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International expert consensus on electronic nicotine delivery systems and heated tobacco products: a Delphi survey

Por: Berlin · I. · Jacot-Sadowski · I. · Humair · J.-P. · Cornuz · J.
Objectives

To provide a consensus from a panel of international experts about electronic nicotine delivery systems (ENDS) and heated tobacco products (HTP).

Design

Cross-sectional survey.

Methods

A Delphi survey was conducted among international experts in tobacco control and smoking cessation. The first part addressed statements or recommendations about ENDS, the second about HTP, both divided into four categories: regulation, sale, use and general issues.

Setting

Experts from 15 countries.

Participants

Individuals with clinical, public health or research expertise in tobacco control and/or smoking cessation.

Results

268 experts were contacted, 92 (34%) completed the first, 55/92 (60%) the second round. Consensus for ENDS: components of e-liquids, an upper limit of nicotine concentration should be defined; a warning on the lack of evidence in long-term safety and addiction potential should be stated; ENDS should not be regulated as consumer products but either as a new category of nicotine delivery or tobacco products; ENDS should not be sold in general stores but in specialised shops, shops selling tobacco or in pharmacies with restriction on sale to minors; administration of illegal drugs is likely with ENDS. Consensus for HTP: HTP have the same addictive potential as cigarettes; they should be regulated as a tobacco product with similar warning messages as cigarettes; their advertisement should not be allowed. ENDS and HTP use should not be allowed in indoor public places; a specific tax should be implemented for ENDS, taxes on HTP should not be lower than those for cigarettes; use of cigarettes is more likely with both ENDS and HTP (dual use) than quitting smoking.

Conclusions

Experts in tobacco control and/or smoking cessation recommend differential regulation for ENDS and HTP. The results of this survey may be useful for health authorities, decision makers and researchers of the tobacco use and cessation field.

How many infants may have died in low-income and middle-income countries in 2020 due to the economic contraction accompanying the COVID-19 pandemic? Mortality projections based on forecasted declines in economic growth

Por: Shapira · G. · de Walque · D. · Friedman · J.
Objectives

While COVID-19 has a relatively small direct impact on infant mortality, the pandemic is expected to indirectly increase mortality of this vulnerable group in low-income and middle-income countries through its effects on the economy and health system performance. Previous studies projected indirect mortality by modelling how hypothesised disruptions in health services will affect health outcomes. We provide alternative projections, relying on modelling the relationship between aggregate income shocks and mortality.

Design

We construct a sample of 5.2 million births by pooling retrospective birth histories reported by women in Demographic and Health Surveys conducted in 83 low-income and middle-income countries between 1985 and 2018. We employ regression models with country-specific fixed-effects and flexible time trends to estimate the impact of gross domestic product per capita on infant mortality rate. We then use growth projections by the International Monetary Fund to predict the effect of the economic downturn in 2020 on infant mortality.

Results

We estimate 267 208 (95% CI 112 000 to 422 415) excess infant deaths in 128 countries, corresponding to a 6.8% (95% CI 2.8% to 10.7%) increase in the total number of infant deaths expected in 2020.

Conclusions

The findings underscore the vulnerability of infants to the negative income shocks such as those imposed by the COVID-19 pandemic. While efforts towards prevention and treatment of COVID-19 remain paramount, the global community should also strengthen social safety nets and assure continuity of essential health services.

Loss of height predicts total and cardiovascular mortality: a cohort study of northern European women

Por: Klingberg · S. · Mehlig · K. · Dangol · R. · Björkelund · C. · Heitmann · B. L. · Lissner · L.
Objective

To examine height changes in middle-aged northern European women in relation to overall and cardiovascular mortality.

Design

Population-based cohort studies with longitudinally measured heights and register-based mortality.

Setting

Sweden and Denmark.

Participants

Population-based samples of 2406 Swedish and Danish women born on selected years in 1908–1952, recruited to baseline examinations at ages 30–60, and re-examined 10–13 years later.

Main outcome measure

Total and cardiovascular disease (CVD) specific mortality during 17–19 years of follow-up after last height measure.

