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Upper respiratory tract infections (URTIs) account for approximately 50% of antibiotic prescriptions in the United Kingdom. General practitioners (GPs) frequently issue such prescriptions simply because they believe that the patient... more
Upper respiratory tract infections (URTIs) account for approximately 50% of antibiotic prescriptions in the United Kingdom. General practitioners (GPs) frequently issue such prescriptions simply because they believe that the patient expects it. Deferred prescribing (issuing a prescription, but with instructions to wait for no spontaneous improvement before deciding whether to use it) might address patients' expectations, while minimising actual antibiotic consumption. Although the technique is quite widely practiced, patients' attitudes and responses to it are unclear. To establish the proportion of recipients who claim to consume their delayed antibiotic prescriptions. To elicit factors associated with patients' decisions to consume their antibiotics, and patients' confidence in taking this decision. Postal questionnaire survey. Patients from 13 group practices in the south of England. Patients who had received a delayed antibiotic prescription for URTI from their G...
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... provide a sharp contrast to those in the West in that there is a shift from the individual to the social environment (Stockman, 1994), while families also play an integral part in influencing the client's decision to... more
... provide a sharp contrast to those in the West in that there is a shift from the individual to the social environment (Stockman, 1994), while families also play an integral part in influencing the client's decision to comply with their medication regime (Razali & Yahya, 1995; Okonji & ...
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Aims The first death in the UK caused by COVID-19 occurred on 5 March 2020. We aim to describe the clinical characteristics and outcomes of major trauma and orthopaedic patients admitted in the early COVID-19 era. Methods A prospective... more
Aims The first death in the UK caused by COVID-19 occurred on 5 March 2020. We aim to describe the clinical characteristics and outcomes of major trauma and orthopaedic patients admitted in the early COVID-19 era. Methods A prospective trauma registry was reviewed at a Level 1 Major Trauma Centre. We divided patients into Group A, 40 days prior to 5 March 2020, and into Group B, 40 days after. Results A total of 657 consecutive trauma and orthopaedic patients were identified with a mean age of 55 years (8 to 98; standard deviation (SD) 22.52) and 393 (59.8%) were males. In all, 344 (approximately 50%) of admissions were major trauma. Group A had 421 patients, decreasing to 236 patients in Group B (36%). Mechanism of injury (MOI) was commonly a fall in 351 (52.4%) patients, but road traffic accidents (RTAs) increased from 56 (13.3%) in group A to 51 (21.6%) in group B (p = 0.030). ICU admissions decreased from 26 (6.2%) in group A to 5 (2.1%) in group B. Overall, 39 patients tested p...
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A randomised controlled trial evaluated the cost and efficacy of community leg ulcer clinics that used four layer compression bandaging. The control treatment was provision of usual care by district nurses.1 Over the 12 month follow-up,... more
A randomised controlled trial evaluated the cost and efficacy of community leg ulcer clinics that used four layer compression bandaging. The control treatment was provision of usual care by district nurses.1 Over the 12 month follow-up, ulcers of patients in the clinic group healed quicker than those in the control group (P=0.03). However, no difference was seen between treatment groups in mean total NHS costs per patient (P=0.89). All statistical tests were two sided, and the critical level of significance was set at 0.05 (5%). For each of the scenarios below in the total population, determine whether a correct conclusion (a), type I error (b), or type …
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Researchers conducted a case-control study to investigate whether sleeping environment was associated with sudden infant death syndrome.1 The researchers aimed to include all cases of sudden unexpected death for infants aged between 7 and... more
Researchers conducted a case-control study to investigate whether sleeping environment was associated with sudden infant death syndrome.1 The researchers aimed to include all cases of sudden unexpected death for infants aged between 7 and 364 days from five regions of England with a combined population of more than 17 million people. A total of 325 cases were identified through registers. For every case, four controls matched for age, locality, and time of sleep were included. Interviews were undertaken with the parents of all cases and controls to ascertain past sleeping environment. Infant’s typical sleeping environment in relation to their parents was classified as usual room sleeper (shared room but not bed), usual solitary sleeper (slept in room separate from parents), or usual bed sharer (shared bed with parents for more than two nights per week). The results are presented in the table, which shows the odds ratios of sudden unexpected death for the categories of the infants’ usual sleeping environment.⇓ View this table: Infant’s sleeping environment in …
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A randomised controlled trial evaluated the effectiveness of an integrated care programme compared with usual care in facilitating the return to work for patients with chronic low back pain.1 The integrated care programme was a combined... more
A randomised controlled trial evaluated the effectiveness of an integrated care programme compared with usual care in facilitating the return to work for patients with chronic low back pain.1 The integrated care programme was a combined patient and workplace directed intervention. The trial participants were 134 adults aged 18-65 years who had had low back pain for more than 12 weeks, were in paid work, and had been absent or partially absent from work. Variables measured at baseline included patient’s sex, age, and level of education. Level of education was classified as low (preschool or primary school), intermediate (secondary school), and high (tertiary, university, or postgraduate). Trial participants were followed for 12 months. The primary outcome was duration of time off work after randomisation until a fully sustained return …
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Page 1. Sinai Probability Theory An Introductory Course Springer Textbook ... Sinai, Yakov G.: Probability theory: an introductory course / Yakov G. Sinai. Transl. ...
