73 results found
Hoang K, Watt H, Golemme M, et al., 2022, Noradrenergic Add-on Therapy with Extended-Release Guanfacine in Alzheimer’s Disease: study protocol for a randomised clinical trial (NorAD) and COVID-19 amendments, Trials, ISSN: 1745-6215
Background:Guanfacine is a α2A adrenergic receptor agonist approved for treating Attention Deficit Hyperactivity Disorder (ADHD). It is thought to act via postsynaptic receptors in the prefrontal cortex, modulating executive functions including the regulation of attention. Attention is affected early in Alzheimer’s Disease (AD), and this may relate to pathological changes within the locus coeruleus, the main source of noradrenergic pathways within the brain. Given that cholinergic pathways, also involved in attention, are disrupted in AD, the combination of noradrenergic and cholinergic treatments may have a synergistic effect in symptomatic AD. The primary objective of the NorAD trial is to evaluate change in cognition with 12 weeks treatment of extended-release guanfacine (GXR) against a placebo as a combination therapy with cholinesterase inhibitors in participants with mild to moderate Alzheimer’s Disease.Methods/Design:NorAD is a 3-month, single-centre, randomised, double-blind, placebo-controlled, phase III trial of extended-release guanfacine (GXR) in participants with mild to moderate Alzheimer’s Disease. A total of 160 participants will be randomised to receive either daily guanfacine or placebo in combination with approved cholinesterase treatment for 12 weeks. The primary outcome is change in cognition, as measured by the Alzheimer’s Disease Assessment Scale-Cognitive subscale (ADAS-Cog), from baseline to follow-up in the treatment group compared to the placebo group. Secondary outcomes include change in additional cognitive measures of attention (Tests of Attention: Trails A and B, Digit-symbol substitution, Test of Everyday attention and CANTAB-RVP), neuropsychiatric symptoms (Neuropsychiatric Inventory), caregiver burden (Zarit Burden Interview) and activities of daily living (Alzheimer’s Disease Co-operative Study – Activities of Daily Living Inventory). From July 2020 observation of change following cessation
Khanzada A, Mousa A, Thompson R, et al., 2021, The Association between GDP and non-communicable disease mortality in the WHO European Region, Publisher: OXFORD UNIV PRESS, ISSN: 1101-1262
Loreto F, Gunning S, Golemme M, et al., 2021, COGNITIVE PERFORMANCE AND AFFECTIVE SYMPTOMS IN PATIENTS UNDERGOING CLINICAL AMYLOID PET IMAGING, British Neuropsychiatry Annual Meeting, Publisher: BMJ PUBLISHING GROUP, ISSN: 0022-3050
O'Farrelly C, Barker B, Watt H, et al., 2021, A video-feedback parenting intervention to prevent enduring behaviour problems in at-risk children aged 12-36 months: the Healthy Start, Happy Start RCT, HEALTH TECHNOLOGY ASSESSMENT, Vol: 25, Pages: 1-+, ISSN: 1366-5278
Loreto F, Gunning S, Golemme M, et al., 2021, Evaluating cognitive profiles of patients undergoing clinical Amyloid-PET Imaging, Brain Communications, Vol: 3, Pages: 1-12, ISSN: 2632-1297
Episodic memory impairment and brain amyloid-beta (Aβ) are two of the main hallmarks of Alzheimer’s Disease (AD). In patients with suspected AD, these are often evaluated through neuropsychological testing and amyloid PET imaging (API), respectively. Crucially, the use of amyloid PET in clinical practice is only indicated in patients with substantial diagnostic uncertainty due to atypical clinical presentation, multiple comorbidities and/or early age of onset. The relationship between Aβ and cognition has been previously investigated, but no study has examined how neuropsychological features relate to the presence of amyloid pathology in the clinical population meeting the appropriate use criteria for API.In this study, we evaluated a clinical cohort of patients (n=107) who presented at the Imperial Memory Clinic and were referred for clinical API and neuropsychological assessment as part of their diagnostic workup. We compared the cognitive performance of amyloid-positive patients (Aβ-pos, n=47) with that of stable amyloid-negative (stableAβ-neg, n=26) and progressive amyloid-negative (progAβ-neg, n=34) patients.The Aβ-pos group performed significantly worse than both the amyloid- negative groups in the visuospatial and working memory domains. Episodic memory performance, instead, effectively differentiated the Aβ-pos group from the stableAβ-neg but not the progAβ-neg group. On affective questionnaires, the stableAβ-neg group reported significantly higher levels of depression than the Aβ-pos group.In our clinical cohort, visuospatial dysfunction and working memory impairment were better indicators of amyloid positivity than episodic memory dysfunction. These findings highlight the limited value of isolated cognitive scores in patients with atypical clinical presentation, comorbidities and/or early age of onset.