Results

For each 1 cm height loss during 10–13 years, the HR (95% CI) for total mortality was 1.14 (1.05 to 1.23) in Swedish women and 1.21 (1.09 to 1.35) in Danish women, independent of key covariates. Low height and high leisure time physical activity at baseline were protective of height loss, independent of age. Considering total mortality, the HR for major height loss, defined as height loss greater than 2 cm, were 1.74 (1.32 to 2.29) in Swedish women and 1.80 (1.27 to 2.54) in Danish women. Pooled analyses indicated that height loss was monotonically associated with an increased mortality, confirming a significant effect above 2 cm height loss. For cause-specific mortality, major height loss was associated with a HR of 2.31 (1.09 to 4.87) for stroke mortality, 2.14 (1.47 to 3.12) for total CVD mortality and 1.71 (1.28 to 2.29) for mortality due to causes other than CVD.

Conclusion

Height loss is a marker for excess mortality in northern European women. Specifically the hazard of CVD mortality is increased in women with height loss during middle age, and the results suggest that the strongest cause-specific endpoint may be stroke mortality. The present findings suggest attention to height loss in early and mid-adulthood to identify women at high risk of CVD, and that regular physical activity may prevent early onset height loss.

Systematic review of academic bullying in medical settings: dynamics and consequences

Por: Averbuch · T. · Eliya · Y. · Van Spall · H. G. C.
Purpose

To characterise the dynamics and consequences of bullying in academic medical settings, report factors that promote academic bullying and describe potential interventions.

Design

Systematic review.

Data sources

We searched EMBASE and PsycINFO for articles published between 1 January 1999 and 7 February 2021.

Study selection

We included studies conducted in academic medical settings in which victims were consultants or trainees. Studies had to describe bullying behaviours; the perpetrators or victims; barriers or facilitators; impact or interventions. Data were assessed independently by two reviewers.

Results

We included 68 studies representing 82 349 respondents. Studies described academic bullying as the abuse of authority that impeded the education or career of the victim through punishing behaviours that included overwork, destabilisation and isolation in academic settings. Among 35 779 individuals who responded about bullying patterns in 28 studies, the most commonly described (38.2% respondents) was overwork. Among 24 894 individuals in 33 studies who reported the impact, the most common was psychological distress (39.1% respondents). Consultants were the most common bullies identified (53.6% of 15 868 respondents in 31 studies). Among demographic groups, men were identified as the most common perpetrators (67.2% of 4722 respondents in 5 studies) and women the most common victims (56.2% of 15 246 respondents in 27 studies). Only a minority of victims (28.9% of 9410 victims in 25 studies) reported the bullying, and most (57.5%) did not perceive a positive outcome. Facilitators of bullying included lack of enforcement of institutional policies (reported in 13 studies), hierarchical power structures (7 studies) and normalisation of bullying (10 studies). Studies testing the effectiveness of anti-bullying interventions had a high risk of bias.

Conclusions

Academic bullying commonly involved overwork, had a negative impact on well-being and was not typically reported. Perpetrators were most commonly consultants and men across career stages, and victims were commonly women. Methodologically robust trials of anti-bullying interventions are needed.

Limitations

Most studies (40 of 68) had at least a moderate risk of bias. All interventions were tested in uncontrolled before–after studies.

Lessons from countries implementing find, test, trace, isolation and support policies in the rapid response of the COVID-19 pandemic: a systematic review

Por: Chung · S.-C. · Marlow · S. · Tobias · N. · Alogna · A. · Alogna · I. · You · S.-L. · Khunti · K. · McKee · M. · Michie · S. · Pillay · D.
Objective

To systematically learn lessons from the experiences of countries implementing find, test, trace, isolate, support (FTTIS) in the first wave of the COVID-19 pandemic.

Design, data sources and eligibility criteria

We searched MEDLINE (PubMed), Cochrane Library, SCOPUS and JSTOR, initially between 31 May 2019 and 21 January 2021. Research articles and reviews on the use of contact tracing, testing, self-isolation and quarantine for COVID-19 management were included in the review.

Data extraction and synthesis

We extracted information including study objective, design, methods, main findings and implications. These were tabulated and a narrative synthesis was undertaken given the diverse research designs, methods and implications.

Results

We identified and included 118 eligible studies. We identified the core elements of an effective find, test, trace, isolate, support (FTTIS) system needed to interrupt the spread of a novel infectious disease, where treatment or vaccination was not yet available, as pertained in the initial stages of the COVID-19 pandemic. We report methods used to shorten case finding time, improve accuracy and efficiency of tests, coordinate stakeholders and actors involved in an FTTIS system, support individuals isolating and make appropriate use of digital tools.

