There is an absence of national statistics for maternal obesity in the UK. This study is the first to describe a nationally representative maternal obesity research data set in England.
Retrospective ...epidemiological study of first trimester obesity.
Data from 34 maternity units were analysed, including 619 323 births between 1989 and 2007. Data analysis included trends in first trimester maternal body bass index status over time, and geographical distribution of maternal obesity. Population demographics including maternal age, parity, ethnic group, deprivation and employment were analysed to identify any maternal obesity-associated health inequalities. All demographics were tested for multicollinearity. Logistic regression analyses were adjusted for all demographics as confounders.
First trimester maternal obesity is significantly increasing over time, having more than doubled from 7.6% to 15.6% over 19 years (P<0.001), and shows geographic variation in incidence. There are also demographic health inequalities associated with maternal obesity, including increased odds of being obese with increasing age, parity, Black ethnic group and deprivation. There is also an association between morbid obesity and increased levels of unemployment.
The increase in maternal obesity has serious implications for the health of mothers, infants and service providers, yielding an additional 47 500 women per year requiring high dependency care in England. The demography of women most at risk of first trimester obesity highlights health inequalities associated with maternal obesity, which urgently needs to be addressed.
The ongoing challenge of latent tuberculosis Esmail, H.; Barry, C. E.; Young, D. B. ...
Philosophical transactions - Royal Society. Biological sciences,
06/2014, Letnik:
369, Številka:
1645
Journal Article
Recenzirano
Odprti dostop
The global health community has set itself the task of eliminating tuberculosis (TB) as a public health problem by 2050. Although progress has been made in global TB control, the current decline in ...incidence of 2% yr−1 is far from the rate needed to achieve this. If we are to succeed in this endeavour, new strategies to reduce the reservoir of latently infected persons (from which new cases arise) would be advantageous. However, ascertainment of the extent and risk posed by this group is poor. The current diagnostics tests (tuberculin skin test and interferon-gamma release assays) poorly predict who will develop active disease and the therapeutic options available are not optimal for the scale of the intervention that may be required. In this article, we outline a basis for our current understanding of latent TB and highlight areas where innovation leading to development of novel diagnostic tests, drug regimens and vaccines may assist progress. We argue that the pool of individuals at high risk of progression may be significantly smaller than the 2.33 billion thought to be immune sensitized by Mycobacterium tuberculosis and that identifying and targeting this group will be an important strategy in the road to elimination.
Delirium has recently been shown as a predictor of death, increased cost, and longer duration of stay in ventilated patients. Sedative and analgesic medications relieve anxiety and pain but may ...contribute to patients' transitioning into delirium.
In this cohort study, the authors designed a priori an investigation to determine whether sedative and analgesic medications independently increased the probability of daily transition to delirium. Markov regression modeling (adjusting for 11 covariates) was used in the evaluation of 198 mechanically ventilated patients to determine the probability of daily transition to delirium as a function of sedative and analgesic dose administration during the previous 24 h.
Lorazepam was an independent risk factor for daily transition to delirium (odds ratio, 1.2 95% confidence interval, 1.1-1.4; P = 0.003), whereas fentanyl, morphine, and propofol were associated with higher but not statistically significant odds ratios. Increasing age and Acute Physiology and Chronic Health Evaluation II scores were also independent predictors of transitioning to delirium (multivariable P values < 0.05).
Lorazepam administration is an important and potentially modifiable risk factor for transitioning into delirium even after adjusting for relevant covariates.
A constitutive mutation in a cancer-susceptibility gene can have implications for clinical treatment and genetic counseling of family members. This study involving 1120 children and adolescents ...showed that 95 (8.5%) had such a mutation.
The frequency of germline mutations in cancer-predisposition genes in children and adolescents with cancer and the implications of such mutations are largely unknown. Previous studies have relied mainly on candidate-gene approaches, which are, by design, limited. To better determine the contribution of germline predisposition mutations to childhood cancer, we used next-generation sequencing, including whole-genome and whole-exome sequencing, to analyze the genomes of 1120 children and adolescents with cancer. We describe the prevalence and spectrum of germline variants among 565 cancer-associated genes, with an emphasis on the analysis of 60 genes that have been associated with autosomal dominant cancer-predisposition syndromes. We . . .
