88, upper limb 0.79 and 0.86, lower limb 0.77 and 0.83, and multisite pain 0.83 and 0.82 in PhysioDirect and SAMBA, respectively. Differences between pain region AUCs were non-significant. Optimal cut-points to discriminate low-risk and medium-risk/high-risk groups depended on pain region and clinical services. CONCLUSIONS: A modified STarT Back Tool similarly predicts 6-month physical health outcome across 5 musculoskeletal pain regions. However, the use of consistent risk-group cut-points was not possible and resulted in poor sensitivity (too many with long-term disability being missed) or specificity (too many with good outcome inaccurately classified as 'at risk') for some pain regions. The draft tool is now being refined and validated within a new programme of research for a broader musculoskeletal population. TRIAL REGISTRATION NUMBER: ISRCTN55666618; Post results

Logging of rainforest and conversion to oil palm reduces bioturbator diversity but not levels of bioturbation

Anthropogenic habitat change is a major driver of species extinctions and altered species communities worldwide. These changes are particularly rapid in the tropics, where logging of rainforests and conversion to agricultural habitats is widespread. Because species have varying effects on their abiotic environment, we expect shifts in species composition to drive changes in ecosystem processes. One important ecosystem process is animal-driven bioturbation: the turnover of soil material by soil-dwelling organisms. We developed a protocol for measuring aboveground bioturbation, and assessed how bioturbation rates and standing amounts of aboveground bioturbated soil change as primary tropical rainforests are logged and converted to oil palm plantation. By identifying the animals that created soil structures, we assigned bioturbation activity to different soil-dwelling groups. Across all habitats, most standing bioturbated soil was generated by termites (97.0%), while short-term, small-scale bioturbation was mainly generated by earthworms (87.3%). The species diversity of social insects (ants and termites) involved in bioturbation was higher in primary forest than in either logged forest or oil palm plantation. However, neither standing bioturbated soil, nor short-term bioturbation rate differed among habitats. Unexpectedly, in primary forest, high levels of bioturbation were associated with low bioturbator diversity. This was because two termite species, where present, conducted nearly all bioturbation. There was no relationship between levels of bioturbation and diversity in the other habitats. Our results emphasize the importance, across all habitats, of termites for generating standing aboveground soil structures, and earthworms for short-term soil turnover. In oil palm plantation, bioturbation relies on a smaller number of species, raising concerns about future environmental change and consequent species loss