Conclusions

We identified in our systematic review the key components of an FTTIS system. These include border controls, restricted entry, inbound traveller quarantine and comprehensive case finding; repeated testing to minimise false diagnoses and pooled testing in resource-limited circumstances; extended quarantine period and the use of digital tools for contact tracing and self-isolation. Support for mental or physical health and livelihoods is needed for individuals undergoing self-isolation/quarantine. An integrated system with rolling-wave planning can best use effective FTTIS tools to respond to the fast-changing COVID-19 pandemic. Results of the review may inform countries considering implementing these measures.

COVID-19 health and social care access for autistic people: European policy review

Background

The global COVID-19 pandemic has had an unprecedented impact on European health and social care systems, with demands on testing, hospital and intensive care capacity exceeding available resources in many regions. This has led to concerns that some vulnerable groups, including autistic people, may be excluded from services.

Methods

We reviewed policies from 15 European member states, published in March–July 2020, pertaining to (1) access to COVID-19 tests; (2) provisions for treatment, hospitalisation and intensive care units (ICUs); and (3) changes to standard health and social care. In parallel, we analysed survey data on the lived experiences of 1301 autistic people and caregivers.

Results

Autistic people experienced significant barriers when accessing COVID-19 services. First, despite being at elevated risk of severe illness due to co-occurring health conditions, there was a lack of accessibility of COVID-19 testing. Second, many COVID-19 outpatient and inpatient treatment services were reported to be inaccessible, predominantly resulting from individual differences in communication needs. Third, ICU triage protocols in many European countries (directly or indirectly) resulted in discriminatory exclusion from lifesaving treatments. Finally, interruptions to standard health and social care left over 70% of autistic people without everyday support.

Conclusions

The COVID-19 pandemic has further exacerbated existing healthcare inequalities for autistic people, probably contributing to disproportionate increases in morbidity and mortality, mental health and behavioural difficulties, and reduced quality of life. An urgent need exists for policies and guidelines on accessibility of COVID-19 services to be updated to prevent the widespread exclusion of autistic people from services, which represents a violation of international human rights law.

Coffee consumption and risk of prostate cancer: a systematic review and meta-analysis

Por: Chen · X. · Zhao · Y. · Tao · Z. · Wang · K.
Objectives

To conduct a systematic review with meta-analysis of cohort studies to evaluate the association of coffee consumption with the risk of prostate cancer.

Data sources

PubMed, Web of Science and Embase were searched for eligible studies up to September 2020.

Study selection

Cohort studies were included.

Data extraction and synthesis

Two researchers independently reviewed the studies and extracted the data. Data synthesis was performed via systematic review and meta-analysis of eligible cohort studies. Meta-analysis was performed with the "metan" and "glst" commands in Stata 14.0.

Main outcomes and measures

Prostate cancer was the main outcome. It was classified as localised prostate cancer which included localised or non-aggressive cancers; advanced prostate cancer which included advanced or aggressive cancers; or fatal prostate cancer which included fatal/lethal cancers or prostate cancer-specific deaths.

Results

Sixteen prospective cohort studies were finally included, with 57 732 cases of prostate cancer and 1 081 586 total cohort members. Higher coffee consumption was significantly associated with a lower risk of prostate cancer. Compared with the lowest category of coffee consumption, the pooled relative risk (RR) was 0.91 (95% CI 0.84 to 0.98), I2= 53.2%) for the highest category of coffee consumption. There was a significant linear trend for the association (p=0.006 for linear trend), with a pooled RR of 0.988 (95% CI 0.981 to 0.995) for each increment of one cup of coffee per day. For localised, advanced and fatal prostate cancer, the pooled RRs were 0.93 (95% CI 0.87 to 0.99), 0.88 (95% CI 0.71 to 1.09) and 0.84 (95% CI 0.66 to 1.08), respectively. No evidence of publication bias was indicated in this meta-analysis.

Conclusions

This study suggests that a higher intake of coffee may be associated with a lower risk of prostate cancer.

Postnatal checks and primary care consultations in the year following childbirth: an observational cohort study of 309 573 women in the UK, 2006-2016

Por: Smith · H. C. · Saxena · S. · Petersen · I.
Objective

To describe women’s uptake of postnatal checks and primary care consultations in the year following childbirth.

Design

Observational cohort study using electronic health records.

Setting

UK primary care.

