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Batura N, Kasteng F, Condoane J, Bagorogosa B, Castel-Branco AC, Kertho E, Källander K, Soremekun S, Lingam R, Vassall A, Tibenderana J, Meek S, Hill Z, Strachan D, Ayebale G, Nakirunda M, Counihan H, Ndima S, Muiambo A, Salomao N, Kirkwood B. Costs of treating childhood malaria, diarrhoea and pneumonia in rural Mozambique and Uganda. Malar J 2022; 21:239. [PMID: 35987625 PMCID: PMC9392282 DOI: 10.1186/s12936-022-04254-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 08/02/2022] [Indexed: 11/26/2022] Open
Abstract
Background Globally, nearly half of all deaths among children under the age of 5 years can be attributed to malaria, diarrhoea, and pneumonia. A significant proportion of these deaths occur in sub-Saharan Africa. Despite several programmes implemented in sub-Saharan Africa, the burden of these illnesses remains persistently high. To mobilise resources for such programmes it is necessary to evaluate their costs, costs-effectiveness, and affordability. This study aimed to estimate the provider costs of treating malaria, diarrhoea, and pneumonia among children under the age of 5 years in routine settings at the health facility level in rural Uganda and Mozambique. Methods Service and cost data was collected from health facilities in midwestern Uganda and Inhambane province, Mozambique from private and public health facilities. Financial and economic costs of providing care for childhood illnesses were investigated from the provider perspective by combining a top-down and bottom-up approach to estimate unit costs and annual total costs for different types of visits for these illnesses. All costs were collected in Ugandan shillings and Mozambican meticais. Costs are presented in 2021 US dollars. Results In Uganda, the highest number of outpatient visits were for children with uncomplicated malaria and of inpatient admissions were for respiratory infections, including pneumonia. The highest unit cost for outpatient visits was for pneumonia (and other respiratory infections) and ranged from $0.5 to 2.3, while the highest unit cost for inpatient admissions was for malaria ($19.6). In Mozambique, the highest numbers of outpatient and inpatient admissions visits were for malaria. The highest unit costs were for malaria too, ranging from $2.5 to 4.2 for outpatient visits and $3.8 for inpatient admissions. The greatest contributors to costs in both countries were drugs and diagnostics, followed by staff. Conclusions The findings highlighted the intensive resource use in the treatment of malaria and pneumonia for outpatient and inpatient cases, particularly at higher level health facilities. Timely treatment to prevent severe complications associated with these illnesses can also avoid high costs to health providers, and households. Trial registration: ClinicalTrials.gov, identifier: NCT01972321. Supplementary Information The online version contains supplementary material available at 10.1186/s12936-022-04254-y.
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McCall PJ, Willder JM, Stanley BL, Messow C, Allan J, Gemmell L, Puxty A, Strachan D, Berry C, Shelley B. Right ventricular dysfunction in patients with COVID-19 pneumonitis whose lungs are mechanically ventilated: a multicentre prospective cohort study. Anaesthesia 2022; 77:772-784. [PMID: 35607911 PMCID: PMC9322018 DOI: 10.1111/anae.15745] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 03/29/2022] [Accepted: 04/06/2022] [Indexed: 12/15/2022]
Abstract
Cardiovascular complications due to COVID-19, such as right ventricular dysfunction, are common. The combination of acute respiratory distress syndrome, invasive mechanical ventilation, thromboembolic disease and direct myocardial injury creates conditions where right ventricular dysfunction is likely to occur. We undertook a prospective, multicentre cohort study in 10 Scottish intensive care units of patients with COVID-19 pneumonitis whose lungs were mechanically ventilated. Right ventricular dysfunction was defined as the presence of severe right ventricular dilation and interventricular septal flattening. To explore the role of myocardial injury, high-sensitivity troponin and N-terminal pro B-type natriuretic peptide plasma levels were measured in all patients. We recruited 121 patients and 118 (98%) underwent imaging. It was possible to determine the primary outcome in 112 (91%). Severe right ventricular dilation was present in 31 (28%), with interventricular septal flattening present in nine (8%). Right ventricular dysfunction (the combination of these two parameters) was present in seven (6%, 95%CI 3-13%). Thirty-day mortality was 86% in those with right ventricular dysfunction as compared with 45% in those without (p = 0.051). Patients with right ventricular dysfunction were more likely to have: pulmonary thromboembolism (p < 0.001); higher plateau airway pressure (p = 0.048); lower dynamic compliance (p = 0.031); higher plasma N-terminal pro B-type natriuretic peptide levels (p = 0.006); and raised plasma troponin levels (p = 0.048). Our results demonstrate a prevalence of right ventricular dysfunction of 6%, which was associated with increased mortality (86%). Associations were also observed between right ventricular dysfunction and aetiological domains of: acute respiratory distress syndrome; ventilation; thromboembolic disease; and direct myocardial injury, implying a complex multifactorial pathophysiology.
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Affiliation(s)
- P. J. McCall
- The Anaesthesia, Critical Care and Peri‐operative Medicine Research GroupUniversity of GlasgowUK
- Department of AnaesthesiaGolden Jubilee National HospitalClydebankUK
| | - J. M. Willder
- West of Scotland School of AnaesthesiaNHS Education for ScotlandGlasgowUK
| | - B. L. Stanley
- Robertson Centre for BiostatisticsUniversity of GlasgowUK
| | - C‐M. Messow
- Robertson Centre for BiostatisticsUniversity of GlasgowUK
| | - J. Allan
- Department of Intensive Care MedicineUniversity Hospital CrosshouseKilmarnockUK
| | - L. Gemmell
- Department of Intensive Care MedicineRoyal Alexandra HospitalPaisleyUK
| | - A. Puxty
- Department of Intensive Care MedicineGlasgow Royal InfirmaryGlasgowUK
| | - D. Strachan
- Department of Intensive Care MedicineUniversity Hospital WishawUK
| | - C. Berry
- Department of Cardiology and ImagingInstitute of Cardiovascular and Medical Sciences, University of GlasgowUK
| | - B.G. Shelley
- Department of AnaesthesiaGolden Jubilee National HospitalClydebankUK
- The Anaesthesia, Critical Care and Peri‐operative Medicine Research GroupUniversity of GlasgowUK
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Eldridge S, Barawi A, Wang H, Roelofs A, Kaneva M, Guan Z, Lydon H, Thomas B, Thorup AS, Fernandez BF, Caxaria S, Strachan D, Ali A, Shanmuganathan K, Pitzalis C, Whiteford J, Henson F, Mccaskie A, De Bari C, Dell’accio F. AB0039 AGRIN REPAIRS BONE AND CARTILAGE IN VIVO. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.2584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Cartilage defects in the joints are reported in 61% of all arthroscopies1&2. The size of the cartilage repair market is estimated to be $2.195 million by 20253. Cartilage defects can evolve into osteoarthritis, in which abnormal load results in cartilage breakdown, joint pain and reduced mobility. Osteoarthritis is the leading cause of permanent disability and absenteeism and affects up to 1/3 of the people over 60yrs. In western countries osteoarthritis costs 1.5-2% of the GDP4. Joint replacement with a prosthesis restores some degree of independence but in up to 20% of patients it does not meet expectations 5 and has a limited life span. There is no pharmacological intervention that arrests or reverts the course of osteoarthritis, despite the desperate need.We previously published that agrin plays an important role in cartilage homeostasis6. The addition of agrin to chondrocytes in vivo resulted in enhanced cartilage formation, suggesting a potential role for agrin in cartilage repair.Objectives:Investigate the potential of agrin for use in cartilage repair.Methods:Critical size osteochondral defects were generated in mice and sheep and injected intraarticularly with type I collagen gel containing agrin or vehicle. Animals were monitored for 8 weeks or 6 months respectively. MicroCT, histological analysis, qPCR, linage tracking, reporter assays, chondrogenesis assay, immunohistochemistry were performed.Results:A single intraarticular administration of agrin induced regeneration of critical-size osteochondral defects in mice, restoring the tissue architecture and bone-cartilage interface. Agrin stem cells to the site of injury and, through simultaneous activation of CREB and suppression of canonical WNT signalling, induced GDF5 expression and differentiation into stable articular chondrocytes, forming stable articular cartilage. In sheep, agrin treatment resulted in regeneration of bone and cartilage, which promoted increased ambulatory activity.Conclusion:Agrin orchestrates repair morphogenesis at the joint surface by modulating multiple signalling pathways, supporting the therapeutic use of agrin for joint surface regeneration.References:[1]Curl, W. W. et al. Cartilage injuries: a review of 31,516 knee arthroscopies. Arthrosc. J. Arthrosc. Relat. Surg. Off. Publ. Arthrosc. Assoc. N. Am. Int. Arthrosc. Assoc. 13, 456–460 (1997).[2]Hjelle, K., Solheim, E., Strand, T., Muri, R. & Brittberg, M. Articular cartilage defects in 1,000 knee arthroscopies. Arthrosc. J. Arthrosc. Relat. Surg. Off. Publ. Arthrosc. Assoc. N. Am. Int. Arthrosc. Assoc. 18, 730–734 (2002).[3]Cartilage Repair Market Size, Share, Industry Analysis 2018-2025 | AMR. Allied Market Research https://www.alliedmarketresearch.com/cartilage-repair-market.[4]Hiligsmann, M. et al. Health economics in the field of osteoarthritis: an expert’s consensus paper from the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO). Semin. Arthritis Rheum. 43, 303–313 (2013).[5]Dieppe, P., Lim, K. & Lohmander, S. Who should have knee joint replacement surgery for osteoarthritis? Int. J. Rheum. Dis. 14, 175–180 (2011).[6]Eldridge, S., et al. Agrin mediates chondrocyte homeostasis and requires both LRP4 and α-dystroglycan to enhance cartilage formation in vitro and in vivo. Annals of the rheumatic diseases 75 (6), 1228-1235 (2016).Acknowledgements:We thank the technical staff in the ARM Lab and Staff at the University of Aberdeen’s Animal Facility and Microscopy and Histology Facility for support. Funding: We gratefully acknowledge funding support of this work by the MRC (MR/L022893/1, MR/N010973/1,and MR/P026362/1), Versus Arthritis (19667, 21515, 20886, and 21621), Rosetrees Trust (A1205), the Medical College of St Bartholomew’s Hospital Trust, and the William Harvey Research Foundation.Disclosure of Interests:Suzanne Eldridge: None declared, Aida Barawi: None declared, Hui Wang: None declared, Anke Roelofs: None declared, Magdalena Kaneva: None declared, Zeyu Guan: None declared, Helen Lydon: None declared, Bethan Thomas: None declared, Anne-Sophie Thorup: None declared, Beatriz F Fernandez: None declared, Sara Caxaria: None declared, Danielle Strachan: None declared, Ahmed Ali: None declared, Kanatheepan Shanmuganathan: None declared, Costantino Pitzalis: None declared, James Whiteford: None declared, Fran Henson: None declared, Andrew McCaskie: None declared, Cosimo De Bari: None declared, Francesco Dell’Accio Consultant of: F.D. has received consultancy fees from Samumed and UCB.