Interactions between dark matter (DM) and radiation (photons or neutrinos) in the early Universe suppress density fluctuations on small mass scales. Here, we perform a thorough analysis of structure ...formation in the fully non-linear regime using N-body simulations for models with DM–radiation interactions and compare the results to a traditional calculation in which DM only interacts gravitationally. Significant differences arise due to the presence of interactions, in terms of the number of low-mass DM haloes and their properties, such as their spin and density profile. These differences are clearly seen even for haloes more massive than the scale on which density fluctuations are suppressed. We also show that semi-analytical descriptions of the matter distribution in the non-linear regime fail to reproduce our numerical results, emphasizing the challenge of predicting structure formation in models with physics beyond collisionless DM.
This is a collaboration between the British Society of Gastroenterology (BSG) and the European Society of Gastrointestinal Endoscopy (ESGE), and is a scheduled update of their 2016 guideline on ...endoscopy in patients on antiplatelet or anticoagulant therapy. The guideline development committee included representatives from the British Society of Haematology, the British Cardiovascular Intervention Society, and two patient representatives from the charities Anticoagulation UK and Thrombosis UK, as well as gastroenterologists. The process conformed to AGREE II principles and the quality of evidence and strength of recommendations were derived using GRADE methodology. Prior to submission for publication, consultation was made with all member societies of ESGE, including BSG. Evidence-based revisions have been made to the risk categories for endoscopic procedures, and to the categories for risks of thrombosis. In particular a more detailed risk analysis for atrial fibrillation has been employed, and the recommendations for direct oral anticoagulants have been strengthened in light of trial data published since the previous version. A section has been added on the management of patients presenting with acute GI haemorrhage. Important patient considerations are highlighted. Recommendations are based on the risk balance between thrombosis and haemorrhage in given situations.
Preeclampsia is an independent cardiovascular risk factor for the mother, and recent studies reveal that offspring of affected pregnancies also may have an increased cardiovascular risk. Our ...objective was to examine evidence for increased cardiovascular risk factors in children exposed to preeclampsia in utero.
We performed a systematic review and meta-analysis on studies reporting traditional cardiovascular risk factors in those exposed to preeclampsia compared to controls. Information was extracted on the classic cardiovascular risk factors, including blood pressure, lipid profile, glucose metabolism, and BMI from articles published between 1948 and August 2011 in Medline and Embase.
Eighteen studies provided cumulated data on 45,249 individuals. In utero exposure to preeclampsia was associated with a 2.39 mm Hg (95% confidence interval: 1.74-3.05; P < .0001) higher systolic and a 1.35 mm Hg (95% confidence interval: 0.90-1.80; P < .00001) higher diastolic blood pressure during childhood and young adulthood. BMI was increased by 0.62 kg/m2 (P < .00001). Associations were similar in children and adolescents, for different genders, and with variation in birth weight. There was insufficient evidence to identify consistent variation in lipid profile or glucose metabolism.
Young offspring of pregnancies complicated by preeclampsia already have increased blood pressure and BMI, a finding that may need to be considered in future primary prevention strategies for cardiovascular disease.
Organosilanes have become a mainstay in organic synthesis as they can participate in a wide number of reactions where they act as a soft carbon nucleophile. They can engage in coupling reactions ...where C–C, C–N, C–O, or a variety of other bonds are formed. Furthermore, organosilanes are effective coupling partners in C–H activations. Despite their utility, synthesis of organosilanes typically relies on precious metals such as platinum and palladium. In the past several years, there has been considerable effort to develop new procedures, which rely on inexpensive catalysts such as first-row transition metals. More specifically, copper-catalyzed silylations have undergone significant development in the past decade. Copper-catalyzed silylations generally rely on either a silylborane, silylzinc, or disilane as the silicon source. However, a number of different transformations can be performed with this small set of reagents including conjugate addition, addition to alkynes, allenes, and carbonyls, coupling reactions, and substitutions. Nearly all of these transformations exhibit high levels of diastereoselectivity, regioselectivity, or enantioselectivity, depending on the transformation. Moreover, there is still plenty of room for further development of copper-catalyzed silylations, which should provide an inexpensive alternative to more traditional silylations.
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