Participants

Women aged 16–49 years who had given birth to a single live infant recorded in The Health Improvement Network (THIN) primary care database in 2006–2016.

Main outcome measures

Postnatal checks and direct consultations in the year following childbirth.

Results

We examined 1 427 710 consultations in 309 573 women who gave birth to 241 662 children in 2006–2016. Of these women, 78.7% (243 516) had a consultation at the time of the postnatal check, but only 56.2% (174 061) had a structured postnatal check documented. Teenage women (aged 16–19 years) were 12% less likely to have a postnatal check compared with those aged 30–35 years (incidence rate ratio (IRR) 0.88, 95% CI 0.85 to 0.91) and those living in the most deprived versus least deprived areas were 10% less likely (IRR 0.90, 95% CI 0.88 to 0.92). Women consulted on average 4.8 times per woman per year and 293 049 women (94.7%) had at least one direct consultation in the year after childbirth. Consultation rates were higher for those with a caesarean delivery (7.7 per woman per year, 95% CI 7.7 to 7.8). Consultation rates peaked during weeks 5–10 following birth (11.8 consultations/100 women) coinciding with the postnatal check.

Conclusions

Two in 10 women did not have a consultation at the time of the postnatal check and four in 10 women have no record of receiving a structured postnatal check within the first 10 weeks after giving birth. Teenagers and those from the most deprived areas are among the least likely to have a check. We estimate up to 350 400 women per year in the UK may be missing these opportunities for timely health promotion and to have important health needs identified following childbirth.

Information given by websites selling home self-sampling COVID-19 tests: an analysis of accuracy and completeness

Por: Taylor-Phillips · S. · Berhane · S. · Sitch · A. J. · Freeman · K. · Price · M. J. · Davenport · C. · Geppert · J. · Harris · I. M. · Osokogu · O. · Skrybant · M. · Deeks · J. J.
Objectives

To assess the accuracy and completeness of information provided by websites selling home self-sampling and testing kits for COVID-19.

Design

Cross-sectional observational study.

Setting

All websites (n=27) selling direct to user home self-sampling and testing kits for COVID-19 (41 tests) in the UK (39 tests) and USA (two tests) identified by a website search on 23 May 2020.

Main outcome measures

Thirteen predefined basic information items to communicate to a user, including who should be tested, when and how testing should be done, test accuracy, and interpretation of results.

Results

Many websites did not provide the name or manufacturer of the test (32/41; 78%), when to use the test (10/41; 24%), test accuracy (12/41; 29%), and how to interpret results (21/41; 51%). Sensitivity and specificity were the most commonly reported test accuracy measures (either reported for 27/41 [66%] tests): we could only link these figures to manufacturers’ documents or publications for four (10%) tests. Predictive values, most relevant to users, were rarely reported (five [12%] tests reported positive predictive values). For molecular virus tests, 9/23 (39%) websites explained that test positives should self-isolate, and 8/23 (35%) explained that test negatives may still have the disease. For antibody tests, 12/18 (67%) websites explained that testing positive does not necessarily infer immunity from future infection. Seven (39%) websites selling antibody tests claimed the test had a CE mark, when they were for a different intended use (venous blood rather than finger-prick samples).

Conclusions

At the point of online purchase of home self-sampling COVID-19 tests, users in the UK are provided with incomplete, and, in some cases, misleading information on test accuracy, intended use, and test interpretation. Best practice guidance for communication about tests to the public should be developed and enforced for online sales of COVID-19 tests.

Self-reported health without clinically measurable benefits among adult users of multivitamin and multimineral supplements: a cross-sectional study

Por: Paranjpe · M. D. · Chin · A. C. · Paranjpe · I. · Reid · N. J. · Duy · P. Q. · Wang · J. K. · O'Hagan · R. · Arzani · A. · Haghdel · A. · Lim · C. C. · Orhurhu · V. · Urits · I. · Ngo · A. L. · Glicksberg · B. S. · Hall · K. T. · Mehta · D. · Cooper · R. S. · Nadkarni · G. N.
Objective

Multiple clinical trials fail to identify clinically measurable health benefits of daily multivitamin and multimineral (MVM) consumption in the general adult population. Understanding the determinants of widespread use of MVMs may guide efforts to better educate the public about effective nutritional practices. The objective of this study was to compare self-reported and clinically measurable health outcomes among MVM users and non-users in a large, nationally representative adult civilian non-institutionalised population in the USA surveyed on the use of complementary health practices.