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Thorup AS, Strachan D, Caxaria S, Poulet B, Thomas B, Eldridge S, Nalesso G, Whiteford J, Pitzalis C, Aigner T, Corder R, Bertrand J, Dell’accio F. OP0200 BLOCKING ROR2 IMPROVES CARTILAGE INTEGRITY AND PROVIDES PAIN RELIEF IN OSTEOARTHRITIS. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.2358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Osteoarthritis (OA) is the leading cause of chronic disability worldwide, affecting 12% of the population, and yet we still do not have a disease-modifying treatment. Cartilage breakdown is the hallmark of OA, and patients suffer from pain and loss of joint function/independence, severely affecting quality of life. Therefore, there is a huge unmet clinical need.Receptor tyrosine kinase–like orphan receptor 2 (ROR2) is a non-canonical WNT receptor that regulates the planar cell polarity pathway, controlling limb outgrowth during development. During skeletal development, chondrocytes require ROR2 to undergo hypertrophy throughout the process of endochondral bone formation1. Loss of function mutations in humans causes Recessive Robinow Syndrome, leading to limb shortening and brachydactyly2,3.Although absent from healthy adult articular cartilage, our initial studies identified high expression levels of ROR2 in chondrocytes from patients with OA, suggesting a role in the disease processObjectives:To test the potential of ROR2 blockade as a disease-modifying treatment for OA.Methods:Human cartilage organoid model in nude mice, menisco-ligament injury (MLI) model of OA in mice, behavioural studies, in vitro studies in cells.Results:ROR2/WNT5A signaling was increased in osteoarthritic cartilage. Blocking ROR2 was sufficient to induce articular chondrogenesis and suppress expression of aggrecanases in a mesenchymal stem cell line, and to support cartilage formation in a human cartilage organoid model in nude mice using primary chondrocytes from patients with OA.In the MLI model of OA, blocking ROR2 in therapeutic regime using atelocollagen-conjugated siRNA resulted in reduced cartilage destruction and in rapid and sustained pain relief. Due to the limited expression pattern of ROR2 in adulthood, no systemic or local toxicity were expected, nor were any observed4.With the current technology, ROR2 blockade requires intra-articular (IA) injections of siRNA conjugated to atelocollagen every 5 days. Preliminary efficacy data of potentially longer-acting ROR2 blockers are promising.The mechanism of action of ROR2 blockade was independent of modulation of canonical WNT signaling.ROR2/WNT5A promoted nuclear localization of YAP, which required both Rho and G-proteins. YAP signaling downstream of ROR2 also required Rho, but not G-proteins. YAP and TEAD inhibition was required, but not sufficient, for the chondrogenic effect of blocking ROR2. Therefore, additional, yet unknown mechanisms must be involved downstream of ROR2.Conclusion:ROR2 blockade has potential as a disease-modifying treatment for OA, resulting in cartilage protection and rapid and sustained pain relief in a murine model. This will be crucial for clinical success of any treatment for OA and promote patient compliance.Our current siRNA-atelocollagen based technology requires IA injections too frequently to be acceptable for patients. We are developing ROR2 blockade which can be administered systemically or IA not more often than every 3 months - work funded by FOREUM.References:[1]DeChiara, T. M. et al. Ror2, encoding a receptor-like tyrosine kinase, is required for cartilage and growth plate development. Nat. Genet.24, 271–4 (2000).[2]Bokhoven, H. Van, Celli, J. & Kayserili, H. Mutation of the gene encoding the ROR2 tyrosine kinase causes autosomal recessive Robinow syndrome. Nature25, 423–426 (2000).[3]Afzal, A., Rajab, A., Fenske, C. & Oldridge, M. Recessive Robinow syndrome, allelic to dominant brachydactyly type B, is caused by mutation of ROR2. Nature25, 419–422 (2000).[4]Thorup, A.-S. et al. ROR2 blockade as a therapy for osteoarthritis. Sci. Transl. Med.12, eaax3063 (2020).Acknowledgements:We gratefully acknowledge funding support of this work by the Medical College of St Bartholomew’s Hospital Trust, the William Harvey Research Foundation, FOREUM foundation for research in rheumatology (1016807), the MRC (MR/L022893/1, MR/N010973/1, MR/P026362/1, MR/K013076/1), Versus Arthritis (21515, 20886, 21621, 20859), and the DFG Emmy-Noether program (BE4328/5-1).Disclosure of Interests:Anne-Sophie Thorup: None declared, Danielle Strachan: None declared, Sara Caxaria: None declared, Blandine Poulet: None declared, Bethan Thomas: None declared, Suzanne Eldridge: None declared, Giovanna Nalesso: None declared, James Whiteford: None declared, Costantino Pitzalis: None declared, Thomas Aigner: None declared, Roger Corder: None declared, Jessica Bertrand: None declared, Francesco Dell’Accio Consultant of: Samumed and UCB
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Gram L, Skordis-Worrall J, Manandhar DS, Strachan D, Morrison J, Saville N, Osrin D, Tumbahangphe KM, Costello A, Heys M. The long-term impact of community mobilisation through participatory women's groups on women's agency in the household: A follow-up study to the Makwanpur trial. PLoS One 2018; 13:e0197426. [PMID: 29758071 PMCID: PMC5951552 DOI: 10.1371/journal.pone.0197426] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Accepted: 05/02/2018] [Indexed: 11/19/2022] Open
Abstract
Women's groups practicing participatory learning and action (PLA) in rural areas have been shown to improve maternal and newborn survival in low-income countries, but the pathways from intervention to impact remain unclear. We assessed the long-term impact of a PLA intervention in rural Nepal on women's agency in the household. In 2014, we conducted a follow-up study to a cluster randomised controlled trial on the impact of PLA women's groups from 2001-2003. Agency was measured using the Relative Autonomy Index (RAI) and its subdomains. Multi-level regression analyses were performed adjusting for baseline socio-demographic characteristics. We additionally adjusted for potential exposure to subsequent PLA groups based on women's pregnancy status and conduct of PLA groups in areas of residence. Sensitivity analyses were performed using two alternative measures of agency. We analysed outcomes for 4030 mothers (66% of the cohort) who survived and were recruited to follow-up at mean age 39.6 years. Across a wide range of model specifications, we found no association between exposure to the original PLA intervention with women's agency in the household approximately 11.5 years later. Subsequent exposure to PLA groups was not associated with greater agency in the household at follow-up, but some specifications found evidence for reduced agency. Household agency may be a prerequisite for actualising the benefits of PLA groups rather than a consequence.
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Affiliation(s)
- Lu Gram
- Institute for Global Health, University College London, London, United Kingdom
- * E-mail:
| | | | | | - Daniel Strachan
- Institute for Global Health, University College London, London, United Kingdom
| | - Joanna Morrison
- Institute for Global Health, University College London, London, United Kingdom
| | - Naomi Saville
- Institute for Global Health, University College London, London, United Kingdom
| | - David Osrin
- Institute for Global Health, University College London, London, United Kingdom
| | | | - Anthony Costello
- Institute for Global Health, University College London, London, United Kingdom
- Department of Maternal, Newborn, Child and Adolescent Health (MCA), World Health Organization, Geneva, Switzerland
| | - Michelle Heys
- Institute for Global Health, University College London, London, United Kingdom
- Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
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Mrschtik M, O'Prey J, Lao LY, Long JS, Beaumatin F, Strachan D, O'Prey M, Skommer J, Ryan KM. DRAM-3 modulates autophagy and promotes cell survival in the absence of glucose. Cell Death Differ 2017; 24:1470. [PMID: 28665403 PMCID: PMC5520458 DOI: 10.1038/cdd.2017.57] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
This corrects the article DOI: 10.1038/cdd.2015.26.
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Correia-Gomes C, Eze JI, Borobia-Belsué J, Tucker AW, Sparrow D, Strachan D, Gunn GJ. Voluntary monitoring systems for pig health and welfare in the UK: Comparative analysis of prevalence and temporal patterns of selected non-respiratory post mortem conditions. Prev Vet Med 2017; 146:1-9. [PMID: 28992912 DOI: 10.1016/j.prevetmed.2017.07.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Revised: 06/12/2017] [Accepted: 07/02/2017] [Indexed: 12/01/2022]
Abstract
Collection of abattoir data related to public health is common worldwide. Standardised on-going programmes that collect information from abattoirs that inform producers about the presence and frequency of disease that are important to them rather than public health hazards are less common. The three voluntary pig health schemes, implemented in the United Kingdom, are integrated systems which capture information on different macroscopic disease conditions detected in slaughtered pigs. Many of these conditions have been associated with a reduction in performance traits and consequent increases in production costs. The schemes are the Wholesome Pigs Scotland in Scotland, the British Pig Health Scheme in England and Wales and the Pig Regen Ltd. health and welfare checks in Northern Ireland. In this study, four post mortem conditions (pericarditis, milk spots, papular dermatitis and tail damage) were surveyed and analysed over a ten and half year period, with the aim to compare the prevalence, monthly variations, and yearly trends between schemes. Liver milk spot was the most frequently recorded condition while tail damage was the least frequently observed condition. The prevalence of papular dermatitis was relatively low compared to liver milk spot and pericarditis in the three schemes. A general decreasing trend was observed for milk spots and papular dermatitis for all three schemes. The prevalence of pericarditis increased in Northern Ireland and England and Wales; while Scotland in recent years showed a decreasing trend. An increasing trend of tail damage was depicted in Scotland and Northern Ireland until 2013/2014 followed by a decline in recent years compared to that of England and Wales with a decreasing trend over the full study period. Monthly effects were more evident for milk spots and papular dermatitis. Similarity of the modus operandi of the schemes made the comparison of temporal variations and patterns in gross pathology between countries possible over time, especially between countries with similar pig production profile. This study of temporal patterns enables early detection of prevalence increases and alerts industry and researchers to investigate the reasons behind such changes. These schemes are, therefore, valuable assets for endemic disease surveillance, early warning for emerging disease and also for monitoring of welfare outcomes.