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Researchers investigated whether vaccination against human papillomavirus (HPV) increased the risk of miscarriage in young women.1 The results of two double blind, multicentre, phase three randomised controlled trials were pooled.... more
Researchers investigated whether vaccination against human papillomavirus (HPV) increased the risk of miscarriage in young women.1 The results of two double blind, multicentre, phase three randomised controlled trials were pooled. Participants had been randomly assigned to receive three doses of bivalent HPV 16/18 VLP vaccine with AS04 adjuvant or hepatitis A vaccine (as control) over six months. The primary outcome was rate of miscarriage after vaccination. Given that a lower miscarriage rate with the HPV vaccine was not a safety concern, a one sided test of statistical significance was performed (P=0.16). Which of the following statements, if any, are true?
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Researchers investigated the effects of long term treatment with metformin on the risk of vitamin B12 deficiency in patients with type 2 diabetes receiving insulin treatment.1 A multicentre randomised placebo controlled trial was used. A... more
Researchers investigated the effects of long term treatment with metformin on the risk of vitamin B12 deficiency in patients with type 2 diabetes receiving insulin treatment.1 A multicentre randomised placebo controlled trial was used. A total of 390 patients were randomly assigned to receive 850 mg metformin or 850 mg placebo three times a day. Primary outcome measures included percentage change in the serum concentration of homocysteine from baseline at 4, 17, 30, 43, and 52 month follow-up. At baseline, the metformin group (n=196) had a mean homocysteine concentration of 14.4 μmol/l (standard deviation 9.7 μmol/l), compared with a mean concentration of 14.6 μmol/l (standard deviation 10.3 μmol/l) for the placebo group (n=194). Which of the following statements, if any, are true for the metformin group at baseline?
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A 79 year old white woman had her bone mineral density (BMD) measured to assess for osteoporosis and fracture risk. The table⇓ shows the results of dual energy x ray absorptiometry (DXA). View this table: Results of dual energy x ray... more
A 79 year old white woman had her bone mineral density (BMD) measured to assess for osteoporosis and fracture risk. The table⇓ shows the results of dual energy x ray absorptiometry (DXA). View this table: Results of dual energy x ray absorptiometry on the right hip of a 79 year old patient Which of the following statements, if any, are true? Answers a , b , and d are true, whereas c is false. Measurement of BMD in the hip and spine is the gold standard for the diagnosis of osteoporosis and assessment of fracture risk. BMD is the ratio of bone mineral content to bone area (expressed in g/cm²). Measurements for three regions of the woman’s right hip are given—the femoral neck, tronchanteric region, and intertrochanteric region. A total BMD measurement was obtained by scanning the entire hip …
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Last week’s question described a trial that assessed the effectiveness of topical intranasal corticosteroids in children aged 4-11 years who had bilateral otitis media with effusion.1 A randomised double blind, placebo controlled... more
Last week’s question described a trial that assessed the effectiveness of topical intranasal corticosteroids in children aged 4-11 years who had bilateral otitis media with effusion.1 A randomised double blind, placebo controlled superiority trial was performed.2 The primary end point was proportion of children cured of bilateral otitis media with effusion in one or both ears at one month. In total, 105 children were allocated to receive nasal mometasone furoate 50 μg, given once daily into each nostril for three months, and 112 to placebo spray. At one month, 40.6% of the topical steroid group and 44.9% of the placebo group were cured. The …
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Researchers undertook a randomised controlled trial to assess the effect of zinc supplementation on the severity and duration of diarrhoea caused by cholera in children.1 Children were recruited if they had watery diarrhoea and dark field... more