Design

Cross-sectional analysis of the effect of MVM consumption on self-reported overall health and clinically measurable health outcomes.

Participants

Adult MVM users and non-users from the 2012 National Health Interview Survey (n=21 603).

Primary and secondary outcome measures

Five psychological, physical, and functional health outcomes: (1) self-rated health status, (2) needing help with routine needs, (3) history of 10 chronic diseases, (4) presence of 19 health conditions in the past 12 months, and (5) Kessler 6-Item (K6) Psychological Distress Scale to measure non-specific psychological distress in the past month.

Results

Among 4933 adult MVM users and 16 670 adult non-users, MVM users self-reported 30% better overall health than non-users (adjusted OR 1.31; 95% CI 1.17 to 1.46; false discovery rate adjusted p

Conclusions

MVM users self-reported better overall health despite no apparent differences in clinically measurable health outcomes. These results suggest that widespread use of multivitamins in adults may be a result of individuals’ positive expectation that multivitamin use leads to better health outcomes or a self-selection bias in which MVM users intrinsically harbour more positive views regarding their health.

The association between cigarette smoking, cancer screening, and cancer stage: a prospective study of the womens health initiative observational cohort

Por: Eng · V. A. · David · S. P. · Li · S. · Ally · M. S. · Stefanick · M. · Tang · J. Y.
Objective

To assess the dose-dependent relationship between smoking history and cancer screening rates or staging of cancer diagnoses.

Design

Prospective, population-based cohort study.

Setting

Questionnaire responses from the Women’s Health Initiative (WHI) Observational Study.

Participants

89 058 postmenopausal women.

Outcome measures

Logistic regression models were used to assess the odds of obtaining breast, cervical, and colorectal cancer screening as stratified by smoking status. The odds of late-stage cancer diagnoses among patients with adequate vs inadequate screening as stratified by smoking status were also calculated.

Results

Of the 89 058 women who participated, 52.8% were never smokers, 40.8% were former smokers, and 6.37% were current smokers. Over an average of 8.8 years of follow-up, current smokers had lower odds of obtaining breast (OR 0.55; 95% CI 0.51 to 0.59), cervical (OR 0.53; 95% CI 0.47 to 0.59), and colorectal cancer (OR 0.71; 95% CI 0.66 to 0.76) screening compared with never smokers. Former smokers were more likely than never smokers to receive regular screening services. Failure to adhere to screening guidelines resulted in diagnoses at higher cancer stages among current smokers for breast cancer (OR 2.78; 95% CI 1.64 to 4.70) and colorectal cancer (OR 2.26; 95% CI 1.01 to 5.05).

Conclusions

Active smoking is strongly associated with decreased use of cancer screening services and more advanced cancer stage at the time of diagnosis. Clinicians should emphasise the promotion of both smoking cessation and cancer screening for this high-risk group.

Correction: Alcohol consumption of UK members of parliament: cross-sectional survey

Rao R, Bakolis I, Das-Munshi J, et al. Alcohol consumption of UK members of parliament: cross-sectional survey. BMJ Open 2020;10:e034929. doi: 10.1136/bmjopen-2019-034929

This article was previously published with an error.

Affiliations of authors should be:

Rahul Rao1, Ioannis Bakolis2, Jayati Das-Munshi3, Daniel Poulter4, Nicole Votruba5, and Graham Thornicroft5

1Old Age Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, London, UK

2Department of Biostatistics and Health Informatics/Centre for Implementation Science, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK

3Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neurosciences, King’s College London, Institute of Psychiatry, London, UK

4House of Commons, London, UK

5Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK

The information ‘Rahul Rao and Ioannis Bakolis are joint first authors.’ was missing.

The line in competing interest ‘GT, IB are supported by the National Institute for Health Research (NIHR) Collaboration...

Identifying the predictors of avoidable emergency department attendance after contact with the NHS 111 phone service: analysis of 16.6 million calls to 111 in England in 2015-2017

Por: Egan · M. · Murar · F. · Lawrence · J. · Burd · H.
Objectives

To measure the frequency of patients making avoidable emergency department (ED) attendances after contact with NHS 111 and to examine whether these attendances can be predicted reliably.

Design

Analysis of 16 563 946 calls made to 111, where each call was linked with a record of whether the patient attended ED within 24 hours.

Setting

All regions of England from March 2015 to October 2017.