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Affiliation(s)
- C Correia-Gomes
- Scotland's Rural College, Kings Building, West Mains Road, Edinburgh, EH9 3JG, United Kingdom.
| | - J I Eze
- Scotland's Rural College, Kings Building, West Mains Road, Edinburgh, EH9 3JG, United Kingdom; Biomathematics and Statistics Scotland (BioSS), JCMB, Edinburgh, EH9 3FD, United Kingdom
| | - J Borobia-Belsué
- MossVet, 34 Seagoe Industrial Estate, Portadown, Craigavon, County Armagh, BT35 8UJ, Northern Ireland, United Kingdom
| | - A W Tucker
- Department of Veterinary Medicine, University of Cambridge, Madingley Road, Cambridge, CB3 0ES, United Kingdom
| | - D Sparrow
- MossVet, 34 Seagoe Industrial Estate, Portadown, Craigavon, County Armagh, BT35 8UJ, Northern Ireland, United Kingdom.
| | - D Strachan
- Boehringer Ingelheim Vetmedica, Ellesfield Avenue, Bracknell, RG12 8YS, United Kingdom
| | - G J Gunn
- Scotland's Rural College, Kings Building, West Mains Road, Edinburgh, EH9 3JG, United Kingdom
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Snell N, Strachan D, Hubbard R, Gibson J, Gruffydd-Jones K, Jarrold I. S32 Epidemiology of chronic obstructive pulmonary disease (COPD) in the uk: findings from the british lung foundation’s ‘respiratory health of the nation’ project. Thorax 2016. [DOI: 10.1136/thoraxjnl-2016-209333.38] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Snell N, Strachan D, Hubbard R, Gibson J, Maher T, Jarrold I. P272 Epidemiology of idiopathic pulmonary fibrosis in the uk: findings from the british lung foundation’s ‘respiratory health of the nation’ project. Thorax 2016. [DOI: 10.1136/thoraxjnl-2016-209333.415] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Gupta RP, Strachan D. P03 Spirometry and survival in large UK population samples of lifelong non-smokers. Br J Soc Med 2016. [DOI: 10.1136/jech-2016-208064.102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Mukherjee M, Stoddart A, Gupta R, Nwaru B, Heaven M, Farr A, Fitzsimmons D, Bandyopadhyay A, Aftab C, Simpson C, Lyons R, Fischbacher C, Dibben C, Shields M, Phillips C, Strachan D, Davies G, McKinstry B, Sheikh A. P218 The epidemiological, healthcare and societal burden and costs of asthma in the UK and member nations: analyses of national databases. Thorax 2015. [DOI: 10.1136/thoraxjnl-2015-207770.354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Mrschtik M, O'Prey J, Lao LY, Long JS, Beaumatin F, Strachan D, O'Prey M, Skommer J, Ryan KM. DRAM-3 modulates autophagy and promotes cell survival in the absence of glucose. Cell Death Differ 2015; 22:1714-26. [PMID: 25929859 PMCID: PMC4563785 DOI: 10.1038/cdd.2015.26] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Revised: 02/15/2015] [Accepted: 02/16/2015] [Indexed: 12/27/2022] Open
Abstract
Macroautophagy is a membrane-trafficking process that delivers cytoplasmic constituents to lysosomes for degradation. The process operates under basal conditions as a mechanism to turnover damaged or misfolded proteins and organelles. As a result, it has a major role in preserving cellular integrity and viability. In addition to this basal function, macroautophagy can also be modulated in response to various forms of cellular stress, and the rate and cargoes of macroautophagy can be tailored to facilitate appropriate cellular responses in particular situations. The macroautophagy machinery is regulated by a group of evolutionarily conserved autophagy-related (ATG) proteins and by several other autophagy regulators, which either have tissue-restricted expression or operate in specific contexts. We report here the characterization of a novel autophagy regulator that we have termed DRAM-3 due to its significant homology to damage-regulated autophagy modulator (DRAM-1). DRAM-3 is expressed in a broad spectrum of normal tissues and tumor cells, but different from DRAM-1, DRAM-3 is not induced by p53 or DNA-damaging agents. Immunofluorescence studies revealed that DRAM-3 localizes to lysosomes/autolysosomes, endosomes and the plasma membrane, but not the endoplasmic reticulum, phagophores, autophagosomes or Golgi, indicating significant overlap with DRAM-1 localization and with organelles associated with macroautophagy. In this regard, we further proceed to show that DRAM-3 expression causes accumulation of autophagosomes under basal conditions and enhances autophagic flux. Reciprocally, CRISPR/Cas9-mediated disruption of DRAM-3 impairs autophagic flux confirming that DRAM-3 is a modulator of macroautophagy. As macroautophagy can be cytoprotective under starvation conditions, we also tested whether DRAM-3 could promote survival on nutrient deprivation. This revealed that DRAM-3 can repress cell death and promote long-term clonogenic survival of cells grown in the absence of glucose. Interestingly, however, this effect is macroautophagy-independent. In summary, these findings constitute the primary characterization of DRAM-3 as a modulator of both macroautophagy and cell survival under starvation conditions.
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Affiliation(s)
- M Mrschtik
- Tumour Cell Death Laboratory, Cancer Research UK Beatson Institute, Garscube Estate, Switchback Rd, Glasgow G61 1BD, UK
| | - J O'Prey
- Tumour Cell Death Laboratory, Cancer Research UK Beatson Institute, Garscube Estate, Switchback Rd, Glasgow G61 1BD, UK
| | - L Y Lao
- Tumour Cell Death Laboratory, Cancer Research UK Beatson Institute, Garscube Estate, Switchback Rd, Glasgow G61 1BD, UK
| | - J S Long
- Tumour Cell Death Laboratory, Cancer Research UK Beatson Institute, Garscube Estate, Switchback Rd, Glasgow G61 1BD, UK
| | - F Beaumatin
- Tumour Cell Death Laboratory, Cancer Research UK Beatson Institute, Garscube Estate, Switchback Rd, Glasgow G61 1BD, UK
| | - D Strachan
- Tumour Cell Death Laboratory, Cancer Research UK Beatson Institute, Garscube Estate, Switchback Rd, Glasgow G61 1BD, UK
| | - M O'Prey
- Tumour Cell Death Laboratory, Cancer Research UK Beatson Institute, Garscube Estate, Switchback Rd, Glasgow G61 1BD, UK
| | - J Skommer
- Tumour Cell Death Laboratory, Cancer Research UK Beatson Institute, Garscube Estate, Switchback Rd, Glasgow G61 1BD, UK
| | - K M Ryan
- Tumour Cell Death Laboratory, Cancer Research UK Beatson Institute, Garscube Estate, Switchback Rd, Glasgow G61 1BD, UK
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Källander K, Strachan D, Soremekun S, Hill Z, Lingam R, Tibenderana J, Kasteng F, Vassall A, Meek S, Kirkwood B. Evaluating the effect of innovative motivation and supervision approaches on community health worker performance and retention in Uganda and Mozambique: study protocol for a randomised controlled trial. Trials 2015; 16:157. [PMID: 25873093 PMCID: PMC4432981 DOI: 10.1186/s13063-015-0657-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Accepted: 03/17/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND If trained, equipped and utilised, community health workers (CHWs) delivering integrated community case management for sick children can potentially reduce child deaths by 60%. However, it is essential to maintain CHW motivation and performance. The inSCALE project aims to evaluate, using a cluster randomised controlled trial, the effect of interventions to increase CHW supervision and performance on the coverage of appropriate treatment for children with diarrhoea, pneumonia and malaria. METHODS/DESIGN Participatory methods were used to identify best practices and innovative solutions. Quantitative community based baseline surveys were conducted to allow restricted randomisation of clusters into intervention and control arms. Individual informed consent was obtained from all respondents. Following formative research and stakeholder consultations, two intervention packages were developed in Uganda and one in Mozambique. In Uganda, approximately 3,500 CHWs in 39 clusters were randomised into a mobile health (mHealth) arm, a participatory community engagement arm and a control arm. In Mozambique, 275 CHWs in 12 clusters were randomised into a mHealth arm and a control arm. The mHealth interventions encompass three components: 1) free phone communication between users; 2) data submission using phones with automated feedback, messages to supervisors for targeted supervision, and online data access for district statisticians; and 3) motivational messages. The community engagement arm in Uganda established village health clubs seeking to 1) improve the status and standing of CHWs, 2) increase demand for health services and 3) communicate that CHWs' work is important. Process evaluation was conducted after 10 months and end-line surveys will establish impact after 12 months in Uganda and 18 months in Mozambique. Main outcomes include proportion of sick children appropriately treated, CHW performance and motivation, and cost effectiveness of interventions. DISCUSSION Study strengths include a user-centred design to the innovations, while weaknesses include the lack of a robust measurement of coverage of appropriate treatment. Evidence of cost-effective innovations that increase motivation and performance of CHWs can potentially increase sustainable coverage of iCCM at scale. TRIAL REGISTRATION (identifier NCT01972321 ) on 22 April 22 2013.
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Affiliation(s)
- Karin Källander
- Malaria Consortium, Development House, 56-64 Leonard Street, London, EC2A 4LT, UK. .,Department of Public Health Sciences, Tomtebodavägen 18A, Karolinska Institutet, 17177, Stockholm, Sweden. .,Department of Epidemiology and Biostatistics, School of Public Health, Makerere University College of Health Science, PO box 8045, Kampala, Uganda.
| | - Daniel Strachan
- Institute for Global Health, University College London, 30 Guilford Street, London, WC1N 1EH, UK.
| | - Seyi Soremekun
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK.
| | - Zelee Hill
- Institute for Global Health, University College London, 30 Guilford Street, London, WC1N 1EH, UK.
| | - Raghu Lingam
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK.
| | - James Tibenderana
- Malaria Consortium Africa, Plot 25 Upper Naguru East Road, Kampala, Uganda.
| | - Frida Kasteng
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
| | - Anna Vassall
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
| | - Sylvia Meek
- Malaria Consortium, Development House, 56-64 Leonard Street, London, EC2A 4LT, UK.
| | - Betty Kirkwood
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK.
