The Airwave Health Monitoring Study was established to evaluate possible health risks associated with use of TETRA, a digital communication system used by police forces and other emergency services ...in Great Britain since 2001. The study has been broadened to investigate more generally the health of the work force.
From 2004, participants from each force who agreed to participate were enrolled either with an enrolment questionnaire or a comprehensive health screening performed locally. This includes questionnaire, 7-day food diaries, anthropometry, measurements of cardiovascular and cognitive function, blood chemistry, coagulation and haematology. Blood and urine samples are stored in vapour phase liquid nitrogen allowing long-term access for biochemical or genetic analysis. Access to the resource is via an access committee and a steering committee, including external scientific advisers as well as representatives of the police officers and staff.
By the end of 2012, the study had recruited 42,112 participants, of whom 35,199 (83.6%) had attended the health screening. Almost two thirds of participants were men and 71% of them were a TETRA user. Being in lower ranks (constable/sergeant and staff) was associated with a worse cardio-metabolic risk profile compared to higher ranks (inspector or chief inspector, superintendent and above).
The Airwave Health Monitoring Study is the only large-scale cohort study of police employees worldwide. The specificities of this sample, such as its well-defined job hierarchy, make it a particularly valuable occupational cohort. Participants have consented to the use of their data and samples for future, currently unspecified, research purposes.
•This study is the first large scale cohort of police employees worldwide.•It investigates the long-term effects on health of TETRA use.•TETRA use is assessed by objective computerised records, questionnaire, and 7 day diaries.•The study collects extensive phenotypic information and stores biological samples.•It is a major resource for biomedical research in the working age population.
ObjectivesPatients with multiple myeloma (MM) experience significant delays in diagnosis due to non-specific symptomatology. The aim of this study was to characterise the frequency and timing of ...clinical features in the primary care setting prior to MM diagnosis.DesignPopulation-based cohort study.SettingElectronic health records data of approximately 17 million patients (2006–2016) within the UK Clinical Practice Research Datalink.ParticipantsPatients aged ≥18 years with newly diagnosed MM (NDMM), no history of solid tumours and ≥2 years registration in a primary care practice prior to MM diagnosis.Main outcome measuresClinical features and symptoms including bone pain, skeletal-related events (SREs), investigation and confirmation of MM diagnostic CRAB criteria (hyperCalcaemia, Renal impairment, Anaemia, Bone lesions) during the 2 years prior to MM diagnosis; time between symptom manifestation and/or relevant investigation and diagnosis of MM.ResultsAmong 2646 patients with NDMM, 47.5% had a bone pain record during the 2-year period prior to MM diagnosis, mainly affecting the back. Regardless of baseline bone pain, investigations for serum calcium level were used in 36.4% of patients prior to MM diagnosis, followed by haemoglobin (65.6%) or renal function (74.1%). Median (Q1, Q3) time from first-recorded bone pain to MM diagnosis was 220 (80, 476) days. Median (Q1, Q3) time from first-recorded hypercalcaemia, renal impairment or anaemia to MM diagnosis was 23 (12, 46), 58 (17, 254) and 73 days (28, 232), respectively. An imaging investigation or referral for imaging was recorded for 60.0% of patients with bone pain/SRE and 32% without.ConclusionsNearly half of patients diagnosed with NDMM presented with bone pain approximately 7 months prior to MM diagnosis. Investigations to evaluate all CRAB criteria, including targeted imaging, were underused. Early recognition of myeloma clinical features and optimised use of investigations in primary care may potentially expedite MM diagnosis.
Introduction
Limited information exists on the epidemiology, treatment, and burden of palmoplantar pustulosis (PPP) and defining the optimal course of treatment remains challenging without approved ...targeted treatments in most countries. Here, we describe the clinical and demographic characteristics, treatments received, and negative health outcomes experienced among patients with PPP in the United States (US) and Germany.
Methods
Retrospective cohort study between 2016 and 2021 using data from the US Merative™ MarketScan® Research Database and IQVIA™ German Disease Analyzer. Adult patients with PPP (ICD-10-CM L40.3) were followed from the date of their first qualifying PPP diagnosis and continued until the earlier of disenrollment or end date of database, during which treatment patterns and incidence rates of negative health outcomes were assessed. Treatment patterns included adherence, non-persistence, discontinuation, re-initiation, switching, and combination therapy.