Participants and data

Our main regression model used a sample of 10 954 783 calls, each with detailed patient-level information.

Main outcome

Whether patients made an unadvised, non-urgent type 1 ED (‘avoidable') attendance within 24 hours of calling 111.

Results

Of 16 563 946 calls to 111, 12 894 561 (77.8%) were not advised to go to ED (ie, they were advised to either attend primary care, attend another non-ED healthcare service or to self-care). Of the calls where the patient was not advised to go to the ED, 691 783 (5.4%) resulted in the patient making an avoidable ED attendance within 24 hours. Among other factors, calls were less likely to result in these attendances when they received clinical input (adjusted OR 0.52, 95% CI 0.51 to 0.53) but were more likely when the patient was female (OR 1.07, 95% CI 1.06 to 1.08) or aged 0–4 years (OR 1.34, 95% CI 1.33 to 1.35).

Conclusions

For every 20 calls where 111 did not advise people to attend the ED, 1 resulted in avoidable ED attendance within 24 hours. These avoidable attendances could be predicted, to a certain extent, based on call characteristics. It may be possible to use this information to help 111 call handlers identify which callers are at higher risk of these attendances.

Alcohol consumption of UK members of parliament: cross-sectional survey

Por: Rao · R. · Bakolis · I. · Das-Munshi · J. · Poulter · D. · Votruba · N. · Thornicroft · G.
Objectives

This study examined the prevalence of risky drinking by members of parliament (MPs), as well as the relationship between risky drinking and age, years spent as an MP, working outside parliament, awareness of the Parliamentary Health and Wellbeing Service, and probable mental ill health.

Design

A survey questionnaire assessed alcohol consumption using the Alcohol Use Disorders Identification Test (AUDIT). Risky drinking was identified by combining categories of increasing (hazardous), higher (harmful) and probable dependent drinking for those with a total score of 8 or more. Comparator groups from the 2014 Adult Psychiatric Morbidity Survey (APMS) were used as controls.

Setting

UK House of Commons.

Participants

650 MPs.

Results

Compared with all 650 MPs, participants (n=146) were more likely to be female (p

Conclusions

A low level of awareness of the Parliamentary Health and Wellbeing Service has implications for improving the detection of risky drinking and improving access to this service by MPs. Possible increased likelihood of risky drinking in MPs who also had an additional work role outside Parliament and among those with probable mental ill health requires further exploration.

Race-ethnic and gender differences in representation within the English National Health Service: a quantitative analysis

Por: Milner · A. · Baker · E. · Jeraj · S. · Butt · J.
Objectives

To evaluate race-ethnic and gender disparities in National Health Service (NHS) England employment in position, prestige and pay.

Design

National study using data from NHS Digital.

Setting

Trusts and clinical commissioning groups in England.

Participants

1 105 390 NHS Hospital and Community Health Service staff.

Results

Chinese people (42.9%, 95% CI 41.7% to 44.1%) are the most likely to be employed as doctors, followed by Asians (28.6%, 95% CI 28.3% to 28.8%) and people of mixed race/ethnicity (17.9%, 95% CI 17.3% to 18.4%); while white people (6.8%, 95% CI 6.7% to 6.8%) are less likely to be employed as doctors. However, white doctors are the most likely to be in the highest paid positions: 46.0% (95% CI 45.6% to 46.4%) of white doctors are consultants, whereas only 33.4% (95% CI 31.6% to 35.2%) of Chinese doctors are consultants. Black people are under-represented both among doctors and as consultants: 6.5% (95% CI 6.4% to 6.7%) of black employees are doctors and 30.6% (95% CI 29.2% to 32.0%) of black doctors are consultants. We found similar results for nurses and health visitors, where white people are over-represented in the higher pay bands. However, among support staff for doctors, nurses and midwives, we found that Chinese people were over-represented in the higher pay bands. These race-ethnic differences were similar for women and men. Additionally, we found that men were more likely to be employed in higher pay bands than women, and this gender disparity was apparent across race-ethnic groups.

Conclusions

Race-ethnic and gender disparities exist in the NHS in position, prestige and pay. To begin to overcome such disparities, the NHS must collect data using consistent race-ethnic categories in order to examine differences over time.