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Hill Z, Dumbaugh M, Benton L, Källander K, Strachan D, ten Asbroek A, Tibenderana J, Kirkwood B, Meek S. Supervising community health workers in low-income countries--a review of impact and implementation issues. Glob Health Action 2014; 7:24085. [PMID: 24815075 PMCID: PMC4016747 DOI: 10.3402/gha.v7.24085] [Citation(s) in RCA: 129] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Revised: 04/04/2014] [Accepted: 04/07/2014] [Indexed: 11/14/2022] Open
Abstract
Background Community health workers (CHWs) are an increasingly important component of health systems and programs. Despite the recognized role of supervision in ensuring CHWs are effective, supervision is often weak and under-supported. Little is known about what constitutes adequate supervision and how different supervision strategies influence performance, motivation, and retention. Objective To determine the impact of supervision strategies used in low- and middle-income countries and discuss implementation and feasibility issues with a focus on CHWs. Design A search of peer-reviewed, English language articles evaluating health provider supervision strategies was conducted through November 2013. Included articles evaluated the impact of supervision in low- or middle-income countries using a controlled, pre-/post- or observational design. Implementation and feasibility literature included both peer-reviewed and gray literature. Results A total of 22 impact papers were identified. Papers were from a range of low- and middle-income countries addressing the supervision of a variety of health care providers. We classified interventions as testing supervision frequency, the supportive/facilitative supervision package, supervision mode (peer, group, and community), tools (self-assessment and checklists), focus (quality assurance/problem solving), and training. Outcomes included coverage, performance, and perception of quality but were not uniform across studies. Evidence suggests that improving supervision quality has a greater impact than increasing frequency of supervision alone. Supportive supervision packages, community monitoring, and quality improvement/problem-solving approaches show the most promise; however, evaluation of all strategies was weak. Conclusion Few supervision strategies have been rigorously tested and data on CHW supervision is particularly sparse. This review highlights the diversity of supervision approaches that policy makers have to choose from and, while choices should be context specific, our findings suggest that high-quality supervision that focuses on supportive approaches, community monitoring, and/or quality assurance/problem solving may be most effective.
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Affiliation(s)
- Zelee Hill
- Institute of Global Health, University College London, London, UK;
| | - Mari Dumbaugh
- Institute of Global Health, University College London, London, UK
| | - Lorna Benton
- Institute of Global Health, University College London, London, UK
| | | | - Daniel Strachan
- Institute of Global Health, University College London, London, UK
| | - Augustinus ten Asbroek
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Betty Kirkwood
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
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Melén E, Granell R, Kogevinas M, Strachan D, Gonzalez JR, Wjst M, Jarvis D, Ege M, Braun-Fahrländer C, Genuneit J, Horak E, Bouzigon E, Demenais F, Kauffmann F, Siroux V, Michel S, von Berg A, Heinzmann A, Kabesch M, Probst-Hensch NM, Curjuric I, Imboden M, Rochat T, Henderson J, Sterne JAC, McArdle WL, Hui J, James AL, William Musk A, Palmer LJ, Becker A, Kozyrskyj AL, Chan-Young M, Park JE, Leung A, Daley D, Freidin MB, Deev IA, Ogorodova LM, Puzyrev VP, Celedón JC, Brehm JM, Cloutier MM, Canino G, Acosta-Pérez E, Soto-Quiros M, Avila L, Bergström A, Magnusson J, Söderhäll C, Kull I, Scholtens S, Marike Boezen H, Koppelman GH, Wijga AH, Marenholz I, Esparza-Gordillo J, Lau S, Lee YA, Standl M, Tiesler CMT, Flexeder C, Heinrich J, Myers RA, Ober C, Nicolae DL, Farrall M, Kumar A, Moffatt MF, Cookson WOCM, Lasky-Su J. Genome-wide association study of body mass index in 23 000 individuals with and without asthma. Clin Exp Allergy 2013; 43:463-74. [PMID: 23517042 DOI: 10.1111/cea.12054] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2012] [Revised: 09/28/2012] [Accepted: 10/22/2012] [Indexed: 12/20/2022]
Abstract
BACKGROUND Both asthma and obesity are complex disorders that are influenced by environmental and genetic factors. Shared genetic factors between asthma and obesity have been proposed to partly explain epidemiological findings of co-morbidity between these conditions. OBJECTIVE To identify genetic variants that are associated with body mass index (BMI) in asthmatic children and adults, and to evaluate if there are differences between the genetics of BMI in asthmatics and healthy individuals. METHODS In total, 19 studies contributed with genome-wide analysis study (GWAS) data from more than 23 000 individuals with predominantly European descent, of whom 8165 are asthmatics. RESULTS We report associations between several DENND1B variants (P = 2.2 × 10(-7) for rs4915551) on chromosome 1q31 and BMI from a meta-analysis of GWAS data using 2691 asthmatic children (screening data). The top DENND1B single nucleotide polymorphisms(SNPs) were next evaluated in seven independent replication data sets comprising 2014 asthmatics, and rs4915551 was nominally replicated (P < 0.05) in two of the seven studies and of borderline significance in one (P = 0.059). However, strong evidence of effect heterogeneity was observed and overall, the association between rs4915551 and BMI was not significant in the total replication data set, P = 0.71. Using a random effects model, BMI was overall estimated to increase by 0.30 kg/m(2) (P = 0.01 for combined screening and replication data sets, N = 4705) per additional G allele of this DENND1BSNP. FTO was confirmed as an important gene for adult and childhood BMI regardless of asthma status. CONCLUSIONS AND CLINICAL RELEVANCE DENND1B was recently identified as an asthma susceptibility gene in a GWAS on children, and here, we find evidence that DENND1B variants may also be associated with BMI in asthmatic children. However, the association was overall not replicated in the independent data sets and the heterogeneous effect of DENND1B points to complex associations with the studied diseases that deserve further study.
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Affiliation(s)
- E Melén
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
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Dil Y, Strachan D, Cairncross S, Korkor AS, Hill Z. Motivations and challenges of community-based surveillance volunteers in the northern region of Ghana. J Community Health 2013; 37:1192-8. [PMID: 22614535 DOI: 10.1007/s10900-012-9569-5] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Community health workers (CHWs) are an important element of many health systems and programmes for the promotion and delivery of a wide range of health interventions and disease surveillance. Understanding the motivation and retention of CHWs is recognized as essential but there are few data from sub-Saharan Africa. This qualitative study explored factors that motivate, and the challenges faced by community-based surveillance volunteers (CBSVs) in the Northern Region of Ghana through semi-structured interviews with 28 CBSVs, 12 zonal coordinators, nine Ghana Health Service (GHS) sub-district level staff, ten GHS district level staff and two GHS regional level staff in the administrative capital. The community emerged as an important motivating factor in terms of altruism, a sense of duty to the community and gaining community respect and pride. This was enhanced by community selection of the volunteers. Major challenges included incorrect community perceptions of CBSVs, problems with transportation and equipment, difficulties conducting both volunteer and farm work and late or lack of payment for ad hoc tasks such as National Immunization Days. Most CBSVs recognized that they were volunteers, understood the constraints of the health system and were not demanding remuneration. However, CBSVs strongly desired something tangible to show that their work is recognized and appreciated and described a number of low cost items that could be used. They also desired equipment such as raincoats and identifiers such as tee-shirts and certificates.
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Affiliation(s)
- Yasemin Dil
- Institute of Child Health, Centre for International Health and Development, University College London, 30 Guilford Street, London, WC1N 1EH, UK
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Rafferty A, Tapper L, Strachan D, Raine C. Cochlear implantation in older patients: outcomes and comparisons. Rev Laryngol Otol Rhinol (Bord) 2013; 134:119-124. [PMID: 24974403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVES A review of adults receiving cochlear implants (Cls) at the Yorkshire Cochlear Implant Service (YCIS) was performed to assess whether age affects use or outcomes. METHODS A retrospective analysis of all patients over the age of 50 implanted and habilitated at the YCIS was undertaken. Outcome measures included quality of life (QoL) questionnaires and speech perception tests: CUNY sentences and BKB sentences. Comparisons were made between patients implanted age 50 to 59 (A), 60 to 69 (B) and 70 and over (C). Patients with English as a second language and those implanted for less than 9 months were excluded. Data was analysed using a repeated measure regression model. RESULTS 80 adults were included; A, 31; B, 29; C, 20. Significant improvements were seen in speech perception scores in all groups from pre-implant to 3 months. No statistically significant difference was found between the 3 groups in any outcome measure. QoL scores overall showed increased independence and greater participation in social activities with all patients feeling their implant had been successful. DISCUSSION Increased life expectancy and availability of cochlear implants (Cls) has led to greater numbers of older patients being eligible for implantation. Our results show improved speech perception and QoL outcomes in all groups. The lack of statistically significant differences between age groups supports the benefits of Cls in the older population. Older age should not be a discriminating factor in candidacy for cochlear implantation and referral of older patients to implant centres should be encouraged.
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McKenzie K, Limbong J, Strachan D. COMPARING CHILD PRODUCT SAFETY CONCERNS WITH INJURY INCIDENTS: DOES THE EVIDENCE SUPPORT THE RESPONSE? Inj Prev 2012. [DOI: 10.1136/injuryprev-2012-040580a.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Ellwood P, Asher MI, Stewart AW, Aït-Khaled N, Mallol J, Strachan D. The challenges of replicating the methodology between Phases I and III of the ISAAC programme. Int J Tuberc Lung Dis 2012; 16:687-93. [PMID: 22507933 DOI: 10.5588/ijtld.11.0226] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The International Study of Asthma and Allergies in Childhood (ISAAC) used standardised methods to examine symptom prevalence of asthma, rhinitis and eczema in adolescents and children between Phases I and III. Centres followed essential rules to ensure comparability of methodology, examined by a centralised data centre. METHODS Centre reports (CRs) were compared for both phases and age groups. Methodological differences were categorised under major deviations (centres excluded), minor deviations (deviations identified in published tables) and very minor deviations (deviations not identified). RESULTS There were 112 CRs for adolescents and 70 for children. Six centres for adolescents and four for children had major deviations and were excluded. Minor deviations (35 for adolescents and 20 for children) were identified in the publications. Very minor deviations (92 for adolescents and 51 for children) were not identified. The odds ratios for having any differences in methodology between phases with a change in Principal Investigator were 0.80 (95%CI 0.36-1.81) for adolescents and 0.91 (95%CI 0.32-2.62) for children. CONCLUSION The majority of the centres replicated the ISAAC methodology to a high standard. Careful documentation of methodology using standardised tools with careful checks allows the full potential of studies such as ISAAC to be realised.
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Affiliation(s)
- P Ellwood
- Department of Paediatrics: Child and Youth Health, The University of Auckland, Auckland, New Zealand.