Loreto F, Gunning S, Golemme M, et al., 2021, Evaluating cognitive profiles of patients undergoing clinical Amyloid-PET Imaging, Brain Communications, ISSN: 2632-1297
Loreto F, Gunning S, Golemme M, et al., 2021, Evaluating cognitive profiles of patients undergoing clinical Amyloid-PET Imaging, Brain Communications, ISSN: 2632-1297
Episodic memory impairment and brain amyloid-beta (Aβ) are two of the main hallmarks of Alzheimer’s Disease (AD). In patients with suspected AD, these are often evaluated through neuropsychological testing and amyloid PET imaging (API), respectively. Crucially, the use of amyloid PET in clinical practice is only indicated in patients with substantial diagnostic uncertainty due to atypical clinical presentation, multiple comorbidities and/or early age of onset. The relationship between Aβ and cognition has been previously investigated, but no study has examined how neuropsychological features relate to the presence of amyloid pathology in the clinical population meeting the appropriate use criteria for API. In this study, we evaluated a clinical cohort of patients (n=107) who presented at the Imperial Memory Clinic and were referred for clinical API and neuropsychological assessment as part of their diagnostic workup. We compared the cognitive performance of amyloid-positive patients (Aβ-pos, n=47) with that of stable amyloid-negative (stableAβ-neg, n=26) and progressive amyloid-negative (progAβ-neg, n=34) patients. The Aβ-pos group performed significantly worse than both the amyloid-negative groups in the visuospatial and working memory domains. Episodic memory performance, instead, effectively differentiated the Aβ-pos group from the stableAβ-neg but not the progAβ-neg group. On affective questionnaires, the stableAβ-neg group reported significantly higher levels of depression than the Aβ-pos group. In our clinical cohort, visuospatial dysfunction and working memory impairment were better indicators of amyloid positivity than episodic memory dysfunction. These findings highlight the limited value of isolated cognitive scores in patients with atypical clinical presentation, comorbidities and/or early age of onset.
Watt H, 2020, Reflections on modern methods: statistics education beyond “significance”: novel plain English interpretations to deepen understanding of statistics and to steer away from misinterpretations, International Journal of Epidemiology, Vol: 49, Pages: 2083-2088, ISSN: 0300-5771
Concerns have been expressed over standards of statistical interpretation. Results with p<0.05 are often referred to as “significant” which, in plain English, implies important. This leads some people directly into the misconception that this provides proof that associations are clinically relevant. There are calls for statistics educators to respond to these concerns. This article provides novel plain English interpretations that are designed to deepen understanding. Experience teaching post-graduates at Imperial College is discussed.A key issue with focusing on “significance”, is the common inappropriate practice of implying no association exists, simply because p>0.05. Referring to strengths of association in “study participants” gives them gravitas, which may help to avoid this. This contrasts with the common practice of focusing on imprecision, by referring to the “sample” and to “point estimates”.Unlike formal statistical definitions, interpretations developed and presented here are rooted in the application of Statistics. They are based on one set of study participants (not many random samples). Precision of strengths of association are based on using strengths in study participants to estimate strengths of association in the population (from which participants were selected by probability random sampling). Reference to “compatibility with study data, dependent on statistical modelling assumptions”, reminds us of the importance of data quality and modelling assumptions. A straight-forward graph shows the relationship between p-values and test statistics. This figure and associated interpretations were developed to illuminate the continuous nature of p-values. This is designed to discourage focus on whether p<0.05, and encourage interpretation of exact p-values.
Boshari T, Sharpe C, Poots A, et al., 2020, An observational study of the association between diverse licensed premises types and alcohol-related violence in an inner-London borough, Journal of Epidemiology and Community Health, Vol: 74, Pages: 1016-1022, ISSN: 0143-005X
Background: An ecological correlation has been observed between licensed premises and alcohol-related violence (ARV). In the United Kingdom to date, no evidence directly connects alcohol-related harm to a single premises type. Recent policies have called for a diversified alcohol offer yet quantitative evidence in support remains sparse. This study aims to inform policy by determining whether diversification of the alcohol economy is desirable, and to inform the licensing process and submission of public health evidence. Methods: Using 11-years of local licensing data from the London Borough of Southwark, alcohol availability over time was approximated by the number of extant alcohol licences, categorised by outlet type: drinking establishments, eateries, takeaways, off-sales, and ‘other’. Harm was quantified drawing on law enforcement intelligence that recorded ARV. A linked dataset was analysed using negative binomial regression, contrasting cumulative impact zones (CIZ) – a common alcohol control policy – with non-CIZ geographies. Results: Each licensed drinking establishment was associated with a 1.6% (95% CI 0.7% to 2.6%; p=0.001) increase in ARV, respectively. ‘Other’ outlets had a protective effect and were associated with a 1.8% (95% CI 1.0% to 2.5%; p<0.001) decrease in ARV. Conclusion: This study provides direct evidence for an association between alcohol-related harm and licensed premises. The varying associations between outlet type and ARV provide local public health stakeholders with an evidence base upon which to advocate for licensing policies that diversify alcohol availability.