Resilience, burnout and coping mechanisms in UK doctors: a cross-sectional study

Por: McKinley · N. · McCain · R. S. · Convie · L. · Clarke · M. · Dempster · M. · Campbell · W. J. · Kirk · S. J.
Aims

This cross-sectional study aimed to assess resilience, professional quality of life and coping mechanisms in UK doctors. It also aimed to assess the impact of demographic variables, such as sex, grade and specialty on these factors.

Methods

During October and November 2018, medical doctors in the UK were eligible to complete an online survey made up of validated psychological instruments. Royal Colleges and other medical organisations invited their membership to participate via newsletters, email invitations, websites and social media.

Results

1651 doctors participated from a wide range of specialties and grades across the UK. The mean resilience score was 65.01 (SD 12.3), lower than population norms. Of those who responded, 31.5% had high burnout (BO), 26.2% had high secondary traumatic stress and 30.7% had low compassion satisfaction (CS). Doctors who responded from emergency medicine were more burned out than any other specialty group (F=2.62, p=0.001, df 14). Those who responded from general practice scored lowest for CS (F=6.43, p

Conclusions

One-third of UK doctors who responded are burned out and suffering from STS. Those who responded from emergency medicine and general practice appear to be suffering the most. Over 100 doctors fell into the at-risk category of high BO, high STS and low CS. Future analysis of the free text responses from doctors may help to identify factors that are playing a role in the high levels of BO and STS being reported by medical staff.

Vitamin D prescribing in children in UK primary care practices: a population-based cohort study

Por: Wan · M. · Horsfall · L. J. · Basatemur · E. · Patel · J. P. · Shroff · R. · Rait · G.
Objective

To examine temporal changes in the incidence and patterns of vitamin D supplementation prescribing by general practitioners (GPs) between 2008 and 2016.

Design

Population-based cohort study.

Setting

UK general practice health records from The Health Improvement Network.

Participants

Children aged 0 to 17 years who were registered with their general practices for at least 3 months.

Outcome measures

Annual incidence rates of vitamin D prescriptions were calculated, and rate ratios were estimated using multivariable Poisson regression to explore differences by sociodemographic factors. Data on the type of supplementation, dose, dosing schedule, linked 25-hydroxyvitamin D (25(OH)D) laboratory test results and clinical symptoms suggestive of vitamin D deficiency were analysed.

Results

Among 2 million children, the crude annual incidence of vitamin D prescribing increased by 26-fold between 2008 and 2016 rising from 10.8 (95% CI: 8.9 to 13.1) to 276.8 (95% CI: 264.3 to 289.9) per 100 000 person-years. Older children, non-white ethnicity and general practices in England (compared with Wales/Scotland/Northern Ireland) were independently associated with higher rates of prescribing. Analyses of incident prescriptions showed inconsistent supplementation regimens with an absence of pre-supplementation 25(OH)D concentrations in 28.7% to 56.4% of prescriptions annually. There was an increasing trend in prescribing at pharmacological doses irrespective of 25(OH)D concentrations, deviating in part from UK recommendations. Prescribing at pharmacological doses for children with deficient status increased from 3.8% to 79.4%, but the rise was also observed in children for whom guidelines recommended prevention doses (0% to 53%). Vitamin D supplementation at pharmacological doses was also prescribed in at least 40% of children with no pre-supplementation 25(OH)D concentrations annually.

Conclusions

There has been a marked and sustained increase in vitamin D supplementation prescribing in children in UK primary care. Our data suggests that national guidelines on vitamin D supplementation for children are not consistently followed by GPs.

Incidence of anorexia nervosa in young people in the UK and Ireland: a national surveillance study

Por: Petkova · H. · Simic · M. · Nicholls · D. · Ford · T. · Prina · A. M. · Stuart · R. · Livingstone · N. · Kelly · G. · Macdonald · G. · Eisler · I. · Gowers · S. · Barrett · B. M. · Byford · S.
Objectives

This study aimed to estimate the incidence of DSM5 anorexia nervosa in young people in contact with child and adolescent mental health services in the UK and Ireland.

Design

Observational, surveillance study, using the Child and Adolescent Psychiatry Surveillance System, involving monthly reporting by child and adolescent psychiatrists between 1st February 2015 and 30th September 2015.

Setting

The study was based in the UK and Ireland.

Participants

Clinician-reported data on young people aged 8–17 in contact with child and adolescent mental health services for a first episode of anorexia nervosa.

Main outcome measures

Annual incidence rates (IRs) estimated as confirmed new cases per 100 000 population at risk.