Researchers undertook a randomised controlled trial to assess the effect of zinc supplementation on the severity and duration of diarrhoea caused by cholera in children.1 Children were recruited if they had watery diarrhoea and dark field microscopy examination of stool was positive for Vibrio cholerae (confirmed by stool culture). Children were randomly allocated to zinc supplementation or placebo. The table compares the primary outcomes (duration of diarrhoea and stool output) and secondary outcomes for the zinc supplementation and placebo groups⇓. All hypothesis tests were performed using a two sided, independent samples t test, with a 0.05 (5%) critical level of significance. Zinc supplementation was found to reduce the duration and severity of diarrhoea in children with cholera. View this table: Impact of zinc supplementation on clinical outcomes in children with cholera Which of the following statements, if any, are true?
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A prospective population based cohort study investigated the association between occupation and pregnancy outcome for mothers who had missed antenatal visits. The mean birth weight was 3371 g (95% confidence interval 3274 to 3469) and... more
A prospective population based cohort study investigated the association between occupation and pregnancy outcome for mothers who had missed antenatal visits. The mean birth weight was 3371 g (95% confidence interval 3274 to 3469) and 3227 g (3140 to 3315 g) for babies born to mothers in non-manual and manual jobs, respectively. On the basis of the above information, which of the following can be deduced for mothers who missed antenatal visits?
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Last week’s question discussed sample standard deviation. For a variable such as body mass index (BMI), the sample standard deviation provides a measure of the average difference between the BMI of individuals in the sample and the sample... more
Last week’s question discussed sample standard deviation. For a variable such as body mass index (BMI), the sample standard deviation provides a measure of the average difference between the BMI of individuals in the sample and the sample mean.1 The example used last week was a cohort study: researchers investigated the association between slow walking speed and risk of death in older people.2 A cohort of 3208 French men and women aged over 65 years living in the community were recruited in 1999 and followed for an average of 5.1 years. At baseline the cohort had a mean BMI of 25.6 kg m-2 with a standard deviation of 4.0 kg m-2. The …
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Researchers evaluated whether a community falls prevention service reduced the rate of falls in older people. They used a randomised controlled trial design. Participants were recruited if they were aged over 60 years, had experienced a... more
Researchers evaluated whether a community falls prevention service reduced the rate of falls in older people. They used a randomised controlled trial design. Participants were recruited if they were aged over 60 years, had experienced a fall while living at home or in residential care, and an emergency ambulance had been called but had not taken them to hospital. Participants were randomised to the community falls prevention service or standard medical and social care (control treatment).1 The primary outcome was rate of falls in one year of follow-up, as recorded in monthly diaries. Analysis was by intention to treat. After randomisation, 99 participants were offered the community falls prevention service and 102 participants were offered the control treatment. Diaries for the intervention group contributed 88.6 person years and those for the control group contributed 84.5 person years. The incidence rates of falls per year were 3.46 in the intervention group and 7.68 in the control group, with an incidence rate ratio equal …
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Background: Earlier studies have suggested a link between asthma and severe headache, and also between migraine and wheezing illness. Recent analysis have also shown an increase of asthma among cases with a prior history of migraine but... more
