Social Deprivation, Inequality, and the Neighborhood-Level Incidence of Psychotic Syndromes in East London

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First cannabis use: does onset shift to younger ages? Findings from 1988 tot 2003 from the Dutch National School Survey on Substance Use

Aims To investigate the hypothesis that changes in cannabis prevalence among Dutch secondary school students (aged 12-17 years) were paralleled by shifts in the age of Krst cannahis use. Design and participants Data were derived from five waves (1988. 1992. 1996.1999 and 2003) of the Dutch National School Survey on Substance Use. a nationally representative cross-sectional study, with a total of i2 777 respondents. Measurements Written questionnaires on cannabis. tobacco, alcohol, other drug use and soclo-dcmographic and behavioural variables were administered in classroom settings. Findings Survival analysis showed a strong increase in cumulative incidences hy age of lirsl cannabis use Troin 1988 to 1992, a further increase in 1996 and stabilization in 1999. continuing into 2003. From 1992 to 1996. age of onset shifted towards younger ages. Onset peaked at age 15 in 1992 and age 14 in 1996, The proportion of life-time cannabis users starting at age 1 3 or younger increased from 26% in 1992 to 41% in 1996. The overall trend was similar for boys and girls. Conclusions The study largely confirmed the expectation that the increase in cannabis use from 1988 to 1996 was paralleled by a decrease in the age of first cannabis use. From 1996 to 2003 age of first cannabis use and prevalence stabilized, possibly occasioned by a change in cannabis policy in the mid-1990s. KEYWORDS Age of onset, cannabis use. secondary school students. trends

Clinician-rated and self-reported psychotic-like experiences in individuals accessing a specialist Youth Mental Health Service

Aim: The prevalence of psychotic-like experiences (PLEs) was explored in a sample of 14- to 25-year-olds with non-psychotic mental health difficulties. Associations between PLEs, psychopathology, functioning, trauma history, and pathways to care were examined. Methods: Data were collected for 202 young people. Clinicians rated PLEs using the Primary Care Checklist (PCC) and functioning using Global Assessment Scales. Eighty-three young people completed self-report assessments of PLEs using the Prodromal Questionnaire (PQ-16) and measures of social anxiety, depression, trauma history, and pathways to care. Results: There was a high prevalence of PLEs in the sample. The prevalence of PLEs was higher when young people self-rated their experiences. Endorsement frequencies for PLEs ranged from 3.5 to 24% on the PCC and 22 to 70% on the PQ-16. Higher scores on the PQ-16 were associated with more pathways into care and greater exposure to traumatic life events. Conclusions: PLEs are common in young people with non-psychotic mental health difficulties and may reflect increased severity and complexity of mental health difficulties. Routine screening and further assessment of PLEs are important in understanding and responding to such experiences. Screening should include self-rating of PLEs as well as clinician-rated scales

Costs and effects of screening and treating low risk women with a singleton pregnancy for asymptomatic bacteriuria, the ASB study

<p>Abstract</p> <p>Background</p> <p>The prevalence of asymptomatic bacteriuria (ASB) in pregnancy is 2-10% and is associated with both maternal and neonatal adverse outcomes as pyelonephritis and preterm delivery. Antibiotic treatment is reported to decrease these adverse outcomes although the existing evidence is of poor quality.</p> <p>Methods/Design</p> <p>We plan a combined screen and treat study in women with a singleton pregnancy. We will screen women between 16 and 22 weeks of gestation for ASB using the urine dipslide technique. The dipslide is considered positive when colony concentration ≥10⁵ colony forming units (CFU)/mL of a single microorganism or two different colonies but one ≥10⁵ CFU/mL is found, or when Group B Streptococcus bacteriuria is found in any colony concentration. Women with a positive dipslide will be randomly allocated to receive nitrofurantoin or placebo 100 mg twice a day for 5 consecutive days (double blind). Primary outcomes of this trial are maternal pyelonephritis and/or preterm delivery before 34 weeks. Secondary outcomes are neonatal and maternal morbidity, neonatal weight, time to delivery, preterm delivery rate before 32 and 37 weeks, days of admission in neonatal intensive care unit, maternal admission days and costs.</p> <p>Discussion</p> <p>This trial will provide evidence for the benefit and cost-effectiveness of dipslide screening for ASB among low risk women at 16–22 weeks of pregnancy and subsequent nitrofurantoin treatment.</p> <p>Trial registration</p> <p>Dutch trial registry: NTR-3068</p