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20
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Weinmayr G, Forastiere F, Kleiner A, Buchele G, Wickens K, Strachan D, Nagel G. P2-321 The relationship between BMI and wheezing in the international study of asthma and allergies in childhood phase 2. Br J Soc Med 2011. [DOI: 10.1136/jech.2011.142976k.54] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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21
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Ghosh R, Cullinan P, Strachan D, Jarvis D. S162 Job categories and risk of adult onset asthma in the 1958 birth cohort from age 16 to age 42 years. Thorax 2010. [DOI: 10.1136/thx.2010.150953.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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22
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Ghosh R, Jarvis D, Strachan D, Cullinan P. S110 Employment histories of people with asthma in the 1958 birth cohort. Thorax 2010. [DOI: 10.1136/thx.2010.150946.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Nagel G, Weinmayr G, Kleiner A, Garcia-Marcos L, Strachan D. Effect of diet on Asthma and Allergic sensitization in Phase Two International Study on Allergies and Asthma in Childhood (ISAAC). Gesundheitswesen 2010. [DOI: 10.1055/s-0030-1266248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Kolaczinski JH, Kolaczinski K, Kyabayinze D, Strachan D, Temperley M, Wijayanandana N, Kilian A. Costs and effects of two public sector delivery channels for long-lasting insecticidal nets in Uganda. Malar J 2010; 9:102. [PMID: 20406448 PMCID: PMC2868859 DOI: 10.1186/1475-2875-9-102] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2009] [Accepted: 04/20/2010] [Indexed: 11/03/2022] Open
Abstract
Background In Uganda, long-lasting insecticidal nets (LLIN) have been predominantly delivered through two public sector channels: targeted campaigns or routine antenatal care (ANC) services. Their combination in a mixed-model strategy is being advocated to quickly increase LLIN coverage and maintain it over time, but there is little evidence on the efficiency of each system. This study evaluated the two delivery channels regarding LLIN retention and use, and estimated the associated costs, to contribute towards the evidence-base on LLIN delivery channels in Uganda. Methods Household surveys were conducted 5-7 months after LLIN distribution, combining questionnaires with visual verification of LLIN presence. Focus groups and interviews were conducted to further investigate determinants of LLIN retention and use. Campaign distribution was evaluated in Jinja and Adjumani while ANC distribution was evaluated only in the latter district. Costs were calculated from the provider perspective through retrospective analysis of expenditure data, and effects were estimated as cost per LLIN delivered and cost per treated-net-year (TNY). These effects were calculated for the total number of LLINs delivered and for those retained and used. Results After 5-7 months, over 90% of LLINs were still owned by recipients, and between 74% (Jinja) and 99% (ANC Adjumani) were being used. Costing results showed that delivery was cheapest for the campaign in Jinja and highest for the ANC channel, with economic delivery cost per net retained and used of USD 1.10 and USD 2.31, respectively. Financial delivery costs for the two channels were similar in the same location, USD 1.04 for campaign or USD 1.07 for ANC delivery in Adjumani, but differed between locations (USD 0.67 for campaign delivery in Jinja). Economic cost for ANC distribution were considerably higher (USD 2.27) compared to campaign costs (USD 1.23) in Adjumani. Conclusions Targeted campaigns and routine ANC services can both achieve high LLIN retention and use among the target population. The comparatively higher economic cost of delivery through ANC facilities was at least partially due to the relatively short time this system had been in existence. Further studies comparing the cost of well-established ANC delivery with LLIN campaigns and other delivery channels are thus encouraged.
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Affiliation(s)
- Jan H Kolaczinski
- Malaria Consortium - Africa Regional Office, PO Box 8045, Plot 2, Sturrock Road, Kampala, Uganda.
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Genuneit J, Cantelmo JL, Weinmayr G, Wong GWK, Cooper PJ, Riikjärv MA, Gotua M, Kabesch M, von Mutius E, Forastiere F, Crane J, Nystad W, El-Sharif N, Batlles-Garrido J, García-Marcos L, García-Hernández G, Morales-Suarez-Varela M, Nilsson L, Bråbäck L, Saraçlar Y, Weiland SK, Cookson WOC, Strachan D, Moffatt MF. A multi-centre study of candidate genes for wheeze and allergy: the International Study of Asthma and Allergies in Childhood Phase 2. Clin Exp Allergy 2010; 39:1875-88. [PMID: 20085599 DOI: 10.1111/j.1365-2222.2009.03364.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND Common polymorphisms have been identified in genes suspected to play a role in asthma. We investigated their associations with wheeze and allergy in a case-control sample from Phase 2 of the International Study of Asthma and Allergies in Childhood. METHODS We compared 1105 wheezing and 3137 non-wheezing children aged 8-12 years from 17 study centres in 13 countries. Genotyping of 55 candidate single nucleotide polymorphisms (SNPs) in 14 genes was performed using the Sequenom System. Logistic regression models were fitted separately for each centre and each SNP. A combined per allele odds ratio and measures of heterogeneity between centres were derived by random effects meta-analysis. RESULTS Significant associations with wheeze in the past year were detected in only four genes (IL4R, TLR4, MS4A2, TLR9, P<0.05), with per allele odds ratios generally <1.3. Variants in IL4R and TLR4 were also related to allergen-specific IgE, while polymorphisms in FCER1B (MS4A2) and TLR9 were not. There were also highly significant associations (P<0.001) between SPINK5 variants and visible eczema (but not IgE levels) and between IL13 variants and total IgE. Heterogeneity of effects across centres was rare, despite differences in allele frequencies. CONCLUSIONS Despite the biological plausibility of IgE-related mechanisms in asthma, very few of the tested candidates showed evidence of association with both wheeze and increased IgE levels. We were unable to confirm associations of the positional candidates DPP10 and PHF11 with wheeze, although our study had ample power to detect the expected associations of IL13 variants with IgE and SPINK5 variants with eczema.
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Affiliation(s)
- J Genuneit
- Institute of Epidemiology, Ulm University, Ulm, Germany.
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Van Iseghem P, Aertsens M, Gin S, Deneele D, Grambow B, Strachan D, McGrail P, Wicks G. GLAMOR - Or How We Achieved a Common Understanding on the Decrease of Glass Dissolution Kinetics. Ceramic Transactions Series 2009. [DOI: 10.1002/9780470538371.ch12] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Gehring U, Strikwold M, Schram-Bijkerk D, Weinmayr G, Genuneit J, Nagel G, Wickens K, Siebers R, Crane J, Doekes G, Di Domenicantonio R, Nilsson L, Priftanji A, Sandin A, El-Sharif N, Strachan D, van Hage M, von Mutius E, Brunekreef B. Asthma and allergic symptoms in relation to house dust endotoxin: Phase Two of the International Study on Asthma and Allergies in Childhood (ISAAC II). Clin Exp Allergy 2009; 38:1911-20. [PMID: 18771486 DOI: 10.1111/j.1365-2222.2008.03087.x] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Several studies have consistently reported inverse associations between exposure to endotoxin in house dust and atopy. With regard to the association between house dust endotoxin and asthma, the results are inconsistent. OBJECTIVES To study the association between house dust endotoxin levels and respiratory symptoms and atopy in populations from largely different countries. METHODS Data were collected within the International Study on Asthma and Allergies in Childhood Phase Two, a multi-centre cross-sectional study of 840 children aged 9-12 years from six centres in the five countries of Albania, Italy, New Zealand, Sweden and the United Kingdom. Living room floor dust was collected and analysed for endotoxin. Health end-points and demographics were assessed by standardized questionnaires. Atopy was assessed by measurements of allergen-specific IgE against a panel of inhalant allergens. Associations between house dust endotoxin and health outcomes were analysed by logistic regression. Odds ratios (ORs) were presented for an overall interquartile range increase in exposure. RESULTS Many associations between house dust endotoxin in living room floor dust and health outcomes varied between countries. Combined across countries, endotoxin levels were inversely associated with asthma ever [adjusted OR (95% confidence interval (CI)) 0.53 (0.29-0.96) for endotoxin levels per m(2) of living room floor] and current wheeze [adjusted OR (95% CI) 0.77 (0.64-0.93) for endotoxin levels per gram of living room floor dust]. There were inverse associations between endotoxin concentrations and atopy, which were statistically significant in unadjusted analyses, but not after adjustment for gender, parental allergies, cat and house dust mite allergens. No associations were found with dust quantity and between endotoxin exposure and hayfever. CONCLUSION These findings suggest an inverse association between endotoxin levels in living room floor dust and asthma in children.
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Affiliation(s)
- U Gehring
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands.
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Smith RL, Warren RB, Eyre S, Ke X, Young HS, Allen M, Strachan D, McArdle W, Gittins MP, Barker JNWN, Griffiths CEM, Worthington J. Polymorphisms in the PTPN22 region are associated with psoriasis of early onset. Br J Dermatol 2008; 158:962-8. [PMID: 18341666 PMCID: PMC2342636 DOI: 10.1111/j.1365-2133.2008.08482.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Background Psoriasis, a chronic inflammatory skin disease, affects approximately 2% of the population worldwide. Although the aetiology of psoriasis is poorly understood, patients with disease of early onset (Type I, age of onset ≤ 40 years) usually have a strong genetic component to the disease. Objectives The purpose of this study was to investigate the role of the protein tyrosine phosphatase nonreceptor type 22 (PTPN22) gene region in susceptibility to Type I psoriasis. Patients and methods Thirteen single nucleotide polymorphisms (SNPs) mapping to the PTPN22 region were genotyped in 647 patients with Type I psoriasis and 566 normal controls. Results The rs2476601 (R620W) SNP, widely associated with other inflammatory autoimmune diseases, showed no evidence of association with susceptibility to Type I psoriasis. Two SNPs (rs1217414 and rs3789604) demonstrated significant association with Type I psoriasis and were subsequently genotyped in a further 253 unrelated patients and 2024 normal controls. rs1217414 and rs3789604 were also significantly associated with Type I psoriasis in the combined datasets (P = 0·003 and P = 0·0002, respectively); furthermore carriage of both risk alleles was also significantly associated (P = 0·002). Conclusions This study demonstrates evidence of association of two SNPs (rs1217414 and rs3789604) in the PTPN22 region with Type I psoriasis, providing evidence for a role of this gene in Type I psoriasis that is not conferred by the R620W variant previously associated with a number of inflammatory diseases.
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Affiliation(s)
- Rh Ll Smith
- arc Epidemiology Unit, The University of Manchester, and Dermatological Sciences, Hope Hospital, Manchester M6 8HD, UK.