Background: Earlier studies have suggested a link between asthma and severe headache, and also between migraine and wheezing illness. Recent analysis have also shown an increase of asthma among cases with a prior history of migraine but without a history of hay fever, allergic rhinitis or eczema. Aim: To examine whether there is an association between migraine and asthma in the United Kingdom. Design of study: Matched case-control study using the General Practice Research Database (GPRD). Setting: Practices in the United Kingdom providing data on 5,110,619 patients to the GPRD. Method: The subjects were the patients with one or more diagnoses of migraine plus treatment for migraine. Each case was matched by general practice, sex, and age, with one control who had never been given a diagnosis of migraine. Case and control groups were compared for prevalence of asthma, chronic obstructive pulmonary disease, respiratory symptoms treated with inhalers or hay fever. Investigations were carried out to determine whether the association between migraine and asthma was stronger among patients with hayfever or those without hayfever, and whether patients with migraine had an increased prescription of other (non-migraine and non-asthma) medications. Results: Among 64 678 case-control pairs, the relative risk of asthma in patients with migraine was 1.59 (95% CI = 1.54 to 1.65) among definite cases, and 0.75 (95% CI = 0.67 to 0.83) among those whose selection as case included beta-blocker prophylaxis. Among definite migraine cases, relative risks of chronic obstructive pulmonary disease, respiratory symptoms, eczema, and hay fever (pollinosis), were all raised (at 1.22, 1.85, 1.55, and 1.67, respectively). The association between migraine and asthma was stronger in patients without a diagnosis of hay fever, than in those with hayfever (relative risk = 1.32 and 1.19, respectively). The relative risk of prescription for a range of non-migraine, non-asthma medications was raised, the exception being anti-diabetic medication. Conclusion: This large case-control study provides evidence for an association between migraine and asthma. Frequent attendance at a general practice surgery may confound this association. However, if the association is real, its elucidation may help the understanding of disease mechanisms shared by migraine and asthma.
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Last week’s question described a cluster randomised controlled trial that assessed the long term effects of an obesity prevention programme in schools. The intervention was delivered over one school year, and it included education focused... more
Last week’s question described a cluster randomised controlled trial that assessed the long term effects of an obesity prevention programme in schools. The intervention was delivered over one school year, and it included education focused on promoting a healthy diet and discouraging consumption of carbonated drinks. The control group received no intervention. In total, 644 children aged 7-11 years from six schools were recruited and followed for three years after randomisation. The main outcomes were anthropometric measures, such as height, weight, and waist circumference. All of these measurements were taken by a single investigator not blinded to treatment allocation. Which of the following statements, if any, are true? a) Individual children were randomised to the intervention or control
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Background/Aims Over the last 12 months (September 2020-21), we have been conducting a clinical trial with two biologic agents comparing pain outcomes in rheumatoid arthritis (RA) (n = 26). Within the trial, we investigated how... more
Background/Aims Over the last 12 months (September 2020-21), we have been conducting a clinical trial with two biologic agents comparing pain outcomes in rheumatoid arthritis (RA) (n = 26). Within the trial, we investigated how participants with RA taking immunosuppressive medication felt about their care and responded to the COVID-19 pandemic. Such information is important to guide healthcare providers. Methods Semi-structured interviews were conducted either face-to-face or virtually with participants who had recently been recruited to the Biologics for Rheumatoid Arthritis Pain (BIORA-PAIN) study and attended a South West London hospital. Participants had a DAS-28-CRP score of above 5.1 and were just starting on biological treatment. Seven interviews were conducted between April-September 2021, lasting between 23-60 minutes during which participants were asked how they managed their RA during the pandemic. All the responding participants were female, aged between 27-74 (mean 50.3...