Lower prevalence of protective antibodies for 2015/2016 influenza A(H1)pdm circulating strains comparing to seroprevalence for 2009 influenza A(H1)pdm virus

DDI-INSA em colaboração com a Rede Portuguesa de Laboratórios para o Diagnóstico da GripeBackground: Since 2009, influenza A(H1)pdm09 is circulating in the human population infecting in different ways specific age groups. The study aims to assess the seroprotection for A/California /07/2009 vaccine strain and evaluate the seroprotection for the circulating A(H1)pdm09 strains (clade 6B) in the Portuguese population. Seroepidemiological data can determine the vulnerable populations to disease and support intervention and action regarding vaccination programmes and other preventive measures, particularly in high-risk groups. Methods: To study influenza immunity a non-probabilistic sample was used. Samples were collected from people attending to hospital laboratories (n=13) for other reasons aside from influenza infection. We developed a cross-sectional study based on a convenience sample of 734 sera collected during July 2016, from all age groups (0–4; 5–14; 15–44; 45-64 and ≥65 years old), both genders, covering mainland and Atlantic islands. Sera were randomly selected. All samples were anonymized and recorded data: district residence/sample collection, gender and age. Antibody titers to A(H1)pdm09 virus strains [A/California /07/2009 and A/Lisboa/58/2015 (clade 6B)] were assessed by hemagglutination inhibition (HI) assay. HI titer>40 were considered protective. Seroprevalence estimates, overall and by age group, were calculated with 95% confidence intervals (95% CI). The HA1 subunit of the hemagglutinin gene from A(H1)pdm09 viruses used in HI were sequenced. Results: In July 2016, the prevalence of protective antibodies for influenza A/California/07/2009 was 38% (95% CI: 34–41) and for A/Lisboa /58/2015 was 23% (95% CI: 21–27). Highest seroprevalence was observed in 5-14 age group for both strains, 55% (95% CI: 47–63) for A/California/07/2009 and 42% (95% CI: 35–50) for A/Lisboa/58/2015. The lowest seroprevalences were detected in the 65+ age group for A/California/07/2009 (28%; 95% CI: 22–36) and in the 45-64 for the A/Lisboa /58/2015 (9%; 95% CI: 6-15). Was observed a reduced prevalence of protective antibodies for A/Lisboa /58/2015 for all age groups, although a higher decrease was seen in the adults 45-64 years old (24% drop in seroprevalence). The influenza A/Lisboa/58/2015 presented four amino acid substitutions in antigenic sites: S162N e K163Q (Sa), S185T (Sb) and S203T (Ca1), belonging to 6B.1clade. Conclusions: Although 38% of study population have demonstrated to have seroprotection for A(H1)pdm09 vaccine strain this could not represent seroprotection to the currently circulating A(H1)pdm09 strains. Individuals in the age group of 45-64 years old are more susceptible to infection by currently circulating influenza A(H1)pdm09 viruses. The presence of K163Q (Sa), S185T (Sb) substitutions are likely to be involved in antigenic drift, as previously described, allowing the virus to escape from immune response namely the one that could be induced by the vaccine. In future this event should be closely monitored, although WHO recommended a new A(H1)pdm09 strain to be included in the next season flu vaccine.N/

Age-related susceptibility to insulin resistance arises from a combination of CPT1B decline and lipid overload

