National Indigenous Palliative Care Needs Study

This study involved extensive consultation with the community to identify the needs of Aboriginal and Torres Strait Islander peoples in palliative care

Response by Welsh et al to letter regarding article “Urinary sodium excretion, blood pressure, and risk of future cardiovascular disease and mortality in subjects without prior cardiovascular disease”

No abstract available

Inequalities in the evolution of the COVID-19 pandemic: an ecological study of inequalities in mortality in the first wave and the effects of the first national lockdown in England

Objectives To examine how ecological inequalities in COVID-19 mortality rates evolved in England, and whether the first national lockdown impacted them. This analysis aimed to provide evidence for important lessons to inform public health planning to reduce inequalities in any future pandemics. Design Longitudinal ecological study. Setting 307 lower-tier local authorities in England. Primary outcome measure Age-standardised COVID-19 mortality rates by local authority, regressed on Index of Multiple Deprivation (IMD) and relevant epidemic dynamics. Results Local authorities that started recording COVID-19 deaths earlier were more deprived, and more deprived authorities saw faster increases in their death rates. By 6 April 2020 (week 15, the earliest time that the 23 March lockdown could have begun affecting death rates) the cumulative death rate in local authorities in the two most deprived deciles of IMD was 54% higher than the rate in the two least deprived deciles. By 4 July 2020 (week 27), this gap had narrowed to 29%. Thus, inequalities in mortality rates by decile of deprivation persisted throughout the first wave, but reduced during the lockdown. Conclusions This study found significant differences in the dynamics of COVID-19 mortality at the local authority level, resulting in inequalities in cumulative mortality rates during the first wave of the pandemic. The first lockdown in England was fairly strict - and the study found that it particularly benefited those living in more deprived local authorities. Care should be taken to implement lockdowns early enough, in the right places - and at a sufficiently strict level - to maximally benefit all communities, and reduce inequalities

Heritability analyses of musculoskeletal conditions and exercise-induced pulmonary haemorrhage in thoroughbred racehorses

Musculoskeletal conditions and exercise-induced pulmonary haemorrhage are commonly diagnosed in Thoroughbred racehorses worldwide, and have serious consequences for racehorse welfare and the racing economy. Despite increasing interest in the study of genetic susceptibility to disease from the veterinary research community as a whole over past decades, the Thoroughbred has been largely ignored as a study group. The availability of software capable of complex genetic analyses using large, unbalanced pedigrees has made the study of genetic susceptibility to disease a realistic prospect for veterinary researchers. This study aimed to complete preliminary analyses of the genetics of a number of important musculoskeletal conditions, and of exercise-induced pulmonary haemorrhage, in two different Thoroughbred populations. Multivariable regression analyses were performed to identify important environmental risk factors for each condition in each population, and heritability analyses were conducted. Genetic correlations between disease conditions were also investigated. Fracture, tendon injury, suspensory ligament injury, osteoarthritis and EIPH/epistaxis were found to be heritable traits in the Hong Kong population. Distal limb fracture, SDFT injury and epistaxis were also found to be heritable in the UK Thoroughbred population. Most heritability estimates were small or moderate in magnitude. Selective breeding strategies that identify those animals with low genetic risk could play a part in future efforts to reduce the incidence of these conditions, in conjunction with favourable environmental manipulations based on research evidence. Due to low heritability, most of the conditions studied here would reduce in incidence slowly if selective breeding were implemented, thus strategic environmental manipulations would be warranted alongside such longer-term efforts to provide effective incidence reductions. A number of conditions were found to be positively genetically correlated, suggesting that risk reduction through breeding could reduce the risk of multiple diseases concurrently. For example, fracture and osteoarthritis were found to be positively genetically correlated (0.85 – 0.89) in the Hong Kong racehorse population. However, using the Hong Kong Thoroughbred population dataset, EIPH/epistaxis and tendon injury were negatively genetically correlated, which suggests that reduction in genetic risk of one of these may lead to increased genetic risk of the other. iii Measures of the durability and performance of racehorses were investigated to assess whether they were heritable traits in the UK and Hong Kong racehorse populations, and to assess their relationship to the disease conditions studied. Selection based on more holistic measures of horse health and longevity such as ‘career length’ could be a more attractive prospect for stakeholders, as this could forego the need to select for many different traits individually. Career length, number of starts over the career, and the level of earnings were all heritable traits in both populations. These holistic traits were found to have variable relationships with the disease conditions studied in each population. These analyses are the first to assess the genetic contribution to risk for many important diseases in the Thoroughbred. They provide a starting point from which further investigations into the applicability of genetic manipulations could yield realistic and achievable tools for racing stakeholders to use to ‘improve’ the breed in future

Estimates of genetic parameters of distal limb fracture and superficial digital flexor tendon injury in UK Thoroughbred racehorses