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Roberts G, Peckitt C, Northstone K, Strachan D, Lack G, Henderson J, Golding J. Relationship between aeroallergen and food allergen sensitization in childhood. Clin Exp Allergy 2006; 35:933-40. [PMID: 16008681 DOI: 10.1111/j.1365-2222.2005.02280.x] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Previous studies measuring the prevalence of allergen sensitization have been relatively small and used small numbers of allergens. To effectively evaluate children with atopic disease, we need an accurate knowledge of which allergens are important. OBJECTIVE To measure the prevalence of sensitization within a large unselected birth cohort, to examine the associations between sensitization to different allergens and determine whether atopy can be defined by a small panel of allergens. METHODS The Avon Longitudinal Study of Parents and Children is a population-based birth cohort of 13,638 singletons surviving to 4 weeks of age. The cohort was skin tested at 7 years of age to house dust mite (Dermatophagoides pteronyssinus), grass pollens, cat, peanuts, mixed tree nuts and egg and one of three other panels: animal danders, foods or aeroallergens. Sensitization was defined as a weal diameter of > or =3 mm. The strength of associations between sensitization to different allergens was tested by calculating the odds ratio adjusted for sensitization to D. pteronyssinus and grass pollen and gender. RESULTS Valid data were obtained from 6412 singletons. Sensitization was most common to aeroallergens: grass pollens (8.5%), D. pteronyssinus (7.8%), cat (4.9%), D. farinae (3.6%), dog (2.7%), horse (1.4%), rabbit (1.4%). Of the foods tested, the most common sensitization was to peanut (1.4%) and mixed tree nuts (1.0%). More than 95% of subjects with sensitization to any of the 29 allergens tested were sensitized to one of grass, D. pteronyssinus or cat allergen. There were strong associations of multiple sensitizations both within and between different allergen classes (pollens, animals, foods, peanut and tree nuts). CONCLUSIONS Seven-year-old children in the UK are primarily sensitized to aeroallergens, but also to peanuts and tree nuts. There are strong associations between sensitization within allergen groups as well as between allergen groups. Further studies are required to observe whether similar associations are seen with clinical allergy to these allergens.
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Affiliation(s)
- G Roberts
- Paediatric Allergy, Asthma and Immunology, Imperial College at St Mary's, London, UK
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Maitra A, Sherriff A, Northstone K, Strachan D, Henderson AJ. Maternal age of menarche is not associated with asthma or atopy in prepubertal children. Thorax 2005; 60:810-3. [PMID: 16055625 PMCID: PMC1747209 DOI: 10.1136/thx.2004.037093] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Maternal sex hormones in pregnancy can theoretically influence the developing fetal immune system and modulate the subsequent development of atopic disorders. Early onset of menarche has been linked to increased oestrogen levels in adult women. A study was undertaken to examine the association between early onset menarche in pregnant women and asthma and atopic status of their children at 7 years of age. METHODS The Avon Longitudinal Study of Parents and Children (ALSPAC) is a longitudinal birth cohort study in which pregnant women, resident in Avon (UK), were recruited on the basis of an expected date of delivery between 1 April 1991 and 31 December 1992. Maternal age at menarche was assessed from prenatal questionnaires administered to the women. Clinical outcomes in the children were based on mothers' responses to self-completion questionnaires and included asthma, eczema, and hay fever. The atopic status of the child was objectively assessed by skin prick tests to a panel of common aeroallergens at the age of 7 years. Analyses used multivariable logistic regression with a diverse range of possible confounders. RESULTS Complete data were available on 5765 woman and child pairs. The prevalence of ever reported asthma to 7 years was 20.4%, eczema 58.6%, hay fever 12.1%, and atopy (defined as any positive (>2 mm weal) response) was present in 20.6%. There were no significant differences in mean age of menarche between mothers of children with and without each of the primary outcomes. Adjusted odds ratios (95% CI) for the latest age of menarche (16+ years) compared with the lowest (<12 years) reference group were 1.41 (1.00 to 1.99) for asthma, 0.98 (0.73 to 1.91) for eczema, 0.95 (0.62 to 1.44) for hay fever, and 0.98 (0.68 to 1.42) for atopy. CONCLUSION No consistent association was found between maternal age at menarche and asthma, eczema, hay fever or atopy in their children during early childhood.
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Affiliation(s)
- A Maitra
- Department of Paediatric Medicine, Blackpool Royal Victoria Hospital, Blackpool FY3 8NR, UK
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31
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Abstract
BACKGROUND Caesarean-section delivery has been associated with the subsequent development of atopy and wheezing in childhood. OBJECTIVE To examine the association between mode of delivery (vaginal vs. caesarean section) and development of atopy, asthma and wheezing disorders in a population-based cohort of children. METHODS The Avon Longitudinal Study of Parents and Children is a longitudinal birth cohort of children born 1 April 1991 to 31 December 1992. Mode of delivery was categorized as vaginal (including forceps and ventouse extractions) or caesarean section (elective and emergency). Primary outcomes were parental report of asthma or wheezing between 69 and 81 months of age, physician-diagnosed asthma (PDA) at 91 months of age and atopy at 7 years by skin prick testing. Possible confounding factors were considered in a multivariable logistic regression model. RESULTS Total livebirths were 14,062, from which were selected 12 367 born to mothers resident in a defined area and delivered in one of two major obstetric hospitals. Of these infants, 10,980 (88.8%) were delivered vaginally and 1387 (11.2%) by caesarean section. Outcome data were available for 7495 (61%) subjects (asthma 69-81 months); 7389 (60%) (wheeze 69-81 months); 7196 (58%) (PDA 91 months) and 5916 (48%) (atopy 7 years). Adjusted odds ratios [95%confidence interval] for caesarean section compared with vaginal delivery were not statistically significant for any outcome we considered: asthma 69-81 months 1.16 [0.9, 1.5]; wheeze 69-81 months 0.95 [0.7, 1.3]; PDA 1.14 [0.9, 1.4]; atopy 1.04 [0.8, 1.3]. CONCLUSION Delivery by caesarean section was not associated with the subsequent development of asthma, wheezing or atopy in later childhood in this population.
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Affiliation(s)
- A Maitra
- Bristol Royal Hospital for Children, Bristol, UK.
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Strachan D, Burton I, Pearson GJ. Is oral azithromycin effective for the treatment of cyclosporine-induced gingival hyperplasia in cardiac transplant recipients? J Clin Pharm Ther 2003; 28:329-38. [PMID: 12911686 DOI: 10.1046/j.1365-2710.2003.00494.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Anecdotal evidence suggests that azithromycin is effective for the treatment of cyclosporine-induced gingival hyperplasia in solid-organ transplant recipients. We present the cases of two heart transplant patients who insidiously developed gingival hyperplasia, likely because of immunosuppression with cyclosporine, which was treated with azithromycin. Evidence supporting the efficacy of azithromycin in the treatment of cyclosporine-induced gingival hyperplasia in solid organ transplant recipients was searched for, identified, and then critically assessed. While no data were found specifically evaluating azithromycin in cardiac transplant patients, there were nine pertinent papers identified that evaluated the clinical question of interest in the renal transplant population [Wahlstrom et al. (1995) The New England Journal of Medicine 332, 753; Boran et al. (1996) Transplantation Proceedings 28, 2316; Gomez et al. (1997) Nephrology Dialysis Transplantation 12, 2694; Ljutic (1997) Dialysis & Transplantation 26, 787; Puig et al. (1997) Transplantation Proceedings 29, 2379; Nash et al. (1998) Transplantation 65, 1611; Nowicki et al. (1998) Annals of Transplantation 3, 25; Wirnsberger et al. (1998) Transplantation Proceedings 30, 2117; Citterio et al. (2001) Transplantation Proceedings 33, 2134]. These studies and case reports are summarized. While more evidence is required to support routine use of azithromycin for the treatment of cyclosporine-induced gingival hyperplasia in cardiac transplant recipients, preliminary published evidence from renal transplant patients is certainly favourable.
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Affiliation(s)
- D Strachan
- Regional Pharmacy Services, Capital Health Region, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
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Ahmadi KR, Lanchbury JS, Reed P, Chiano M, Thompson D, Galley M, Line A, Lank E, Wong HJ, Strachan D, Spector TD. Novel association suggests multiple independent QTLs within chromosome 5q21-33 region control variation in total humans IgE levels. Genes Immun 2003; 4:289-97. [PMID: 12761566 DOI: 10.1038/sj.gene.6363968] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Asthma is a common, heterogeneous, complex disease accompanied by raised total and specific immunoglobulin-E (IgE) antibody levels. Despite numerous previous reports of linkage and association of asthma, atopy and serum IgE levels to genes within the 5q21-33 region, definitive, replicable results are still not available. We used the classical twin design to (i) estimate the relative contributions of genes and environment to variation in total IgE levels, (ii) assess genetic linkage, and (iii) examine allelic association of 11 microsatellite markers spanning the 5q21-33 region to total IgE. Variation in total IgE level was shown to be highly heritable (65%). Although evidence for linkage of the 11 microsatellites to IgE was not observed, the omnibus test of association, not confounded by population substructure, showed positive association of D5S393 and D5S673 to IgE. Genes in the vicinity of D5S673 include hepatitis A virus receptor (HAVCR-1) and IL-12B. Recently, the mouse orthologue of HAVCR-1, the T-cell membrane family of proteins, have been shown to be in strong association with expression of airway hyperactivity in a mouse model of human asthma and atopy. IL-12B subserves many proinflammatory functions and also induces B cells proliferation.
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Affiliation(s)
- K R Ahmadi
- Twin Research & Genetic Epidemiology Unit, St Thomas' Hospital, and Molecular Immunogenetics Unit, Department of Rheumatology, GKT School of Medicine, King's College London, UK.
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Soriano JB, Kiri VA, Maier WC, Strachan D. Increasing prevalence of asthma in UK primary care during the 1990s. Int J Tuberc Lung Dis 2003; 7:415-21. [PMID: 12757040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023] Open
Abstract
OBJECTIVE To estimate recent prevalence trends of physician-diagnosed asthma in primary care in the UK, and to test the hypothesis that the asthma epidemic in the UK peaked in the mid-1990s and is currently declining. METHODS A retrospective cohort of asthma patients was obtained from the General Practice Research Database (GPRD). From January 1990 to February 1999, asthmatics were followed up to death, censoring or mention of chronic obstructive pulmonary disease (COPD) in their clinical record. Prevalence rates of ever and managed asthma were obtained by sex, age and calendar year. RESULTS AND CONCLUSION From 1990 to 1998, annual prevalence rates of managed physician-diagnosed asthma in women rose from 3.01% (95%CI 2.99-3.03) to 5.14% (95%CI 5.10-5.18), and in men from 3.44% (95%CI 3.41-3.46) to 5.06% (95 %CI 5.02-5.10) (P for trend <0.01 in both). In 1998, prevalence rates of managed asthma in children aged 5-14 affected 7.86% (95%CI 7.71-8.00) of girls and 10.30% (95%CI 10.15-10.47) of boys. Increasing prevalence rates in adult asthma (maximum 4.11% in 1998, 95%CI 4.03-4.19) and elderly asthma (maximum 3.37% in 1998, 95%CI 3.29-3.46) were observed as well in 1998. The study shows that the burden of asthma in UK primary care during the 1990s was still increasing.