Abstract Background The skeletal muscle plays a central role in glucose homeostasis through the uptake of glucose from the extracellular medium in response to insulin. A number of factors are known to disrupt the normal response to insulin leading to the emergence of insulin resistance (IR). Advanced age and a high-fat diet are factors that increase the susceptibility to IR, with lipid accumulation in the skeletal muscle being a key driver of this phenomenon. It is debated, however, whether lipid accumulation arises due to dietary lipid overload or from a decline of mitochondrial function. To gain insights into the interplay of diet and age in the flexibility of muscle lipid and glucose handling, we combined lipidomics, proteomics, mitochondrial function analysis and computational modelling to investigate young and aged mice on a low- or high-fat diet (HFD). Results As expected, aged mice were more susceptible to IR when given a HFD than young mice. The HFD induced intramuscular lipid accumulation specifically in aged mice, including C18:0-containing ceramides and diacylglycerols. This was reflected by the mitochondrial β-oxidation capacity, which was upregulated by the HFD in young, but not in old mice. Conspicuously, most β-oxidation proteins were upregulated by the HFD in both groups, but carnitine palmitoyltransferase 1B (CPT1B) declined in aged animals. Computational modelling traced the flux control mostly to CPT1B, suggesting a CPT1B-driven loss of flexibility to the HFD with age. Finally, in old animals, glycolytic protein levels were reduced and less flexible to the diet. Conclusion We conclude that intramuscular lipid accumulation and decreased insulin sensitivity are not due to age-related mitochondrial dysfunction or nutritional overload alone, but rather to their combined effects. Moreover, we identify CPT1B as a potential target to counteract age-dependent intramuscular lipid accumulation and thereby IR

The assessment of the prognosis of musculoskeletal conditions in older adults presenting to general practice: a research protocol

BACKGROUND: Musculoskeletal conditions represent a common reason for consulting general practice yet with the exception of low back pain, relatively little is known about the prognosis of these disorders. Recent evidence suggests that common 'generic' factors may be of value when assessing prognosis, irrespective of the location of the pain. This study will test a generic assessment tool used as part of the general practice consultation to determine prognosis of musculoskeletal complaints. METHODS/DESIGN: Older adults (aged 50 years and over) presenting to six general practices with musculoskeletal complaints will be assessed as part of the routine consultation using a generic assessment of prognosis. Participants will receive a self-completion questionnaire at baseline, three, six and 12 months post consultation to gather further data on pain, disability and psychological status. The primary outcome measure is participant's global rating of change. DISCUSSION: Prognosis is considered to be a fundamental component of scientific medicine yet prognostic research in primary care settings is currently neglected and prognostic enquiry is disappearing from general medical textbooks. This study aims to address this issue by examining the use of generic prognostic factors in a general practice setting

Adoption of new health products in low and middle income settings: how product development partnerships can support country decision making

When a new health product becomes available, countries have a choice to adopt the product into their national health systems or to pursue an alternate strategy to address the public health problem. Here, we describe the role for product development partnerships (PDPs) in supporting this decision-making process. PDPs are focused on developing new products to respond to health problems prevalent in low and middle income settings. The impact of these products within public sector health systems can only be realized after a country policy process. PDPs may be the organizations most familiar with the evidence which assists decision making, and this generally translates into involvement in international policy development, but PDPs have limited reach into endemic countries. In a few individual countries, there may be more extensive involvement in tracking adoption activities and generating local evidence. This local PDP involvement begins with geographical prioritization based on disease burden, relationships established during clinical trials, PDP in-country resources, and other factors. Strategies adopted by PDPs to establish a presence in endemic countries vary from the opening of country offices to engagement of part-time consultants or with long-term or ad hoc committees. Once a PDP commits to support country decision making, the approaches vary, but include country consultations, regional meetings, formation of regional, product-specific committees, support of in-country advocates, development of decision-making frameworks, provision of technical assistance to aid therapeutic or diagnostic guideline revision, and conduct of stakeholder and Phase 4 studies. To reach large numbers of countries, the formation of partnerships, particularly with WHO, are essential. At this early stage, impact data are limited. But available evidence suggests PDPs can and do play an important catalytic role in their support of country decision making in a number of target countries

