Efficacy and safety of eslicarbazepine acetate monotherapy in patients converting from carbamazepine.

OBJECTIVE: To evaluate the influence of prior use of carbamazepine (CBZ) and other antiepileptic drugs (AEDs) with a putatively similar mechanism of action (inhibition of voltage-gated sodium channels; VGSCs) on seizure outcomes and tolerability when converting to eslicarbazepine acetate (ESL), using data pooled from 2 controlled conversion-to-ESL monotherapy trials (studies: 093-045, 093-046). METHODS: Adults with treatment-resistant focal (partial-onset) seizures were randomized 2:1 to ESL 1600 or 1200 mg once daily. The primary efficacy endpoint was study exit (meeting predefined exit criteria related to worsening seizure control) versus an historical control group. Other endpoints included change in seizure frequency, responder rate, and tolerability. Endpoints were analyzed for subgroups of patients who received CBZ (or any VGSC inhibitor [VGSCi]) during baseline versus those who received other AEDs. RESULTS: Of 365 patients in the studies, 332 were evaluable for efficacy. The higher risk of study exit in the subgroups that received CBZ (or any VGSCi) during baseline, versus other AEDs, was not statistically significant (hazard ratios were 1.49 for +CBZ vs -CBZ [P = .10] and 1.27 for +VGSCi vs. -VGSCi [P = .33]). Reductions in seizure frequency and responder rates were lower in patients who converted from CBZ or other VGSCi compared with those who converted from other AEDs. There were no notable differences in overall tolerability between subgroups, but the incidence of some adverse events (eg, dizziness, somnolence, nausea) differed between subgroups and/or between treatment periods. SIGNIFICANCE: Baseline use of CBZ or other major putative VGSC inhibitors did not appear to significantly increase the risk of study exit due to worsening seizure control, or to increase the frequency of side effects when converting to ESL monotherapy. However, bigger improvements in efficacy may be possible in patients converting to ESL monotherapy from an AED regimen that does not include a VGSC inhibitor

Beaten into Submissiveness? An Investigation into the Protective Strategies used by Survivors of Domestic Abuse

This is a pre-copyedited, author-produced pdf of an article accepted for publication in Journal of Interpersonal Violence following peer review. Laura Irving & Ben Chi-pun Liu, 'Beaten into Submissiveness? An investigation Into the Protective Strategies Used by Survivors of Domestic Abuse', Journal of Interpersonal Violence, first published online 14 December 2016, available online at doi: 10.1177/0886260516682520 © The Author(s) 2016 Published by SAGEThe aim of the study was to identify the prevalence and perceived helpfulness of a variety of protective strategies that were used by female survivors of domestic abuse and to explore factors that may have influenced strategy usage. Forty participants were recruited from a voluntary sector domestic abuse service, commissioned by an outer London local authority in the UK. The measurement tools used were the Intimate Partner Violence Strategies Index and the CAADA Domestic Abuse, Stalking and ‘Honour’-Based Violence (DASH) Risk Assessment Checklist. The average age was 33 (SD=7.9, range: 20-57), half reported to be of Asian ethnicity, 37.5% White and 12.5% Black or Mixed ethnicity. The average DASH score was 9.8 (SD=13.2, range: 0-18) and an average of 18 (SD=6.7, range: 1-29) protective strategies were utilised by each participant. All of the most commonly used strategies were from the Placating category. Though Safety Planning strategies were rated as the most helpful by all participants, Placating strategies were also rated as helpful by two-thirds of participants. Stepwise multiple regression showed that Placating was the only significant predictor of DASH score (β=0.375, p<0.05) and accounted for 14% of the variance of DASH score. Findings showed that women utilized a diverse range of protective strategies with placating strategies being most intensely used and rated as helpful. However, placating strategy usage could be a risk factor as opposed to a protective factor. This study has also demonstrated that greater placating strategies were used by White than South Asian women, and women who were employed used more formal strategies. This research has extended the knowledge base of protective strategies that professionals can draw from to underpin decisions and interventions when working with domestic abuse survivors.Peer reviewedFinal Accepted Versio

From Navas to Kaltoft: The European Court of Justice’s evolving definition of disability and the implications for HIV-positive individuals

This article will examine the definition of disability developed by the European Court of Justice for the purposes of the Employment Equality Directive and examine whether it is sufficient for the purpose of bringing People Living with HIV/AIDS within its scope. The article will argue that in order to adequately protect People Living with HIV/AIDS within the EU from discrimination, the European Court of Justice needs to ensure that a coherent EU wide definition of disability, based fully upon the social model of disability, is adopted. This is necessary in order to ensure adequate protection not only for People Living with HIV/AIDS but for all individuals with disabilities from discrimination throughout the EU. In addition to this central argument, this paper will argue that the lack of a coherent definition of disability grounded in the social model fragments protection for People Living with HIV/AIDS across the EU leading to a number of possible unintended consequences

Screening patients with Diabetes Mellitus for Tuberculosis in China.

Objective  There is a high burden of both diabetes (DM) and tuberculosis (TB) in China, and as DM increases the risk of TB and adversely affects TB treatment outcomes, there is a need for bidirectional screening of the two diseases. How this is best performed is not well determined. In this pilot project in China, we aimed to assess the feasibility and results of screening DM patients for TB within the routine healthcare setting of five DM clinics. Method  Agreement on how to screen, monitor and record was reached in May 2011 at a national stakeholders meeting, and training was carried out for staff in the five clinics in July 2011. Implementation started in September 2011, and we report on 7 months of activities up to 31 March 2012. DM patients were screened for TB at each clinic attendance using a symptom-based enquiry, and those positive to any symptom were referred for TB investigations. Results  In the three quarters, 72% of 3174 patients, 79% of 7196 patients and 68% of 4972 patients were recorded as having been screened for TB, resulting in 7 patients found who were already known to have TB, 92 with a positive TB symptom screen and 48 of these newly diagnosed with TB as a result of referral and investigation. All patients except one were started on anti-TB treatment. TB case notification rates in screened DM patients were several times higher than those of the general population, were highest for the five sites combined in the final quarter (774/100 000) and were highest in one of the five clinics in the final quarter (804/100 000) where there was intensive in-house training, special assignment of staff for screening and colocation of services. Conclusion  This pilot project shows that it is feasible to carry out screening of DM patients for TB resulting in high detection rates of TB. This has major public health and patient-related implications