A retrospective cohort study of distal limb fracture and superficial digital flexor tendon (SDFT) injury in Thoroughbred racehorses was conducted using health records generated by the British Horseracing Authority (BHA) between 2000 and 2010. After excluding records of horses that had both flat and jump racing starts, repeated records were reduced to a single binary record per horse (<i>n</i> = 66,507, 2982 sires), and the heritability of each condition was estimated using residual maximum likelihood (REML) with animal logistic regression models. Similarly, the heritability of each condition was estimated for the flat racing and jump racing populations separately. Bivariate mixed models were used to generate estimates of genetic correlations between SDFT injury and distal limb fracture. The heritability of distal limb fracture ranged from 0.21 to 0.37. The heritability of SDFT injury ranged from 0.31 to 0.34. SDFT injury and distal limb fracture were positively genetically correlated. These findings suggest that reductions in the risk of the conditions studied could be attempted using targeted breeding strategies

Static Socio-Ecological COVID-19 Vulnerability Index and Vaccine Hesitancy Index for England

Background: Population characteristics can be used to infer vulnerability of communities to COVID-19, or to the likelihood of high levels of vaccine hesitancy. Communities harder hit by the virus, or at risk of being so, stand to benefit from greater resource allocation than their population size alone would suggest. This study reports a simple but efficacious method of ranking small areas of England by relative characteristics that are linked with COVID-19 vulnerability and vaccine hesitancy. Methods: Publicly available data on a range of characteristics previously linked with either poor COVID-19 outcomes or vaccine hesitancy were collated for all Middle Super Output Areas of England (MSOA, n=6790, excluding Isles of Scilly), scaled and combined into two numeric indices. Multivariable linear regression was used to build a parsimonious model of vulnerability (static socio-ecological vulnerability index, SEVI) in 60% of MSOAs, and retained variables were used to construct two simple indices. Assuming a monotonic relationship between indices and outcomes, Spearman correlation coefficients were calculated between the SEVI and cumulative COVID-19 case rates at MSOA level in the remaining 40% of MSOAs over periods both during and out with national lockdowns. Similarly, a novel vaccine hesitancy index (VHI) was constructed using population characteristics aligned with factors identified by an Office for National Statistics (ONS) survey analysis. The relationship between the VHI and vaccine coverage in people aged 12+years (as of 2021-06-24) was determined using Spearman correlation. The indices were split into quintiles, and MSOAs within the highest vulnerability and vaccine hesitancy quintiles were mapped. Findings: The SEVI showed a moderate to strong relationship with case rates in the validation dataset across the whole study period, and for every intervening period studied except early in the pandemic when testing was highly selective. The SEVI was more strongly correlated with case rates than any of its domains (rs 0·59 95% CI 0.57-0.62) and outperformed an existing MSOA-level vulnerability index. The VHI was significantly negatively correlated with COVID-19 vaccine coverage in the validation data at the time of writing (rs -0·43 95% CI -0·46 to -0·41). London had the largest number and proportion of MSOAs in quintile 5 (most vulnerable/hesitant) of SEVI and VHI concurrently. Interpretation: The indices presented offer an efficacious way of identifying geographical disparities in COVID-19 risk, thus helping focus resources according to need. Funding: Funder: Integrated Covid Hub North East Award number: n/a Grant recipient: Fiona Matthew

Distribution and patterns of spread of recolonising Eurasian beavers (Castor fiber Linnaeus 1758) in fragmented habitat, Agdenes peninsula, Norway

The Agdenes peninsula, Sør-Trøndelag, Norway, 1060km2, is a heavily dissected mountainous landscape with numerous small watersheds, of mainly steep gradient, flowing separately into the sea or to fjords. Suitable habitat for permanent beaver occupation occurs mainly as isolated patches within these watersheds. Eurasian beavers were directly reintroduced to the area in 1926 and 1928. The last known individual of this population died in 1961. In 1968-69 2 pairs and a young animal were reintroduced on the Ingdalselva watershed. The current population is descended from these animals, and probably from the later 1990s by immigrants from the adjacent Orkla river system. In 2010-11 the area was surveyed and 24 beaver family group home ranges located, 20 of which were currently active and 4 abandoned; the population size was estimated at about 80 individuals within family territories plus in any year a number of dispersing individuals. Eighteen of the active territories were located on just four watersheds, Ingdalselva and three immediately adjacent to it. The remaining two territories were isolated on different watersheds distant from any other known group, requiring multiple crossings between watersheds and/or considerable movements through salt water to reach from them. Signs of vagrant individuals were found widely, including on a number of watersheds not occupied by any family group, though containing suitable habitat for permanent colonisation. Known data on the date of establishment of each family group is given, and the pattern of recolonisation to date discussed. An isolated population of beavers on a section of the Orkla river system, first noted in 1933, has been attributed to spread from the first study area reintroductions. However, there are grounds to suspect that this population may have had a different origin. Genetic studies would be useful to elucidate this point. beaver, Castor fiber, distribution, reintroduction, dispersal, Agdenes, Sør-Trøndelag, NorwayDistribution and patterns of spread of recolonising Eurasian beavers (Castor fiber Linnaeus 1758) in fragmented habitat, Agdenes peninsula, NorwaypublishedVersio

Can vaccination roll-out be more equitable if population risk is taken into account?