O'Farrelly C, Watt H, Babalis D, et al., 2020, A brief home-based parenting intervention (VIPP-SD) to reduce behaviour problems in young children: A pragmatic randomised clinical trial., JAMA Pediatrics, ISSN: 1072-4710
Sharpe CA, Poots A, Watt H, et al., 2019, An observational study to examine how Cumulative Impact Zones influence alcohol availability from different types of licensed outlets in an inner London Borough, BMJ Open, Vol: 9, Pages: 1-8, ISSN: 2044-6055
OBJECTIVES: Cumulative Impact Zones (CIZs) are a widely implemented local policy intended to restrict alcohol availability in areas proliferated with licensed outlets. Limited previous research has questioned their effectiveness and suggested they may play a more nuanced role in shaping local alcohol environments. This study evaluates the association between CIZ implementation and the number of licence applications made and the number issued, relative to a control region. DESIGN: A quantitative observational study.SETTING: The inner London Borough of Southwark, which currently enforces three CIZs. POPULATION: Licence applications received by Southwark Council’s Licensing Authority between 1 April 2006 and 31 March 2017 (N = 1254).INTERVENTIONS: CIZ implementation. PRIMARY OUTCOME MEASURES: Five outlet types were categorised and evaluated: Drinking Establishments, Eateries, Takeaways, Off Sales, and Other Outlets. Primary outcome measures were the number of applications received and the number of licences issued. These were analysed using Poisson regression of counts over time.RESULTS: Across all CIZs, implementation was associated with greater increases in the number of eateries in CIZ regions (IRR = 1.58, 95% CI: 1.02 – 2.52, P = 0.04) and number of takeaway venues (IRR = 3.89, 95% CI: 1.32 – 11.49, P = 0.01), relative to the control area. No discernible association was found for the remaining outlet types. Disaggregating by area indicated a 10-fold relative increase in the number of new eateries in Peckham CIZ (IRR = 10.38, 95% CI: 1.39 – 77.66, P = 0.02) and a four-fold relative increase in the number of newly licensed takeaways in Bankside CIZ (IRR = 4.38, 95% CI: 1.20 – 15.91, P = 0.03).CONCLUSIONS: Cumulative Impact Zones may be useful as policy levers to shape local alcohol environments to support the licensing goals of specific geographical areas and diversify the night-time economy.
Green K, Cooke O'Dowd N, Watt H, et al., 2019, Prescribing trends of gabapentin, pregabalin and oxycodone; a secondary analysis of primary care prescribing patterns in England, BJGP Open, Vol: 3, Pages: 1-10, ISSN: 2398-3795
BackgroundThe risk of iatrogenic harm from prescription drug use, misuse and abuse of drugssuch as gabapentin, pregabalin and oxycodone is substantial. In recent years, deathsassociated with these drugs in England have increased.AimsTo characterise general practice prescribing trends for gabapentin, pregabalin andoxycodone – termed dependence forming medicines (DFM) – in England and describepotential drivers of unwarranted variation.Design and SettingThis study is a retrospective secondary analysis of open source, publicly availablegovernment data from various sources pertaining to primary care demographics andprescriptions.MethodsThis study used five consecutive years (April 2013 – March 2018) of aggregate datato investigate longitudinal trends of prescribing and variation in prescribing trends atpractice and clinical commissioning group (CCG) level.ResultsAnnual prescriptions of gabapentin, pregabalin and oxycodone have increased eachyear over the period. Variation in prescribing trends were associated with GP practicedeprivation quintile, where the most deprived GP practices prescribe 313% (p<0.001)and 238% (p<0.001) greater volumes of gabapentin and pregabalin per person thanpractices in the least deprived quintile. The highest prescribing CCGs of each of thesedrugs were predominantly in northern and eastern regions of England.ConclusionsSubstantial increases in gabapentin, pregabalin and oxycodone prescriptions areconcerning and will increase iatrogenic harm from drug-related morbidity and mortality.More research is needed to understand the large variation in prescribing between general practices; and to develop and implement interventions to reduce unwarrantedvariation and increase the appropriateness of prescribing of these drugs.
