Do early-life exposures explain why more advantaged children get eczema? Findings from the U.K. Millennium Cohort Study

Background: Atopic dermatitis (eczema) in childhood is socially patterned, with higher incidence in more advantaged populations. However, it is unclear what factors explain the social differences. Objectives: To identify early-life risk factors for eczema, and to explore how early-life risk factors explain any differences in eczema. Methods: We estimated odds ratios (ORs) for ever having had eczema by age 5 years in 14 499 children from the U.K. Millennium Cohort Study (MCS), with a focus on maternal, antenatal and early-life risk factors and socioeconomic circumstances (SECs). Risk factors were explored to assess whether they attenuated associations between SECs and eczema. Results: Overall 35·1% of children had ever had eczema by age 5 years. Children of mothers with degree-level qualifications vs. no educational qualifications were more likely to have eczema (OR 1·52, 95% confidence interval 1·31–1·76), and there was a gradient across the socioeconomic spectrum. Maternal atopy, breastfeeding (1–6 weeks and ≥ 6 months), introduction of solids under 4 months or cow's milk under 9 months, antibiotic exposure in the first year of life and grime exposure were associated with an increased odds of having eczema. Female sex, Pakistani and Bangladeshi ethnicity, smoking during pregnancy, exposure to environmental tobacco smoke and having more siblings were associated with reduced odds for eczema. Controlling for maternal, antenatal and early-life characteristics (particularly maternal smoking during pregnancy, breastfeeding and number of siblings) reduced the OR for eczema to 1·26 (95% confidence interval 1·03–1·50) in the group with the highest educational qualifications compared with the least. Conclusions: In a representative U.K. child cohort, eczema was more common in more advantaged children. This was explained partially by early-life factors including not smoking during pregnancy, breastfeeding and having fewer siblings

LOVING YOUR LIVER: the complete guide to liver detox

Loving Your Liver. The Complete Guide to Liver Detox is a comprehensive guide to liver “maintenance”. Written in a simple and intuitive way, it helps understand what the liver is, what it does, how it works, how it is affected by our lifestyle, the most common diseases that can affect it and most importantly, how to take care of it. Of course, the key to a good liver detox lies in nutrition and for this very reason the learning journey with Hrvoje Miletic and Simon Taylor-Robinson ends with a section entirely dedicated to a number of delicious recipes that are good for the liver without sacrificing taste. Hrvoje Miletic is a noted food expert in Croatia and across Europe. He holds international diplomas in culinary affairs and in management. Hrvoje’s experience in the United Kingdom and across Europe has moulded his culinary experience and flair. He is currently a food researcher and entrepreneur, using his skills to help people lead a healthy lifestyle. His considerable expertise is reflected in the book. Simon Taylor-Robinson is a medical doctor. He trained as a gastroenterologist and hepatologist. He has conducted medical research on liver disease with projects around the world. During his career, he has combined being a clinical doctor with liver expertise with being a medical researcher and a teacher at the undergraduate and postgraduate level. He also holds several honorary Professorial appointments at institutions in sub-Saharan Africa and in Asia

Community-based trial of screening for Chlamydia trachomatis to prevent pelvic inflammatory disease: the POPI (prevention of pelvic infection) trial.

BACKGROUND: Pelvic inflammatory disease (PID) is common and can lead to tubal factor infertility, ectopic pregnancy or chronic pelvic pain. Despite major UK government investment in the National Chlamydia Screening Programme, evidence of benefit remains controversial. The main aim of this trial was to investigate whether screening and treatment of chlamydial infection reduced the incidence of PID over 12 months. Secondary aims were to conduct exploratory studies of the role of bacterial vaginosis (BV) in the development of PID and of the natural history of chlamydial infection. DESIGN: Randomised controlled trial with follow up after 12 months. SETTING NON-HEALTHCARE: Common rooms and lecture theatres at 20 universities and further education colleges in Greater London. PARTICIPANTS: 2500 sexually active female students were asked to complete a questionnaire on sexual health and provide self-administered vaginal swabs and smears. INTERVENTION: Vaginal swabs from intervention women were tested for chlamydia by polymerase chain reaction (PCR) and those infected referred for treatment. Vaginal swabs from control women were stored and analysed after a year. Vaginal smears were Gram stained and analysed for BV. MAIN OUTCOME MEASURE: Incidence of clinical PID over 12 months in intervention and control groups. Possible cases of PID will be identified from questionnaires and record searches. Confirmation of the diagnosis will be done by detailed review of medical records by three independent researchers blind to whether the woman is in intervention or control group. TRIAL REGISTRATION: Clinical Trials NCT 00115388

Is the prevalence of HIV wrongly estimated in Nigeria? Some insights from a 2017 World AIDS day experience from a Nigerian Non-Governmental Organisation