Results

305 incident cases of anorexia nervosa were reported over the 8-month surveillance period and assessed as eligible for inclusion. The majority were young women (91%), from England (70%) and of white ethnicity (92%). Mean age was 14.6 years (±1.66) and mean percentage of median expected body mass index for age and sex was 83.23% (±10.99%). The overall IR, adjusted for missing data, was estimated to be 13.68 per 100 000 population (95% CI 12.88 to 14.52), with rates of 25.66 (95% CI 24.09 to 27.30) for young women and 2.28 (95% CI 1.84 to 2.79) for young men. Incidence increased steadily with age, peaking at 15 (57.77, 95% CI 50.41 to 65.90) for young women and 16 (5.14, 95% CI 3.20 to 7.83) for young men. Comparison with earlier estimates suggests IRs for children aged 12 and under have increased over the last 10 years.

Conclusion

These results provide new estimates of the incidence of anorexia nervosa in young people. Service providers and commissioners should consider evidence to suggest an increase in incidence in younger children.

Trial registration number

ISRCTN12676087.

Antidepressant use during pregnancy and the risk of gestational diabetes mellitus: a nested case-control study

Por: Dandjinou · M. · Sheehy · O. · Berard · A.
Objectives

The aim of this study was to determine the association between antidepressant (AD) classes, types and duration of use during pregnancy and the risk of gestational diabetes mellitus (GDM).

Design and setting

A nested case–control study was conducted within the Quebec Pregnancy Cohort (QPC), a Canadian provincial database which includes data on all pregnancies and children in Quebec from January 1998 to December 2015.

Primary outcome measures

Gestational diabetes mellitus.

Participants

Cases of GDM were identified after week 20 of pregnancy and randomly matched 1:10 to controls on gestational age at index date (ie, calendar date of GDM) and year of pregnancy. AD exposure was assessed by filled prescriptions between the beginning of pregnancy (first day of last menstrual period) and index date. Conditional logistic regression models were used to estimate crude and adjusted odds ratios (aOR).

Results

Among 20 905 cases and 209 050 matched controls, 9741 (4.2%) women were exposed to ADs. When adjusting for potential confounders, AD use was associated with an increased risk of GDM (aOR 1.19, 95% CI 1.08 to 1.30); venlafaxine (aOR 1.27, 95% CI 1.09 to 1.49) and amitriptyline (aOR 1.52, 95% CI 1.25 to 1.84) were also associated with an increased risk of GDM. Moreover, the risk of GDM was increased with longer duration of AD use, specifically for serotonin norepinephrine reuptake inhibitors, tricyclic ADs and combined use of two AD classes. No statistically significant association was observed for selective serotonin reuptake inhibitors.

Conclusion

The findings suggest that ADs—and specifically venlafaxine and amitriptyline—were associated with an increased risk of GDM.

Is an obesity simulation suit in an undergraduate medical communication class a valuable teaching tool? A cross-sectional proof of concept study

Por: Herrmann-Werner · A. · Loda · T. · Wiesner · L. M. · Erschens · R. S. · Junne · F. · Zipfel · S.
Objective

With the growing prevalence of overweight and obesity, medical students should be prepared to engage in weight management and obesity-related communications in order to prevent patients from having stigmatising experiences. In addition, medical students should have training to reduce anti-fat prejudices.

Design

Cross-sectional proof of concept study.

Setting

University Hospital Tuebingen, Germany.

Participants

246 participants (207 second-year medical students, 13 standardised patients (SPs) and 22 teachers) took part in the study.

Primary and secondary outcome measures

The primary outcome was the assessment of degree of reality of the encounter with the SP wearing an obesity simulation suit (OSS). The secondary outcome was the evaluation of students’ awareness and prejudice against patients with obesity in a simulated role play. Additionally, a description of the advantages and disadvantages when using such a teaching tool is delivered.

Results

The OSS contributed to a realistic perception of the patient group depicted in a role play according to students, teachers and SPs. OSS body mass index estimation by students, teachers and SPs correctly was over 30 kg/m2—thus in the range of obesity. In a selected subscale of the Anti-Fat Attitudes Test, students showed significantly stronger anti-fat stigmatisation compared with teachers and SPs.

Conclusions

An OSS worn by an SP is a valuable teaching tool to raise awareness about patients with obesity. It gives a realistic picture of the encounter. Stigmatisation was low in general but was especially present in the students. Further research should include intervention studies to address this issue.

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