Boshari T, Sharpe C, Poots A, et al., 2018, Public health and alcohol licensing policy in local government: an observational study of licensed premises and alcohol-related violence in London, UK, Public Health Science 2018, Publisher: Elsevier, Pages: S12-S12, ISSN: 0140-6736
Shather Z, Laverty A, Bottle RA, et al., 2018, Sustained socio-economic inequalities in hospital admissions for cardiovascular events among people with diabetes in England, The American Journal of Medicine, Vol: 131, Pages: 1340-1348, ISSN: 0002-9343
ObjectiveThis study aimed to determine changes in absolute and relative socio-economic inequalities in hospital admissions for major cardiovascular events and procedures among people with diabetes in England.MethodsWe identified all patients with diagnosed diabetes aged ≥45 years admitted to hospital in England between 2004-2005 and 2014-2015 for acute myocardial infarction, stroke, percutaneous coronary intervention (PCI) and coronary artery bypass graft (CABG). Socio-economic status was measured using Index of Multiple Deprivation. Diabetes-specific admission rates were calculated for each year by deprivation quintile. We assessed temporal changes using negative binomial regression models.ResultsMost admissions for cardiovascular causes occurred among people aged ≥65 years (71%) and men (63.3%), and the number of admissions increased steadily from the least to the most deprived quintile. People with diabetes in the most deprived quintile had 1.94-fold increased risk of acute myocardial infarction (95% CI 1.79-2.10), 1.92-fold risk of stroke (95% CI 1.78-2.07), 1.66-fold risk of CABG (95% CI 1.50-1.74), and 1.76-fold risk of PCI (95% CI 1.64-1.89) compared with the least deprived group. Absolute differences in rates between the least and most deprived quintiles did not significantly change for acute myocardial infarction (P=0.29) and were reduced for stroke, CABG and PCI (by 17.5, 15 and 11.8 per 100,000 people with diabetes, respectively, P≤0.01 for all).ConclusionsSocio-economic inequalities persist in diabetes-related hospital admissions for major cardiovascular events in England. Besides improved risk stratification strategies considering socio-economically defined needs, wide-reaching population-based policy interventions are required to reduce inequalities in diabetes outcomes.
Vamos E, Shather Z, Laverty A, et al., 2018, Socio-economic inequalities in hospital admissions for major cardiovascular events in people with diabetes in England, 54th Annual Meeting of the European-Association-for-the-Study-of-Diabetes (EASD), Publisher: SPRINGER, Pages: S576-S576, ISSN: 0012-186X
Sharpe CA, Poots AJ, Watt H, et al., 2018, Controlling alcohol availability through local policy: an observational study to evaluate Cumulative Impact Zones in a London borough, Journal of Public Health, Vol: 40, Pages: e260-e268, ISSN: 1741-3842
BackgroundCumulative impact zones (CIZs) are a discretionary policy lever available to local government, used to restrict the availability of alcohol in areas deemed already saturated. Despite little evidence of their effect, over 200 such zones have been introduced. This study explores the impact of three CIZs on the licensing of venues in the London Borough of Southwark.MethodsUsing 10 years of licensing data, we examined changes in the issuing of licences on the introduction of three CIZs within Southwark, relative to control areas. The number of licence applications made (N = 1110), the number issued, and the proportion objected to, were analysed using negative binomial regression.ResultsIn one area tested, CIZ implementation was associated with 119% more licence applications than control areas (incidence rate ratios (IRR) = 2.19, 95% confidence intervals (CI): 1.29–3.73, P = 0.004) and 133% more licences granted (IRR = 2.33, 95% CI: 1.31–4.16, P = 0.004). No significant effect was found for the other two areas. CIZs were found to have no discernible effect on the relative proportion of licence applications receiving objections.ConclusionsCIZs are proposed as a key lever to limit alcohol availability in areas of high outlet density. We found no evidence that CIZ establishment reduced the number of successful applications in Southwark.
Norheim G, Mueller JE, Njanpop-Lafourcade B-M, et al., 2018, Natural immunity against capsular group X N. meningitidis following an outbreak in Togo, 2007, Vaccine, Vol: 36, Pages: 1297-1303, ISSN: 0264-410X
BACKGROUND: Capsular group X N. meningitidis (MenX) has emerged as a cause of localized disease outbreaks in sub-Saharan Africa, but the human immune response following exposure to MenX antigens is poorly described. We therefore assessed the natural immunity against MenX in individuals who were living in an area affected by a MenX outbreak during 2007 in Togo, West Africa. During 2009, 300 healthy individuals (100 aged 3-5 years, 100 aged 13-19 years and 100 aged 20-25 years) were included in the study, and serum responses were compared with sera from age-matched controls from the U.K. and Burkina Faso. METHODS: MenX serum bactericidal antibody (SBA) was measured using rabbit complement, and antibodies against MenX polysaccharide (XPS) and outer membrane vesicles (XOMVs) were quantified by ELISA. RESULTS: The proportion of Togolese individuals with an SBA titer of ≥8 against the MenX strain was 29% (95% confidence interval (CI) 18-41) among those aged 3-5 years, 34% (95% CI 9-60) among those aged 13-19 years and 32% (95% CI 24-40) among those aged 20-25 years. These were significantly higher than observed in the control populations from the U.K (range 13-16%) and Burkina Faso (range 2-6%). CONCLUSION: In Togolese individuals, the concentration of serum IgG against XPS was higher among the two older age groups as compared to the youngest age group. Antibody concentrations against MenX PS correlated significantly with SBA titers. This supports further development of a MenX PS based conjugate vaccine. Further studies are needed to verify the ability of MenX PS to induce SBA in humans.