Developing a decision aid to guide public sector health policy decisions: A study protocol

<p>Abstract</p> <p>Background</p> <p>Decision aids have been developed in a number of health disciplines to support evidence-informed decision making, including patient decision aids and clinical practice guidelines. However, policy contexts differ from clinical contexts in terms of complexity and uncertainty, requiring different approaches for identifying, interpreting, and applying many different types of evidence to support decisions. With few studies in the literature offering decision guidance specifically to health policymakers, the present study aims to facilitate the structured and systematic incorporation of research evidence and, where there is currently very little guidance, values and other non-research-based evidence, into the policy making process. The resulting decision aid is intended to help public sector health policy decision makers who are tasked with making evidence-informed decisions on behalf of populations. The intent is not to develop a decision aid that will yield uniform recommendations across jurisdictions, but rather to facilitate more transparent policy decisions that reflect a balanced consideration of all relevant factors.</p> <p>Methods/design</p> <p>The study comprises three phases: a modified meta-narrative review, the use of focus groups, and the application of a Delphi method. The modified meta-narrative review will inform the initial development of the decision aid by identifying as many policy decision factors as possible and other features of methodological guidance deemed to be desirable in the literatures of all relevant disciplines. The first of two focus groups will then seek to marry these findings with focus group members' own experience and expertise in public sector population-based health policy making and screening decisions. The second focus group will examine issues surrounding the application of the decision aid and act as a sounding board for initial feedback and refinement of the draft decision aid. Finally, the Delphi method will be used to further inform and refine the decision aid with a larger audience of potential end-users.</p> <p>Discussion</p> <p>The product of this research will be a working version of a decision aid to support policy makers in population-based health policy decisions. The decision aid will address the need for more structured and systematic ways of incorporating various evidentiary sources where applicable.</p

An assessment of the levels of phthalate esters and metals in the Muledane open dump, Thohoyandou, Limpopo Province, South Africa

<p>Abstract</p> <p>Background</p> <p>This work reports the determination of the levels of phthalate esters (dimethyl phthalate (DMP), diethyl phthalate (DEP), dibutyl phthalate (DBP), diethyl hexyl phthalate (DEHP)) and metals (lead, cadmium, manganese, zinc, iron, calcium) in composite soil samples. The soil samples were collected randomly within the Muledane open dump, Thohoyandou, Limpopo province, South Africa. Control samples were collected about 200 m away from the open dump. The phthalate esters were separated and determined by capillary gas chromatography with a flame ionization detector, whilst the metals were determined by atomic absorption spectrophotometry.</p> <p>Results</p> <p>Open dump values for the phthalate esters and metals to be generally higher in comparison to control samples for DMP, DEP, DBP and DEHP – the mean values calculated were 0.31 ± 0.12, 0.21 ± 0.05, 0.30 ± 0.07, and 0.03 ± 0.01 mg/kg, respectively, for the open dump soil samples. Nonetheless, the mean open dump values for lead, cadmium, manganese, zinc, iron and calcium were 0.07 ± 0.04, 0.003 ± 0.001, 5.02 ± 1.92, 0.31 ± 0.02, 11.62 ± 9.48 and 0.12 ± 0.13 mg/kg, respectively. The results were compared statistically.</p> <p>Conclusion</p> <p>Our results revealed that the discarding of wastes into the open dump is a potential source of soil contamination in the immediate vicinity and beyond, <it>via </it>dispersal. Increased levels of phthalate esters and metals in the soil pose a risk to public health, plants and animals. Sustained monitoring of these contaminants is recommended, in addition to upgrading the facility to a landfill.</p