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Prospective Phase II Pilot Study of Rabbit Antithymocyte Globulin (ATG, Thymoglobuline) with Ciclosporin for Patients with Acquired Aplastic Anemia and Matched Pair Analysis with Patients Treated with Horse ATG (Lymphoglobuline) and Ciclosporin: A Study From the EBMT Severe Aplastic Anemia Workin...more
Abstract 2408 Background Previously, horse antithymocyte globulin (hATG) with ciclosporin (CSA) was the standard immunosuppressive therapy (IST) for patients with aplastic anemia (AA) ineligible for HSCT, with response rates of 60–75%... more
Abstract 2408 Background Previously, horse antithymocyte globulin (hATG) with ciclosporin (CSA) was the standard immunosuppressive therapy (IST) for patients with aplastic anemia (AA) ineligible for HSCT, with response rates of 60–75% within 3–4 months. Rabbit ATG (rATG, Thymoglobuline, Genzyme) was reserved for non-response or relapse after a course of hATG. Following the withdrawal of hATG (Lymphoglobuline) from the market, the use of rATG as first line IST has been evaluated prospectively with hATG (ATGAM, Pfizer) in a randomised study from NIH (Scheinberg et al, NEJM, 2011), reporting significantly lower response rate and worse outcome after rATG. We report here the results of a multicenter, EBMT, phase II pilot study of 35 patients with AA enrolled between August 2008 and August 2010 at 10 centres (EUdraCT number 2007–000902–55). Patients enrolled were ineligible for matched sibling HSCT, had not received prior ATG or CSA and included both severe AA (SAA) and transfusion dependent non-severe AA (NSAA). The median age was 36 years (range 17–75). Six (17%) patients had very severe AA, 20 (57%) SAA and 9 (26%) had NSAA. Primary endpoint was response at 6 months. Dose of rATG was 3.75mg/kg daily for 5 days. CSA dose was 5mg/kg daily from day +1. For prevention of serum sickness, prednisolone was given at 1–2mg/kg daily from day 1–5, then the dose halved every 5 days. Results were compared in a 3: 1 ratio with 105 historical patients from the EBMT registry, matched for categorised age and disease severity, and who had been treated with hATG (Lymphoglobuline, Genzyme) and CSA. The study was designed to demonstrate a 25% difference in total response to rATG, with 80% power at a 5% level of significance. The median follow up for all patients treated with rATG is 285 days (6–781). Results At 3 months, no patients had achieved a complete response (CR). Partial response (PR) occurred in 11 (34%). Two patients died, on day +6 and +9, and one was lost to follow up. At 6 months, CR rate was 7% (n=2) and PR rate 32% (n=11). One patient relapsed at 59 days. Five patients underwent unrelated donor HSCT for non-response to rATG, at day +153, 168, 321, 322 and 460 post rATG. Infections occurred in 22 (63%), elevated liver function in 10 (29%), rash in 8 (23%), haemorrhage in 7 (20%), hypertension in 6 (17%), abnormal renal function in 6 (17%), arthralgia in 5 (14%), avascular bone necrosis in one. There were 10 deaths after rATG (28.5%) and one following subsequent HSCT. Infections were the main cause of death in 9/10 patients. For rATG, overall survival at 2 yr was 56%, compared to 78% for hATG, p=0.001. Overall survival after censoring HSCT patients was 39% for rATG and 72% for hATG, p=0.0005. On multivariate analysis, rATG (RR = 3.4, p=0.003) and age…
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Traditional null hypothesis significance testing (NHST) incorporating the critical level of significance of 0.05 has become the cornerstone of decision-making in health care, and nowhere less so than in obstetric and gynecological... more
Traditional null hypothesis significance testing (NHST) incorporating the critical level of significance of 0.05 has become the cornerstone of decision-making in health care, and nowhere less so than in obstetric and gynecological research. However, such practice is controversial. In particular, it was never intended for clinical significance to be inferred from statistical significance. The inference of clinical importance based on statistical significance (p < 0.05), and lack of clinical significance otherwise (p ≥ 0.05) represents misunderstanding of the original purpose of NHST. Furthermore, the limitations of NHST-sensitivity to sample size, plus type I and II errors-are frequently ignored. Therefore, decision-making based on NHST has the potential for recurrent false claims about the effectiveness of interventions or importance of exposure to risk factors, or dismissal of important ones. This commentary presents the history behind NHST along with the limitations that modern-day NHST presents, and suggests that a statistics reform regarding NHST be considered.