Ramchandani P, O'Farrelly C, Babelis D, et al., 2017, Preventing enduring behavioural problems in young children through early psychological intervention (Healthy Start, Happy Start): study protocol for a randomized controlled trial, Trials, Vol: 18, ISSN: 1745-6215
Background: Behavioural problems are common in early childhood, and can result in enduring costs to the individualand society, including an increased risk of mental and physical illness, criminality, educational failure and drug andalcohol misuse. Most previous research has examined the impact of interventions targeting older children whendifficulties are more established and harder to change, and have rarely included fathers. We are conducting a trial of apsychological intervention delivered to families with very young children, engaging both parents where possible.Methods: This study is a two-arm, parallel group, researcher-blind, randomized controlled trial, to test the clinicaleffectiveness and cost-effectiveness of a parenting intervention, Video Feedback Intervention to Promote PositiveParenting and Sensitive Discipline (VIPP-SD) for parents of young children (12–36 months) at risk of behaviouraldifficulties. VIPP-SD is an evidence-based parenting intervention developed at Leiden University in the Netherlandswhich uses a video-feedback approach to support parents, particularly by enhancing parental sensitivity and sensitivediscipline in caring for children.The trial will involve 300 families, who will be randomly allocated into either an intervention group, who will receivethe video-feedback intervention (n = 150), or a control group, who will receive treatment as usual (n = 150). The trialwill evaluate whether VIPP-SD, compared to treatment as usual, leads to lower levels of behavioural problems in youngchildren who are at high risk of developing these difficulties. Assessments will be conducted at baseline, and 5 and24 months post-randomization. The primary outcome measure is a modified version of the Preschool Parental Accountof Child Symptoms (Pre-PACS), a structured clinical interview of behavioural symptoms. Secondary outcomes includecaregiver-reported behavioural difficulties, parenting behaviours, parental sensitivity, parental mood and anxiety a
Harris MJ, Marti J, Watt H, et al., 2017, Explicit Bias Toward High-Income Country Research: A Randomized, Blinded, Crossover Experiment Of English Clinicians, Health Affairs, Vol: 36, Pages: 1997-2004, ISSN: 0278-2715
Unconscious bias may interfere with the interpretation of research from some settings, particularly from lower-income countries. Most studies of this phenomenon have relied on indirect outcomes such as article citation counts and publication rates; few have addressed or proven the effect of unconscious bias in evidence interpretation. In this randomized, blinded crossover experiment in a sample of 347 English clinicians, we demonstrate that changing the source of a research abstract from a low- to a high-income country significantly improves how it is viewed, all else being equal. Using fixed-effects models, we measured differences in ratings for strength of evidence, relevance, and likelihood of referral to a peer. Having a high-income-country source had a significant overall impact on respondents’ ratings of relevance and recommendation to a peer. Unconscious bias can have far-reaching implications for the diffusion of knowledge and innovations from low-income countries.
Cowling TE, Laverty AA, Harris MJ, et al., 2017, Contract and ownership type of general practices and patient experience in England: multilevel analysis of a national cross-sectional survey, Journal of the Royal Society of Medicine, Vol: 110, Pages: 440-451, ISSN: 1758-1095
Objective: To examine associations between the contractand ownership type of general practices and patient experiencein England.Design: Multilevel linear regression analysis of a nationalcross-sectional patient survey (General Practice PatientSurvey).Setting: All general practices in England in 2013–2014(n ¼ 8017).Participants: 903,357 survey respondents aged 18 years orover and registered with a general practice for six monthsor more (34.3% of 2,631,209 questionnaires sent).Main outcome measures: Patient reports of experienceacross five measures: frequency of consulting a preferreddoctor; ability to get a convenient appointment; rating ofdoctor communication skills; ease of contacting the practiceby telephone; and overall experience (measured onfour- or five-level interval scales from 0 to 100). Modelsadjusted for demographic and socioeconomic characteristicsof respondents and general practice populations and arandom intercept for each general practice.Results: Most practices had a centrally negotiated contractwith the UK government (‘General Medical Services’54.6%; 4337/7949). Few practices were limited companieswith locally negotiated ‘Alternative Provider MedicalServices’ contracts (1.2%; 98/7949); these practices providedworse overall experiences than General MedicalServices practices (adjusted mean difference 3.04, 95%CI 4.15 to 1.94). Associations were consistent in directionacross outcomes and largest in magnitude for frequencyof consulting a preferred doctor (12.78, 95% CI15.17 to 10.39). Results were similar for practicesowned by large organisations (defined as having 20 practices)which were uncommon (2.2%; 176/7949).Conclusions: Patients registered to general practicesowned by limited companies, including large organisations,reported worse experiences of their care than otherpatients in 2013–2014.