Introduction: HIV is still a major public health challenge, especially in resource-limited settings. In Nigeria, it is estimated that over 50% of those infected with HIV do not know their status. With the recent Nigerian governmental approval of a "Test and Start Strategy", we embarked on HIV testing and services in four defined locations to mark 2017 World AIDS Day. The aim of this report is to document the process and outcome of the exercise. Methods: four teams led by senior clinical associates implemented the services and were mandated to test at least 100 persons per location. At each location, we carried out the following activities: (1) short advocacy to community leaders, (2) HIV testing and counselling, (3) disclosure of results, post-test counselling and healthy life-style education and (4) distribution of free male condoms and Information, Education and Communication (IEC) material. Results: a total of 237 people (male 195, female 42) were tested, the majority of whom were between 19 and 49 years (93.7%). Two people were found to be positive, giving a 0.84% positivity rate. Informal interactions between service providers and the people tested revealed that people were aware of HIV as a public health problem, and people positively received HIV services. Although there is a selection bias, as those tested will not be truly representative of the population, the current positively rate of less than 1% is low compared to previous Nigerian estimates, which are based on antenatal testing. However, the exercise showed a willingness to be tested and fair knowledge of HIV as a problem. Population-based data from across Nigeria should be aggregated to determine community prevalence pending the National population-based HIV survey in 2018. Such information will inform evidence-based decisions on the necessity of such large-scale surveys in future years. Conclusion: there is an urgent need to define the real prevalence of HIV in Nigeria through a well planned and executed community based survey

Community psychiatry care: an urgent need in Nigeria

Nigeria’s mental health policy was formulated in 1991, but it did not make adequate provision for community-based psychiatric care. Since there are only seven government-owned psychiatry facilities in Nigeria and these are always overwhelmed, there is the need to overhaul the existing policy and emphasise the urgency of a shift from inpatient psychiatric mental healthcare towards a community-based multidisciplinary psychiatric healthcare system

Key performance indicators for successful simulation projects

There are many factors that may contribute to the successful delivery of a simulation project. To provide a structured approach to assessing the impact various factors have on project success, we propose a top-down framework whereby 15 Key Performance Indicators (KPI) are developed that represent the level of successfulness of simulation projects from various perspectives. They are linked to a set of Critical Success Factors (CSF) as reported in the simulation literature. A single measure called Project’s Success Measure (PSM), which represents the project’s total success level, is proposed. The framework is tested against 9 simulation exemplar cases in healthcare and this provides support for its reliability. The results suggest that responsiveness to the customer’s needs and expectations, when compared with other factors, holds the strongest association with the overall success of simulation projects. The findings highlight some patterns about the significance of individual CSFs, and how the KPIs are used to identify problem areas in simulation projects.This study was supported by the Multidisciplinar Assessment of Technology Centre for Healthcare (MATCH) program (EPSRC Grant EP/F063822/1)

Optical/Near-Infrared Imaging of Infrared-Excess Palomar-Green QSOs

Ground-based high spatial-resolution (FWHM < 0.3-0.8") optical and near-infrared imaging (0.4-2.2um) is presented for a complete sample of optically selected Palomar-Green QSOs with far-infrared excesses at least as great as those of "warm" AGN-like ultraluminous infrared galaxies (L_ir/L_big-blue-bump > 0.46). In all cases, the host galaxies of the QSOs were detected and most have discernable two-dimensional structure. The QSO host galaxies and the QSO nuclei are similar in magnitude at H-band. H-band luminosities of the hosts range from 0.5-7.5 L* with a mean of 2.3 L*, and are consistent with those found in ULIGs. Both the QSO nuclei and the host galaxies have near-infrared excesses, which may be the result of dust associated with the nucleus and of recent dusty star formation in the host. These results suggest that some, but not all, optically-selected QSOs may have evolved from an infrared-active state triggered by the merger of two similarly-sized L* galaxies, in a manner similar to that of the ultraluminous infrared galaxies.Comment: Aastex format, 38 pages, 4 tables, 10 figures. Higher quality figures are available in JPG forma

Interplay between T Regulatory and T Helper 17 Lymphocytes in Modulation of Immunity to Blood Stage Malaria Infection

Malaria claims millions of lives worldwide each year. While a pro-inflammatory immune response is required to control parasite replication and promote clearance of infected erythrocytes, considerable disease pathology is caused by an excessive and dysregulated inflammatory reactivity to blood stage infection. Clinical symptoms, including fever and chills, correspond to production by CD4+ T helper (Th) lymphocytes of high levels of pro-inflammatory cytokines including tumour necrosis factor-α, interleukin-12 and interferon- γ in response to parasite components released upon erythrocyte rupture. Differentiation into specific effector Th subsets is directed by polarizing cytokines and expression of master transcription factors. From a perspective of homeostasis, further regulatory Th subsets have been described that secrete specific cytokines to modulate the effector immune response and thus play a pivotal role in protecting the body from direct and indirect pathogenic effects of malaria infection. In particular, T regulatory (Treg) lymphocytes are associated with immune tolerance and play a crucial role in suppressing the host response by inhibiting the function of effector subsets such as Th1 and Th17. This prevents inflammation produced downstream by (non-T) effectors cells. Treg lymphocytes, exemplified by CD4+CD25+Foxp3+ cells, gradually increase in number during infection to achieve and maintain the homeostasis of an otherwise imbalanced T cell response. This editorial discusses the production of Treg and Th17 lymphocytes and the interrelated roles played by their signature cytokines during malaria infection and considers the contribution of each to parasite clearance or progression