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OBJECTIVE To evaluate the impact of a previous pregnancy and delivery on perineal trauma rates in the subsequent vaginal birth. METHODS Retrospective cohort study. The perineal outcomes of secundiparous women with history of previous... more
OBJECTIVE To evaluate the impact of a previous pregnancy and delivery on perineal trauma rates in the subsequent vaginal birth. METHODS Retrospective cohort study. The perineal outcomes of secundiparous women with history of previous (first) delivery in one of three categories: failed operative vaginal delivery (FOVD) and second stage emergency caesarean section (EmCS); elective caesarean section (ELCS), and vaginal delivery (VD) with intact perineum, were compared with a control primiparous group. RESULTS The percentage OASIs at first vaginal delivery after prior FOVD+EmCS was 17.3%(n=9), 12.9%(n=18) after previous ELCS, and 0.6%(n=9) after prior VD maintaining an intact perineum, compared with 6%(n=1193) in the control primiparous group of women. Multivariate regression analysis demonstrated prior FOVD+EmCS and ELCS were associated with a statistically significant increased risk of OASIs of 180% and 110% when compared to control (odds ratio (OR): 2.80; 95% confidence interval (CI): 1.35-5.78 and OR: 2.10; 95%CI: 1.27-3.48) respectively. Prior VD with intact perineum was associated with a statistically significantly reduced risk of OASIs (OR: 0.09; 95%CI: 0.04-0.17). CONCLUSIONS Previous FOVD+EmCS and ELCS were associated with increased risk of OASIs in subsequent vaginal delivery compared to control, whilst previous VD with intact perineum was associated with decreased risk.
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Over the last fifteen years, graduate entry programmes for admission to undergraduate MBBS courses have become increasingly popular in the UK. At St. George’s, University of London, students entering the graduate entry MB BS programme... more
Over the last fifteen years, graduate entry programmes for admission to undergraduate MBBS courses have become increasingly popular in the UK. At St. George’s, University of London, students entering the graduate entry MB BS programme will have a first degree in any discipline whilst some have further degrees. Challenges typically arise when teaching and learning medical statistics. Students do not necessarily expect to study statistics at medical school, whilst confidence and expertise varies depending on the student’s previous degree and how long ago they studied mathematics. The presentation will focus on how teaching of medical statistics when integrated with the basic and clinical sciences, plus learning through group work can help address heterogeneity in students. In particular students are encouraged to be independent, identifying and meeting their own individual learning needs in order to progress.
Objectives: Measure the prevalence and severity of disability, and examine disability risk factors among adults living with HIV in London, United Kingdom (UK). Methods: We conducted a quantitative cross-sectional study. The following... more
Objectives: Measure the prevalence and severity of disability, and examine disability risk factors among adults living with HIV in London, United Kingdom (UK). Methods: We conducted a quantitative cross-sectional study. The following self-reported questionnaires were administered: World Health Organization Disability Assessment Schedule 2.0 (WHODAS), HIV Disability Questionnaire (HDQ), a disability item using the Equality Act disability definition (EADD), and demographic and HIV questionnaire. We calculated the proportion (95% Confidence Interval; CI) of severe and moderate disability as measured using EADD and WHODAS scores ≥2 respectively. We measured disability severity with HDQ domain severity scores. We used demographic and HIV characteristic questionnaire responses to assess potential risk factors of severe (EADD) and moderate (WHODAS scores ≥2) disability using logistic regression analysis, and HDQ severity domain scores using linear regression analysis. Results: Of 201 parti...
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In C. Reading (Ed.), Data and context in statistics education: Towards an evidence-based society. Over the last fifteen years, graduate entry programmes for admission to undergraduate MBBS courses have become increasingly popular in the... more
In C. Reading (Ed.), Data and context in statistics education: Towards an evidence-based society. Over the last fifteen years, graduate entry programmes for admission to undergraduate MBBS courses have become increasingly popular in the UK. At St. George's, University of London, students entering the graduate entry MB BS programme will have a first degree in any discipline whilst some have further degrees. Challenges typically arise when teaching and learning medical statistics. Students do not necessarily expect to study statistics at medical school, whilst confidence and expertise varies depending on the student's previous degree and how long ago they studied mathematics. The presentation will focus on how teaching of medical statistics when integrated with the basic and clinical sciences, plus learning through group work can help address heterogeneity in students. In particular students are encouraged to be independent, identifying and meeting their own individual learnin...