Woringer M, cecil E, watt H, et al., 2017, Evaluation of community provision of a preventive cardiovascular programme - the National Health Service Health Check in reaching the under-served groups by primary care in England: cross sectional observational study, BMC Health Services Research, Vol: 17, ISSN: 1472-6963
Background:Cardiovascular disease (CVD) is the leading cause of premature mortality and a major contributor of health inequalities in England. Compared to more affluent and white counterparts, deprived people and ethnic minorities tend to die younger due to preventable CVD associated with lifestyle. In addition, deprived, ethnic minorities and younger people are less likely to be served by CVD prevention services. This study assessed the effectiveness of community-based outreach providers in delivering England’s National Health Services (NHS) Health Check programme, a CVD preventive programme to under-served groups.Methods:Between January 2008 and October 2013, community outreach providers delivered a preventive CVD programme to 50,573 individuals, in their local communities, in a single consultation without prescheduled appointments. Community outreach providers operated on evenings and weekends as well as during regular business hours in venues accessible to the general public. After exclusion criteria, we analysed and compared socio-demographic data of 43,177 Health Check attendees with the general population across 38 local authorities (LAs). We assessed variation between local authorities in terms of age, sex, deprivation and ethnicity structures using two sample t-tests and within local authority variation in terms of ethnicity and deprivation using Chi squared tests and two sample t-tests respectively.Results:Using Index of Multiple Deprivation, the mean deprivation score of the population reached by community outreach providers was 6.01 higher (p < 0.05) than the general population. Screened populations in 29 of 38 LAs were significantly more deprived (p < 0.05). No statistically significant difference among ethnic minority groups was observed between LAs. Nonetheless some LAs – namely Leicester, Thurrock, Sutton, South Tyneside, Portsmouth and Gateshead were very successful in recruiting ethnic minority groups. The mean proportion of men s
Fayaz A, Watt HC, Langford RM, et al., 2017, The Association Between Chronic Pain and Cardiac Disease: A Cross-sectional Population Study, Clinical Journal of Pain, Vol: 32, Pages: 1062-1068, ISSN: 0749-8047
Objectives: Chronic pain may increase the risk of cardiac disease, but the extent to which confounding variables account for this association has yet to be satisfactorily established. This study aims to examine the possibility of an independent association between these 2 variables.Methods: We applied logistic regression analysis to data from 8596 adults surveyed in a population study of the health of the population of England. The association between cardiac disease (angina and/or myocardial infarction) and chronic pain (pain lasting >3 months) was explored, taking account of 10 potentially confounding variables including the regular use of nonsteroidal anti-inflammatory drugs.Results: Participants reporting chronic pain (n=3023) were more likely to experience cardiac disease than those without pain: odds ratio (OR), 1.55; 95% confidence interval (CI), 1.15-2.07. Subsets of participants fulfilling various criteria for high-intensity chronic pain demonstrated stronger associations with cardiac disease suggesting a “dose-response” element to the relationship: chronic widespread pain (OR, 3.3; 95% CI, 1.42-7.68); higher-disability chronic pain (OR, 2.35; 95% CI, 1.71-3.23); and higher average chronic pain score (OR, 1.95; 95% CI, 1.40-2.71). Adjustment for regular prescription of nonsteroidal anti-inflammatory drugs did not reduce the association of chronic pain with cardiac disease.Discussion: Patients reporting chronic pain, in particular those most severely affected, may be at significantly increased risk of cardiac disease. Future studies should focus on determining whether reducing the impact of chronic pain can improve cardiac health.
Smith TDH, Watt H, Gunn L, et al., 2016, Recommending oral probiotics to reduce winter antibiotic prescriptions in people with asthma: a pragmatic randomized controlled trial, Annals of Family Medicine, Vol: 14, Pages: 422-430, ISSN: 1544-1717
PURPOSE Evidence from studies mainly in children has shown that orally administered probiotics may prevent respiratory tract infections and associated antibiotic use. We evaluated whether advice to take daily probiotics can reduce antibiotic prescribing for winter respiratory tract infections in people with asthma.METHODS We conducted a randomized controlled, parallel-group pragmatic study for participants aged 5 years and older with asthma in a UK primary care setting. The intervention was a postal leaflet with advice to take daily probiotics from October 2013 to March 2014, compared with a standard winter advice leaflet. Primary outcome was the proportion of participants prescribed antibiotics for respiratory tract infections.RESULTS There were 1,302 participants randomly assigned to a control group (n = 650) or intervention group (n = 652). There was no significant difference in the primary outcome measure, with 27.7% receiving antibiotics in the intervention group and 26.9% receiving antibiotics in the control group (odds ratio = 1.04; 95% CI, 0.82–1.34). Uptake of probiotics was low, but outcomes were similar in those who accessed probiotics (adjusted odds ratio = 1.08; 95% CI, 0.69–1.69, compared with controls). We also found no evidence of an effect on respiratory tract infections or asthma exacerbations.CONCLUSIONS In this pragmatic community-based trial in people with asthma, we found no evidence that advising use of winter probiotics reduces antibiotic prescribing.