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Affiliation(s)
- J B Soriano
- Worldwide Epidemiology, GlaxoSmithKline Research and Development, Greenford, Middlesex, UK.
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Hansell A, Hollowell J, McNiece R, Nichols T, Strachan D. Validity and interpretation of mortality, health service and survey data on COPD and asthma in England. Eur Respir J 2003; 21:279-86. [PMID: 12608442 DOI: 10.1183/09031936.03.00006102] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The comparability of asthma and chronic obstructive pulmonary disease (COPD) epidemiology in different English routine data sources was examined to explore their use and validity in investigating environmental influences on respiratory health. National data were obtained for mortality, emergency hospital admissions, general practitioner contacts and symptoms in the early 1990s. Age/sex patterns, seasonal variations and regional and urban/rural age/sex standardised event ratios were examined. Spearman rank correlations were used to describe consistency of regional rankings across data sets. Asthma showed inconsistent disease patterns in different data sources and weak correlations for regional rankings but COPD was notably consistent. Unmeasured confounders may partly explain the findings, but individual level adjustment for social class and smoking (possible for symptoms) only partially attenuated the higher COPD rates in northern and urban areas and did not affect findings for asthma. When epidemiological patterns are consistent across data sources as with chronic obstructive pulmonary disease in England, healthcare use is likely to reflect the underlying prevalence and severity of disease and can be used to study environmental influences. When patterns vary, as with asthma, the validity of the data in relation to its intended use must be carefully considered.
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Affiliation(s)
- A Hansell
- Public Health Sciences, St George's Hospital Medical School, London, UK.
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Maguire H, Dale JW, McHugh TD, Butcher PD, Gillespie SH, Costetsos A, Al-Ghusein H, Holland R, Dickens A, Marston L, Wilson P, Pitman R, Strachan D, Drobniewski FA, Banerjee DK. Molecular epidemiology of tuberculosis in London 1995-7 showing low rate of active transmission. Thorax 2002; 57:617-22. [PMID: 12096206 PMCID: PMC1746370 DOI: 10.1136/thorax.57.7.617] [Citation(s) in RCA: 89] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Tuberculosis notification rates for London have risen dramatically in recent years. Molecular typing of Mycobacterium tuberculosis has contributed to our understanding of the epidemiology of tuberculosis throughout the world. This study aimed to assess the degree of recent transmission of M tuberculosis in London and subpopulations of the community with high rates of recent transmission. METHODS M tuberculosis isolates from all persons from Greater London diagnosed with culture positive tuberculosis between 1 July 1995 and 31 December 1997 were genetically fingerprinted using IS6110 restriction fragment length polymorphism (RFLP) typing. A structured proforma was used during record review of cases of culture confirmed tuberculosis. Cluster analysis was performed and risk factors for clustering were examined in a univariate analysis followed by a logistic regression analysis with membership of a cluster as the outcome variable. RESULTS RFLP patterns were obtained for 2042 isolates with more than four copies of IS6110; 463 (22.7%) belonged to 169 molecular clusters, which ranged in size from two (65% of clusters) to 12 persons. The estimated rate of recent transmission was 14.4%. Young age (0-19 years) (odds ratio (OR) 2.65, 95% confidence interval (CI) 1.59 to 4.44), birth in the UK (OR 1.55, 95% CI 1.04 to 2.03), black Caribbean ethnic group (OR 2.19, 95% CI 1.15 to 4.16), alcohol dependence (OR 2.33, 95% CI 1.46 to 3.72), and streptomycin resistance (OR 1.82, 95% CI 1.15 to 2.88) were independently associated with an increased risk of clustering. CONCLUSIONS Tuberculosis in London is largely caused by reactivation or importation of infection by recent immigrants. Newly acquired infection is also common among people with recognised risk factors. Preventative interventions and early diagnosis of immigrants from areas with a high incidence of tuberculosis, together with thorough contact tracing and monitoring of treatment outcome among all cases of tuberculosis (especially in groups at higher risk of recent infection), remains most important.
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Affiliation(s)
- H Maguire
- Public Health Laboratory Service (PHLS) Communicable Disease Surveillance Centre, London W2 3QR, UK
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Sherriff A, Peters TJ, Henderson J, Strachan D. Risk factor associations with wheezing patterns in children followed longitudinally from birth to 3(1/2) years. Int J Epidemiol 2001; 30:1473-84. [PMID: 11821366 DOI: 10.1093/ije/30.6.1473] [Citation(s) in RCA: 100] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND There is a paucity of detailed longitudinal data on wheeze in early childhood. Not all children who wheeze in early infancy will continue to wheeze into childhood and beyond. This study aims to investigate possible risk factors for different patterns of wheeze in the pre-school years. SUBJECTS AND METHODS Study participants were part of the Avon Longitudinal Study of Parents and Children (ALSPAC). Maternal reports of child wheeze between birth and 6 months and again between 30 and 42 months were gathered prospectively. Children were categorized into early wheeze, persistent wheeze or late onset wheeze. A large number of risk factors were assessed for each wheezing phenotype using multivariable logistic regression models. RESULTS Over 70% of children who wheezed in the first 6 months did not wheeze 3 years later. Wheezing between 0-6 months was independently associated with the presence of older siblings, male sex, delivery between April and December, bottle feeding, young maternal age, prenatal tobacco smoke exposure, atopy and parental history of asthma. From within this group of early wheezers, risk factors for wheeze that persisted beyond 6 months included pre-term delivery, young maternal age, living in rented local authority housing, atopy and a maternal (not paternal) history of asthma. Atopy and a family history of asthma emerged as the main predictors of wheeze that developed after 6 months of age. CONCLUSION It is clear that a number of wheezing syndromes exist by 3(1/2) years, albeit with some degree of overlap. Detailed follow-up of this cohort is underway to determine whether risk factor associations determined in the first 3(1/2) years have long-term significance for the clinical entity termed 'asthma'.
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Affiliation(s)
- A Sherriff
- Unit of Paediatric and Perinatal Epidemiology, Institute of Child Health, University of Bristol, Bristol, UK.
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Abstract
In the first phase of the International Study of Asthma and Allergies in Childhood, a large difference in occurrence of asthma symptoms was seen between children in Albania and the UK. We did skin-prick tests with various allergens and measured peak expiratory flow rate in about 1000 children from each country. A large difference in the proportion of exercise-induced bronchial reactivity was evident between children from Albania and the UK (0.8% vs 5.4%, respectively). However, the frequency of allergic sensitisation was closely similar (15.0% vs 17.8%, respectively). These results suggest that large geographical variations in asthma prevalence can arise without differences in frequency of atopy.
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Abstract
We investigated the hypothesis that sporadic food poisoning is a result of the consumption of food cooked or prepared outside the home. We did a case-control study, set in an urban emergency department, to find out the odds ratios for the risk of food poisoning associated with various patterns of consumption. We found that recent eating out (exposure on the day of or day before presentation) was associated with an odds ratio of 2.41 (95% CI 1.29-4.50) for presenting with food poisoning.
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Abstract
Pharyngeal pouches occur most commonly in elderly patients (over 70 years) and typical symptoms include dysphagia, regurgitation, chronic cough, aspiration, and weight loss. The aetiology remains unknown but theories centre upon a structural or physiological abnormality of the cricopharyngeus. A diagnosis is easily established on barium studies. Treatment is surgical via an endoscopic or external cervical approach and should include a cricopharyngeal myotomy. Unfortunately pharyngeal pouch surgery has long been associated with significant morbidity, partly due to the surgery itself and also to the fact that the majority of patients are elderly and often have general medical problems. External approaches are associated with higher complication rates than endoscopic procedures. Recently, treatment by endoscopic stapling diverticulotomy has becoming increasingly popular as it has distinct advantages, although long term results are not yet available. The small risk of developing carcinoma within a pouch that is not excised remains a contentious issue and is an argument for long term follow up or treating the condition by external excision, particularly in younger patients.
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Affiliation(s)
- M A Siddiq
- Department of Otorhinolaryngology, Head and Neck Surgery, Bradford Royal Infirmary, Duckworth Lane, Bradford BD9 6RJ, UK.
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Abstract
BACKGROUND It has been suggested that pregnancy and early life may influence the development of asthma in the offspring, but published studies have not carefully controlled for potential biases. METHODS In a large British birth cohort of 4065 natural children of 2583 mothers, we investigated whether in utero and perinatal influences contribute to the development and the severity of asthma in childhood, allowing for possible confounders of the relationship, and considering the nonindependence of familial data. RESULTS Child asthma (10.1%) was more frequently reported by mothers when there had been health complications during pregnancy (prevalence =14.3%; adjusted odds ratio [ORadj] =2.01; 95% confidence interval, 1.52-2.67), labor, or delivery (19.3%, ORadj =1.35, 1.01-1.81); child illness or health complications during the first week of life (22.6%, ORadj =1.35, 1.01-1.82); and birth weight of < 2.5 kg (7.0%, ORadj =1.57, 1.10-2.25). Specific causes of health complications during pregnancy which significantly related to asthma were early or threatened labor (ICD: 644) (4.8%, ORadj =1.58, 1.03-2.40) and the malposition or malpresentation of the fetus (ICD: 652) (1.6%, ORadj =3.63, 1.47-8.91). CONCLUSION The results provide further evidence that in utero and perinatal factors may increase the risk of developing asthma.