Background COVID-19 vaccination in many countries, including England, has been prioritised primarily by age. However, people of the same age can have very different health statuses. Frailty is a commonly used metric of health and has been found to be more strongly associated with mortality than age among COVID-19 inpatients. Methods We compared the number of first vaccine doses administered across the 135 NHS Clinical Commissioning Groups (CCGs) of England to both the over 50 population and the estimated frail population in each area. Area-based frailty estimates were generated using the English Longitudinal Survey of Ageing (ELSA), a national survey of older people. We also compared the number of doses to the number of people with other risk factors associated with COVID- 19: Atrial fibrillation, chronic kidney disease, diabetes, learning disabilities, obesity and smoking status. Results We estimate that after 79 days of the vaccine program, across all Clinical Commissioning Group areas, the number of people who received a first vaccine per frail person ranged from 4.4 (95% CI 4.0-4.8) and 20.1 (95% CI 18.3-21.9). The prevalences of other risk factors were also poorly associated with the prevalence of vaccination across England. Conclusions Vaccination with age-based priority created area-based inequities in the number of doses administered relative to the number of people who are frail or have other risk factors associated with COVID-19. As frailty has previously been found to be more strongly associated with mortality than age for COVID-19 inpatients, an age-based priority system may increase the risk of mortality in some areas during the vaccine roll-out period. Authorities planning COVID-19 vaccination programmes should consider the disadvantages of an age-based priority system

Analysis of good practices in Europe and Africa

According to the Global Status Report on Road Safety 2015 of WHO (WHO, 2015), “road traffic injuries claim more than 1.2 million lives each year and have a huge impact on health and development”. Based on the WHO regions, there has been a deterioration in road fatality rates in the WHO Africa region from 24.1 fatalities per 100,000 inhabitants in 2010 to 26.6 fatalities per 100,000 inhabitants in 2013. Over the same period, there was an improvement in road fatality rates in the WHO Europe region. Road trauma in Africa is expected to worsen further, with fatalities per capita projected to double over the period 2015-2030 (Small and Runji, 2014). The SaferAfrica project aims at establishing a Dialogue Platform between Africa and Europe focused on road safety and traffic management issues. It will represent a high-level body with the main objective of providing recommendations to update the African Road Safety Action Plan and the African Road Safety Charter, as well as fostering the adoption of specific initiatives, properly funded. The main objective of work package 7 (WP7) is to analyse good road safety practices realised at country, corridor and regional levels in Africa and to compare these practices with those of other countries and with international experiences. Also included in this WP7, are good practices in road safety management and in the policy-making and integration of road safety with other policy areas. WP7 includes the definition of a transferability audit, tailored to Africa conditions that can be used to assess the suitability of road safety interventions in the context of African countries. Finally, promising local projects were identified, that may be implemented in selected African countries (Tunisia, Kenya, Cameroon, Burkina Faso and South Africa); to this end, a procedure for assessing the potential adaptability to the local contexts (transferability audit) will be developed in WP7 and applied to promising interventions. Following a successful transferability audit, a detailed concept definition of the retained interventions will be made by SaferAfrica participants and local road safety experts. Furthermore, factsheets on five key challenging African safety issues will be developed as synthesised working documents, containing all technical and financial information necessary for understanding the corresponding set of proposed interventions...

Urinary sodium excretion, blood pressure and risk of future cardiovascular disease and mortality in subjects without prior cardiovascular disease

Hypertension is a risk factor for cardiovascular disease. Increased urinary sodium excretion, representing dietary sodium intake, is associated with hypertension. Low sodium intake has been associated with increased mortality in observational studies. Further studies should assess whether confounding relationships explain associations between sodium intake and outcomes. We studied UK Biobank participants (n=457 484; mean age, 56.3 years; 44.7% men) with urinary electrolytes and blood pressure data. Estimated daily urinary sodium excretion was calculated using Kawasaki formulae. We analyzed associations between sodium excretion and blood pressure in subjects without cardiovascular disease, treated hypertension, or diabetes mellitus at baseline (n=322 624). We tested relationships between sodium excretion, incidence of fatal and nonfatal cardiovascular disease, heart failure, and mortality. Subjects in higher quintiles of sodium excretion were younger, with more men and higher body mass index. There was a linear relationship between increasing urinary sodium excretion and blood pressure. During median follow-up of 6.99 years, there were 11 932 deaths (1125 cardiovascular deaths) with 10 717 nonfatal cardiovascular events. There was no relationship between quintile of sodium excretion and outcomes. These relationships were unchanged after adjustment for comorbidity or excluding subjects with events during the first 2 years follow-up. No differing risk of incident heart failure (1174 events) existed across sodium excretion quintiles. Urinary sodium excretion correlates with elevated blood pressure in subjects at low cardiovascular risk. No pattern of increased cardiovascular disease, heart failure, or mortality risk was demonstrated with either high or low sodium intake