Background: Huntington’s disease patients have a number of peripheral manifestations suggestive of metabolic and endocrine abnormalities. We, therefore, investigated a number of metabolic factors in a 24-hour study of Huntington’s disease gene carriers (premanifest and moderate stage II/III) and controls.Methods:Control (n = 15), premanifest (n = 14) and stage II/III (n = 13) participants were studied with blood sampling over a 24-hour period. A battery of clinical tests including neurological rating and function scales were performed. Visceral and subcutaneous adipose distribution was measured using magnetic resonance imaging. We quantified fasting baseline concentrations of glucose, insulin, cholesterol, triglycerides, lipoprotein (a), fatty acids, amino acids, lactate and osteokines. Leptin and ghrelin were quantified in fasting samples and after a standardised meal. We assessed glucose, insulin, growth hormone and cortisol concentrations during a prolonged oral glucose tolerance test.Results:We found no highly significant differences in carbohydrate, protein or lipid metabolism markers between healthy controls, premanifest and stage II/III Huntington’s disease subjects. For some markers (osteoprotegerin, tyrosine, lysine, phenylalanine and arginine) there is a suggestion (p values between 0.02 and 0.05) that levels are higher in patients with premanifest HD, but not moderate HD. However, given the large number of statistical tests performed interpretation of these findings must be cautious.Conclusions:Contrary to previous studies that showed altered levels of metabolic markers in patients with Huntington’s disease, our study did not demonstrate convincing evidence of abnormalities in any of the markers examined. Our analyses were restricted to Huntington’s disease patients not taking neuroleptics, anti-depressants or other medication affecting metabolic pathways. Even with the modest sample sizes studied, the lack of highly signific
Kalliolia E, Silajdzic E, Nambron R, et al., 2015, A 24-Hour Study of the Hypothalamo-Pituitary Axes in Huntington's Disease, PLOS One, Vol: 10, ISSN: 1932-6203
Background: Huntington’s disease is an inherited neurodegenerative disorder characterised by motor, cognitive and psychiatric disturbances. Patients exhibit other symptoms including sleep and mood disturbances, muscle atrophy and weight loss which may be linked to hypothalamic pathology and dysfunction of hypothalamo-pituitary axes.Methods: We studied neuroendocrine profiles of corticotropic, somatotropic and gonadotropic hypothalamo-pituitary axes hormones over a 24-hour period in controlled environment in 15 healthy controls, 14 premanifest and 13 stage II/III Huntington’s disease subjects. We also quantified fasting levels of vasopressin, oestradiol, testosterone, dehydroepiandrosterone sulphate, thyroid stimulating hormone, free triiodothyronine, free total thyroxine, prolactin, adrenaline and noradrenaline. Somatotropic axis hormones, growth hormone releasing hormone, insulin-like growth factor-1 and insulin-like factor binding protein-3 were quantified at 06:00 (fasting), 15:00 and 23:00. A battery of clinical tests, including neurological rating and function scales were performed.Results: 24-hour concentrations of adrenocorticotropic hormone, cortisol, luteinizing hormone and follicle-stimulating hormone did not differ significantly between the Huntington’s disease group and controls. Daytime growth hormone secretion was similar in control and Huntington’s disease subjects. Stage II/III Huntington’s disease subjects had lower concentration of post-sleep growth hormone pulse and higher insulin-like growth factor-1:growth hormone ratio which did not reach significance. In Huntington’s disease subjects, baseline levels of hypothalamo-pituitary axis hormones measured did not significantly differ from those of healthy controls.Conclusions: The relatively small subject group means that the study may not detect subtle perturbations in hormone concentrations. A targeted study of the somatotropic axis in larger cohorts may be warran
Cowling TE, Harris M, Watt H, et al., 2015, Access to primary care and the route of emergency admission to hospital: retrospective analysis of national hospital administrative data, BMJ Quality & Safety, Vol: 25, Pages: 432-440, ISSN: 2044-5415
Background The UK government is pursuing policies to improve primary care access, as many patients visit accident and emergency (A and E) departments after being unable to get suitable general practice appointments. Direct admission to hospital via a general practitioner (GP) averts A and E use, and may reduce total hospital costs. It could also enhance the continuity of information between GPs and hospital doctors, possibly improving healthcare outcomes.Objective To determine whether primary care access is associated with the route of emergency admission—via a GP versus via an A and E department.Methods Retrospective analysis of national administrative data from English hospitals for 2011–2012. Adults admitted in an emergency (unscheduled) for ≥1 night via a GP or an A and E department formed the study population. The measure of primary care access—the percentage of patients able to get a general practice appointment on their last attempt—was derived from a large, nationally representative patient survey. Multilevel logistic regression was used to estimate associations, adjusting for patient and admission characteristics.Results The analysis included 2 322 112 emergency admissions (81.9% via an A and E department). With a 5 unit increase in the percentage of patients able to get a general practice appointment on their last attempt, the adjusted odds of GP admission (vs A and E admission) was estimated to increase by 15% (OR 1.15, 95% CI 1.12 to 1.17). The probability of GP admission if ≥95% of appointment attempts were successful in each general practice was estimated to be 19.6%. This probability reduced to 13.6% when <80% of appointment attempts were successful. This equates to 139 673 fewer GP admissions (456 232 vs 316 559) assuming no change in the total number of admissions. Associations were consistent in direction across geographical regions of England.Conclusions Among hospital inpatients admitted as an emergency, patients