Results
The prevalence of PPP was 0.005% and 0.065% in the MarketScan database and German Disease Analyzer, respectively, with 1629 and 3866 patients meeting the inclusion criteria. Most patients were female (71.3%, 67.8%), with mean (SD) age of 54.1 (11.7) and 56.9 (14.3) years, respectively. One year post index, most patients received topical treatment (77.4%, 65.3%), but non-persistence and discontinuation were high. Oral and biologic treatments displayed higher levels of adherence, particularly apremilast and tofacitinib among oral treatments and TNF inhibitors and IL-23 inhibitors among biologics. Rates of negative health outcomes were higher among patients not receiving treatment post-index compared with those receiving treatment post-index across both databases, regardless of prior treatment history.
Conclusions
Establishing treatment guidelines remains an unmet need for patients with PPP and could improve quality of life by reducing the occurrence of negative health outcomes. The findings from this study may provide insight into the effectiveness of current treatment options for patients with PPP and can be leveraged to support the development of treatment guidelines.
Familial hypercholesterolemia (FH) is common, but underdiagnosed, and few systematic early screening programs exist.
To assess health outcomes among those with a recorded diagnosis of FH and ...potential cases of FH with no recorded diagnosis.
Retrospective cohort study using the UK Clinical Practice Research Datalink. Records of adults were classified as diagnosed FH (FHCoded), or via accepted algorithms using LDL-C and clinical characteristics as potential FH (FHPotential) or unlikely FH (FHUnlikely) using the DLCN or EUROASPIRE criteria (but no record of FH). Outcomes assessed were premature cardiovascular (CV) events, premature deaths and life expectancy.
Among 1,729,046 individuals free from CV events, a record of FHCoded before the age of 40 was 0.3/1000 (IQR 0.3–0.4) and increased with age. Where LDL-C levels were available, 1.8/1000 (IQR 1.6–2.0) could be classified as FHPotential. LDL-C was higher for both FHCoded and FHPotential vs FHUnlikely (185.6 and 216.6 vs 116 mg/dL, respectively, p<0.001). Compared to FHUnlikely both FHCoded and FHPotential cohorts had a higher risk of premature cardiovascular events (both p<0.001) with highest rates among FHCoded. Risk of premature deaths did not differ between FHCoded and FHUnlikely, but was 1.88 (95% CI 1.27–2.78, p = 0.002) for FHPotential vs FHCoded and 2.40 (95% CI 1.57–3.67, p<0.001) for FHPotential vs FHUnlikely. At age 18, the FHPotential cohort had a life expectancy 16 years lower than the FHCoded cohort (p<0.001).
Potential cases of FH had a doubling in risk of premature death and a large reduction in life expectancy compared to individuals with a recorded diagnosis of FH. These findings strengthen the critical importance of identifying potential cases of FH early and early treatment.
The objective of this study is to support those undertaking a multi-criteria decision analysis (MCDA) by reviewing the approaches adopted in healthcare MCDAs to date, how these varied with the ...objective of the study, and the lessons learned from this experience. Searches of EMBASE and MEDLINE identified 40 studies that provided 41 examples of MCDA in healthcare. Data were extracted on the objective of the study, methods employed, and decision makers’ and study authors’ reflections on the advantages and disadvantages of the methods. The recent interest in MCDA in healthcare is mirrored in an increase in the application of MCDA to evaluate healthcare interventions. Of the studies identified, the first was published in 1990, but more than half were published since 2011. They were undertaken in 18 different countries, and were designed to support investment (coverage and reimbursement), authorization, prescription, and research funding allocation decisions. Many intervention types were assessed: pharmaceuticals, public health interventions, screening, surgical interventions, and devices. Most used the value measurement approach and scored performance using predefined scales. Beyond these similarities, a diversity of different approaches were adopted, with only limited correspondence between the approach and the type of decision or product. Decision makers consulted as part of these studies, as well as the authors of the studies are positive about the potential of MCDA to improve decision making. Further work is required, however, to develop guidance for those undertaking MCDA.
To ascertain whether increases in psychological symptoms in children and parents after meningococcal disease are sustained over time, and to examine the psychosocial and illness associations of 12-mo ...psychological outcome.
A prospective, cohort study using repeated measures.
Three pediatric intensive care units and 19 general pediatric wards across greater London.
Fifty-six children, aged 3 to 16 yrs, admitted to hospital with meningococcal disease and their parents.