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Affiliation(s)
- I Annesi-Maesano
- Department of Toxicological and Environmental Epidemiology, Epidemiology and Biostatistics Unit, INSERM, Villejuif, France
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Abstract
OBJECTIVES The importance of airborne fungal and other spores in provoking asthma attacks is uncertain. Panel studies have generated evidence that suggests a link between outdoor spore counts and severity of asthma. There have been no population based time series studies relating outdoor exposure to spores with incidence of attacks of asthma. METHODS Outcomes were hospital admissions for asthma on 2002 days during 1987-94, for children and adults in the Trent region of England. Predictors were daily counts of 25 spore taxa from volumetric traps in Derby on the same and previous day. Admissions for asthma were adjusted for weekly, seasonal, and longer term trends by log linear autoregressive models. Spore counts on 6 days of asthma epidemics were also examined. RESULTS When spore counts for individual taxa were analysed as quantitative variables, two positive and two negative correlations (out of a possible 100) were significant at the 5% level. When spore counts were dichotomised at the 90th percentile, one negative and eight positive correlations (out of 100) were significant at the 5% level. All significantly positive associations related to admissions among children, but none involved the total spore count. However, total spores were above the 90th percentile on four of the six epidemic days (odds ratio (OR) 9.92, 95% confidence interval (95% CI) 1.41 to 109.84), but epidemics occurred on only four of 343 days with high total moulds. CONCLUSIONS There was some evidence that exceptional rates of admission for asthma tend to occur on days with high total mould spore counts, but no specific taxon was consistently implicated. The predictive power was insufficient to support a public warning system.
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Affiliation(s)
- R Newson
- Imperial College School of Medicine, London, UK
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Abstract
BACKGROUND Little is known of the epidemiology of pneumothorax. Routinely available data on pneumothorax in England are described. METHODS Patients consulting in primary care with a diagnosis of pneumothorax in each year from 1991 to 1995 inclusive were identified from the General Practice Research Database (GPRD). Emergency hospital admissions for pneumothorax were identified for the years 1991-4 from the Hospital Episode Statistics (HES) data. Mortality data for England & Wales were obtained for 1950-97. Analyses of pneumothorax rates by age and sex were performed for all data sources. Seasonal and geographical analyses were carried out for the HES data. RESULTS The overall person consulting rate for pneumothorax (primary and secondary combined) in the GPRD was 24. 0/100 000 each year for men and 9.8/100 000 each year for women. Hospital admissions for pneumothorax as a primary diagnosis occurred at an overall incidence of 16.7/100 000 per year and 5.8/100 000 per year for men and women, respectively. Mortality rates were 1. 26/million per year for men and 0.62/million per year for women. The age distribution in both men and women showed a biphasic distribution for both GP consultations and hospital admissions. Deaths showed a single peak with highest rates in the elderly. There was an urban-rural trend observed for hospital admissions in the older age group (55+ years) with admission rates in the conurbations significantly higher than in the rural areas. Analysis for trends in mortality data for 1950-97 showed a striking increase in the death rate for pneumothorax in those aged 55+ years between 1960 and 1990, with a steep decline in the 1990s. Mortality in the younger age group (15-34 years) remained low and constant. CONCLUSION There is evidence of two epidemiologically distinct forms of spontaneous pneumothorax in England. The explanation for the rise and fall in mortality for secondary pneumothorax is obscure.
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Affiliation(s)
- D Gupta
- Heartlands Research Institute, Birmingham Heartlands Hospital, Birmingham B9 5SS, UK
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Strachan D, Clarke SE, England RJ. The effectiveness of topical treatment in discharging ears with in-dwelling ventilation tubes. Rev Laryngol Otol Rhinol (Bord) 2000; 121:27-9. [PMID: 10865480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
The efficacy and tolerability of topical treatment (both drops and spray) in the treatment of otorrhoea in those ears with ventilation tubes in-situ was studied. Sixty patients were randomised into two treatment groups. One group used an antibacterial/anti-inflammatory ear drop preparation (Otosporin) and the other group a similar preparation administered as an ear spray (Otomize). A 'blind' clinical assessment was made one and three weeks after commencing treatment. Both treatments (drops and spray) significantly improved patients' symptoms and signs after one week (p < 0.001). The spray was significantly easier to administer (p < 0.01) and caused less discomfort on application (p < 0.02).
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Affiliation(s)
- D Strachan
- York District Hospital, Bradford Royal Infirmary, ENT Department, United Kingdom
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Yoo CH, Lipp MJ, Strachan D, Daniels WB. Linewidth collapse in three-photon exciton-polariton spectra of CsI under pressure. Phys Rev Lett 2000; 84:3875-3878. [PMID: 11019228 DOI: 10.1103/physrevlett.84.3875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2000] [Indexed: 05/23/2023]
Abstract
Unusual phenomena occurring under hydrostatic compression in the near-band-edge structure of CsI crystals were examined using the nonlinear optical technique of three-photon excitation. The lowest one-photon allowed transition to the exciton-polariton A of gamma-4 symmetry redshifts, while the one-photon forbidden paraexciton C of gamma-5 symmetry blueshifts to a crossing of energies at 4.4 kbar. During this process, the A level exhibits strong spectral line narrowing by more than a factor of 10, while the C level intensity increases by about the same factor. We believe this is the first reported observation of pressure induced line narrowing of deep UV electronic states in solids.
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Affiliation(s)
- CH Yoo
- Department of Physics and Astronomy, University of Delaware, Newark, Delaware 19716, USA
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Walton J, Doll R, Asscher W, Hurley R, Langman M, Gillon R, Strachan D, Wald N, Fletcher P. Consequences for research if use of anonymised patient data breaches confidentiality. BMJ 1999; 319:1366. [PMID: 10567154 PMCID: PMC1117094 DOI: 10.1136/bmj.319.7221.1366] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Abstract
BACKGROUND In younger age groups there is a summer peak in asthma deaths, but whether this is due to social or environmental factors is not known. One suggested social factor is a summer holiday away from home during which there may be a lack of compliance with medication or greater difficulty in getting medical help. In older age groups there is a winter peak in asthma deaths. OBJECTIVE To study the contribution of 'holiday deaths' to seasonal variations in asthma mortality in England and Wales. METHODS Routinely collected mortality statistics were used (all asthma deaths of persons dying in England and Wales, 1991-93 and 1995). Deaths occurring 40 miles or more from home were estimated using the District Health Authority in which the person was usually resident; the registration district of death; and the 'transferability code' (derived by the Office for National Statistics). RESULTS There were 484 asthma deaths in people aged 0-34 years, and 6337 asthma deaths in people aged 35 years or more. Deaths estimated to occur 40 miles or more from home contributed little (16%) to the summer peak in asthma deaths age 0-34 years, and nothing to the winter peak in asthma deaths age 35 years or more. CONCLUSIONS Holidays away from home do not play an important part in explaining the seasonal variation of either young or old asthma deaths. Other social or environmental factors are more important.
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Affiliation(s)
- T Nichols
- St George's Hospital Medical School, London, UK
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Hansell A, Hollowell J, Nichols T, McNiece R, Strachan D. Use of the General Practice Research Database (GPRD) for respiratory epidemiology: a comparison with the 4th Morbidity Survey in General Practice (MSGP4). Thorax 1999; 54:413-9. [PMID: 10212105 PMCID: PMC1763769 DOI: 10.1136/thx.54.5.413] [Citation(s) in RCA: 113] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND The General Practice Research Database (GPRD) covers over 6% of the population of England and Wales and holds data on diagnoses and prescribing from 1987 onwards. Most previous studies using the GPRD have concentrated on drug use and safety. A study was undertaken to assess the validity of using the GPRD for epidemiological research into respiratory diseases. METHODS Age-specific and sex-specific rates derived from the GPRD for 11 respiratory conditions were compared with patient consultation rates from the 4th Morbidity Survey in General Practice (MSGP4). Within the GPRD comparisons were made between patient diagnosis rates, patient prescription rates, and patient "prescription plus relevant diagnosis" rates for selected treatments. RESULTS There was good agreement between consultation rates in the MSGP4 and diagnosis or "prescription plus diagnosis" from the GPRD in terms of pattern and magnitude, except for "acute bronchitis or bronchiolitis" where the best comparison was the combination category of "chest infection" and/or "acute bronchitis or bronchiolitis". Within the GPRD, patient prescription rates for inhalers, tuberculosis or hayfever therapy showed little similarity with diagnosis only rates but a similarity was seen with the combination of "prescription plus diagnosis" which may be a better reflection of morbidity than diagnosis alone. CONCLUSIONS The GPRD appears to be valid for primary care epidemiological studies by comparison with MSGP4 and offers advantages in terms of large size, a longer time period covered, and ability to link prescriptions with diagnoses. However, careful interpretation is needed because not all consultations are recorded and the coding system used contains terms which do not directly map to ICD codes.
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Affiliation(s)
- A Hansell
- Department of Public Health Sciences, St George's Hospital Medical School, Cranmer Terrace, London SW17 0RE, UK
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Williams H, Robertson C, Stewart A, Aït-Khaled N, Anabwani G, Anderson R, Asher I, Beasley R, Björkstén B, Burr M, Clayton T, Crane J, Ellwood P, Keil U, Lai C, Mallol J, Martinez F, Mitchell E, Montefort S, Pearce N, Shah J, Sibbald B, Strachan D, von Mutius E, Weiland SK. Worldwide variations in the prevalence of symptoms of atopic eczema in the International Study of Asthma and Allergies in Childhood. J Allergy Clin Immunol 1999; 103:125-38. [PMID: 9893196 DOI: 10.1016/s0091-6749(99)70536-1] [Citation(s) in RCA: 604] [Impact Index Per Article: 24.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Little is known about the prevalence of atopic eczema outside Northern Europe. OBJECTIVES We sought to describe the magnitude and variation in the prevalence of atopic eczema symptoms throughout the world. METHODS A cross-sectional questionnaire survey was conducted on random samples of schoolchildren aged 6 to 7 years and 13 to 14 years from centers in 56 countries throughout the world. Those children with a positive response to being questioned about the presence of an itchy relapsing skin rash in the last 12 months that had affected their skin creases were considered to have atopic eczema. Children whose atopic eczema symptoms resulted in sleep disturbance for 1 or more nights per week were considered to have severe atopic eczema. RESULTS Complete data was available for 256,410 children aged 6 to 7 years in 90 centers and 458,623 children aged 13 to 14 years in 153 centers. The prevalence range for symptoms of atopic eczema was from less than 2% in Iran to over 16% in Japan and Sweden in the 6 to 7 year age range and less than 1% in Albania to over 17% in Nigeria for the 13 to 14 year age range. Higher prevalences of atopic eczema symptoms were reported in Australasia and Northern Europe, and lower prevalences were reported in Eastern and Central Europe and Asia. Similar patterns were seen for symptoms of severe atopic eczema. CONCLUSIONS Atopic eczema is a common health problem for children and adolescents throughout the world. Symptoms of atopic eczema exhibit wide variations in prevalence both within and between countries inhabited by similar ethnic groups, suggesting that environmental factors may be critical in determining disease expression. Studies that include objective skin examinations are required to confirm these findings.
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Affiliation(s)
- H Williams
- Queen's Medical Centre, University Hospital, Nottingham, United Kingdom
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