Watt H, Harris M, Noyes J, et al., 2015, Development of a composite outcome score for a complex intervention - measuring the impact of Community Health Workers, Trials, Vol: 16, ISSN: 1745-6215
BackgroundIn health services research, composite scores to measure changes in health-seeking behaviour and uptake of services do not exist. We describe the rationale and analytical considerations for a composite primary outcome for primary care research. We simulate its use in a large hypothetical population and use it to calculate sample sizes. We apply it within the context of a proposed cluster randomised controlled trial (RCT) of a Community Health Worker (CHW) intervention.MethodsWe define the outcome as the proportion of the services (immunizations, screening tests, stop-smoking clinics) received by household members, of those that they were eligible to receive. First, we simulated a population household structure (by age and sex), based on household composition data from the 2011 England and Wales census. The ratio of eligible to received services was calculated for each simulated household based on published eligibility criteria and service uptake rates, and was used to calculate sample size scenarios for a cluster RCT of a CHW intervention. We assume varying intervention percentage effects and varying levels of clustering.ResultsAssuming no disease risk factor clustering at the household level, 11.7% of households in the hypothetical population of 20,000 households were eligible for no services, 26.4% for 1, 20.7% for 2, 15.3% for 3 and 25.8% for 4 or more. To demonstrate a small CHW intervention percentage effect (10% improvement in uptake of services out of those who would not otherwise have taken them up, and additionally assuming intra-class correlation of 0.01 between households served by different CHWs), around 4,000 households would be needed in each of the intervention and control arms. This equates to 40 CHWs (each servicing 100 households) needed in the intervention arm. If the CHWs were more effective (20%), then only 170 households would be needed in each of the intervention and control arms.ConclusionsThis is a useful first step towards a proce
Laverty AA, Elkin SL, Watt HC, et al., 2015, Impact of a COPD Discharge Care Bundle on Readmissions following Admission with Acute Exacerbation: Interrupted Time Series Analysis, PLOS ONE, Vol: 10, ISSN: 1932-6203
Laverty AA, Diethelm P, Hopkinson NS, et al., 2015, Use and abuse of statistics in tobacco industry-funded research on standardised packaging, Tobacco Control, Vol: 24, Pages: 422-424, ISSN: 0964-4563
n this commentary we consider the validity of tobacco industry-funded research on the effects of standardised packaging in Australia. As the first country to introduce standardised packs, Australia is closely watched, and Philip Morris International has recently funded two studies into the impact of the measure on smoking prevalence. Both of these papers are flawed in conception as well as design but have nonetheless been widely publicised as cautionary tales against standardised pack legislation. Specifically, we focus on the low statistical significance of the analytical methods used and the assumption that standardised packaging should have an immediate large impact on smoking prevalence.
Koshy E, Watt H, Curcin V, et al., 2015, Tonsillectomy among children with low baseline acute throat infection consultation rates in UK general practices: a cohort study, BMJ Open, Vol: 5, ISSN: 2044-6055
Objective: To investigate the effectiveness oftonsillectomy in reducing acute throat infection (ATI)consultation rates over 6 years’ follow-up amongchildren with low baseline ATI consultation rates.Design: Retrospective cohort study.Setting: UK general practices from the ClinicalPractice Research Datalink.Participants: Children aged 4–15 years with ≤3 ATIconsultations during the 3 years prior to 2001(baseline). 450 children who underwent tonsillectomy(tonsillectomy group) and 13 442 other children withan ATI consultation (comparison group) in 2001.Main outcome measures: Mean differences in ATIconsultation rates over the first 3 years’ andsubsequent 3 years’ follow-up compared with 3 yearsprior to 2001 (baseline); odds of ≥3 ATI consultationsat the same time points.Results: Among children in the tonsillectomy group,the 3-year mean ATI consultation rate decreased from1.31 to 0.66 over the first 3 years’ follow-up andfurther declined to 0.60 over the subsequent 3 years’follow-up period. Compared with children who had nooperation, those who underwent tonsillectomyexperienced a reduction in 3-year mean ATIconsultations per child of 2.5 (95% CI 2.3 to 2.6,p<0.001) over the first 3 years’ follow-up, but only 1.2(95% CI 1.0 to 1.4, p<0.001) over the subsequent3 years’ follow-up compared with baseline,respectively. This equates to a mean reduction of 3.7ATI consultations over a 6-year period andapproximates to a mean annual reduction of 0.6 ATIconsultations per child, per year, over 6 years’ followup.Children who underwent tonsillectomy were alsomuch less likely to experience ≥3 ATI consultationsduring the first 3 years’ follow-up (adjusted OR=0.12,95% CI 0.08 to 0.17) and the subsequent 3 years’follow-up (adjusted OR=0.24, 95% CI 0.14 to 0.41).Conclusions: Among children with low baseline ATIrates, there was a statistically significant reduction inATI consultation rates over 6 years’ foll
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