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Researchers investigated the association between genitourinary infections that occur from the month before conception to the end of the first trimester and gastroschisis. A case-control study design was used. The mothers of 505 offspring... more
Researchers investigated the association between genitourinary infections that occur from the month before conception to the end of the first trimester and gastroschisis. A case-control study design was used. The mothers of 505 offspring with gastroschisis were identified as cases and mothers of 4924 healthy liveborn infants as controls. Women self reported urinary tract infections and sexually transmitted infections.1 A genitourinary infection was reported by 81 cases compared with 425 controls. The odds of genitourinary infection was 81/424 for cases and 425/4499 for controls (table⇓). A significant association was reported between self reported genitourinary infections just before conception until early pregnancy and gastroschisis (adjusted odds ratio 1.5, 95% confidence interval 1.1 to 1.9). The odds ratio was adjusted for maternal age, body mass index before conception, smoking, and Hispanic ethnicity. View this table: Self reported genitourinary infections during the month before conception to end of first trimester for mothers of offspring born with gastrochisis (cases) and healthy live born babies …
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Researchers investigated whether antipsychotic drugs were associated with venous thromboembolism. A population based nested case-control study design was used. Data were taken from the UK QResearch primary care database consisting of... more
Researchers investigated whether antipsychotic drugs were associated with venous thromboembolism. A population based nested case-control study design was used. Data were taken from the UK QResearch primary care database consisting of 7 267 673 patients. Cases were adult patients with a first ever record of venous thromboembolism between 1 January 1996 and 1 July 2007. For each case, up to four controls were identified, matched by age, calendar time, sex, and practice. Exposure to antipsychotic drugs was assessed on the basis of prescriptions on, or during the 24 months before, the index date.1 There were 25 532 eligible cases (15 975 with deep vein thrombosis and 9557 with pulmonary embolism) and 89 491 matched controls. The primary outcome was the odds ratios for venous thromboembolism associated with antipsychotic drugs adjusted for comorbidity and concomitant drug exposure. When adjusted using logistic regression to control for potential confounding, prescription of antipsychotic drugs in the previous 24 months was significantly associated with an increased occurrence of venous thromboembolism compared with non-use (odds ratio 1.32, 95% confidence interval 1.23 to 1.42). The researchers concluded that prescription of antipsychotic drugs was associated with venous thromboembolism in a large primary care population. Which of the following statements, if any, are true? Statements a , b , and c are true, …
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Research Interests: Psychology, Medicine, Humans, Sleep Quality, Circadian Rhythm, and 15 moreFemale, Sleep disorders, Male, Drug Addiction, Sleep, Detoxification, Patient Admission, Middle Aged, Methadone, Adult, Elsevier, Psychology and Cognitive Sciences, Total Sleep Time, Medical and Health Sciences, and Substance Withdrawal Syndrome
Background Bulimia nervosa affects women at a peak age of reproductive functioning, but few studies have examined the impact of pregnancy on bulimia. Aim To examine the impact of pregnancy on symptoms of bulimia nervosa and associated... more
Background Bulimia nervosa affects women at a peak age of reproductive functioning, but few studies have examined the impact of pregnancy on bulimia. Aim To examine the impact of pregnancy on symptoms of bulimia nervosa and associated psychopathology. Method Women actively suffering from bulimia nervosa during pregnancy (n=94) were interviewed using the eating disorder examination (12th edn) and structured clinical interview for DSM–III–R, with additional structured questions. Behaviours were recorded at conception, each trimester and postnatally. Relative risks were calculated for prognostic factors. Results Bulimic symptoms improved throughout pregnancy. After delivery, 57% had worse symptoms than pre-pregnancy, but 34% were no longer bulimic. Relapse was predicted by behavioural severity and persistence, previous anorexia nervosa (‘Type II’ bulimia), gestational diabetes and ‘unplanned’ pregnancy. Unplanned pregnancies were the norm, usually resulting from mistaken beliefs about ...
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Researchers used a case-control study to investigate whether passive smoking during childhood was associated with lung cancer in adulthood. Passive smoking in childhood was recorded using self completed questionnaires. Participants were... more
Researchers used a case-control study to investigate whether passive smoking during childhood was associated with lung cancer in adulthood. Passive smoking in childhood was recorded using self completed questionnaires. Participants were recorded as exposed to smoking if anyone smoked regularly where the participant lived as a child. Those individuals with diagnosed lung cancer were more likely to have been exposed to smoking in childhood than those without diagnosed lung cancer (72.8% v 53.4%; P<0.001).1 Which of the following statements, if any, are true?