Child and parent psychological symptoms were measured, using the Strengths and Difficulties Questionnaire (SDQ) and the General Health Questionnaire (GHQ) at three time points: before/during hospital admission, 3 mos, and 12 mos after discharge. The Impact of Event Scale (IES) was used at the two follow-up points. During the follow-up period, there were statistically significant increases over child pre-illness levels in parent-rated emotional, conduct, hyperactivity, and impact SDQ scores; the most significant change at 12-mo follow-up was an increase in impact on daily living scores. At 12 mos, five (11%) of 43 children were at risk for posttraumatic stress disorder. The strongest correlations of 12-mo child psychological symptoms (total SDQ scores)--in addition to premorbid total SDQ score--were illness-related changes in parenting, maternal IES and GHQ scores. At 12 mos, 13 (24%) of 54 mothers and six (15%) of 40 fathers scored at high risk for posttraumatic stress disorder. The strongest correlation of maternal posttraumatic stress disorder symptoms (IES scores) was paternal posttraumatic stress disorder symptoms.
Admission to the hospital with meningococcal disease is followed by an increase in psychological symptoms in children at home, some of which are persistent and impairing, and by continuing posttraumatic stress symptoms in a proportion of children and parents. Psychosocial (pre- and postmorbid) factors predict problems at 12-mo follow-up.
Abstract
While multiple studies have evaluated the persistence of biologic agents in patients with plaque psoriasis (Yiu ZZN, Becher G, Kirby B et al. Drug survival associated with effectiveness and ...safety of treatment with guselkumab, ixekizumab, secukinumab, ustekinumab and adalimumab in patients with psoriasis. JAMA Dermatol 2022; 158:1131–41), persistence data for adalimumab biosimilars are limited. From BADBIR, we assessed AMGEVITA persistence in UK patients aged ≥ 18 years with a diagnosis of chronic plaque psoriasis, who had received at least one dose of AMGEVITA between October 2018 and July 2021 with at least 6 months of follow-up. Study outcomes included AMGEVITA persistence at 6, 12, 18 and 24 months (primary); reasons for AMGEVITA discontinuation (secondary) and Psoriasis Area Severity Index (PASI) score from baseline to 6 months after AMGEVITA start date (exploratory). Outcomes were analysed overall and separately for biologic-experienced (transitioned to AMGEVITA from another biologic) vs. biologic-naïve (started AMGEVITA with no prior biologics) patients. Persistence was defined as the continuous use of AMGEVITA from first administration to discontinuation using a permissible gap of < 90 days assessed using Kaplan–Meier survival methodology. Of 1432 eligible patients, most (n = 1,183; 82.6%) were biologic experienced, 40.1% (n = 574) were female and 56% were aged 35–54 years. At AMGEVITA initiation, mean (SD) time since psoriasis diagnosis overall was 25.4 (12.9) years, and 20.6 (12.6) and 26.6 (12.7) years in biologic-naïve and biologic-experienced patients, respectively; mean (SD) PASI was 8.1 (8.7) in the overall population, and 14.8 (7.6) and 3.2 (5.6) in biologic-naïve and biologic-experienced patients, respectively. Overall, AMGEVITA persistence at 6, 12, 18 and 24 months was 0.94 95% confidence interval (CI) 0.93–0.95, 0.87 (95% CI 0.86–0.89), 0.84 (95% CI 0.82–0.86) and 0.82 (95% CI 0.80–0.84), respectively; 17.7% (n = 253) of patients discontinued AMGEVITA and mean (SD) time to discontinuation was 9.4 (6.0) months. The most common reasons for AMGEVITA discontinuation were ineffectiveness (n = 102; 40.3%) and adverse events (n = 74; 29.2%). Persistence at 6, 12, 18 and 24 months was higher in biologic-experienced patients than in biologic-naïve patients: 0.94 (95% CI 0.92–0.95), 0.88 (95% CI 0.86–0.90), 0.85 (95% CI 0.83–0.87) and 0.84 (95% CI 0.81–0.86) vs. 0.94 (95% CI 0.91–0.97), 0.84 (95% CI 0.78–0.88), 0.77 (95% CI 0.71–0.82) and 0.74 (95% CI 0.68–0.80), respectively. Mean (SD) time to AMGEVITA discontinuation was similar in biologic-naïve and biologic-experienced patients: 9.0 (6.1) and 10.5 (5.6) months, respectively. Among patients with non-missing data (n = 94 in both groups), mean (SD) change in PASI score at 6 months was −11.3 (8.6) in biologic-naïve and −1.0 (4.4) in biologic-experienced patients. In conclusion, patients with chronic plaque psoriasis initiating AMGEVITA in UK clinical practice demonstrated high drug persistence over 2 years, irrespective of prior biologic use.
Funding sources: this analysis was funded by Amgen.
Mobile phone use is increasing but there is also concern for adverse health effects. Well-designed prospective studies to assess several health outcomes are required. In designing a study of mobile ...phone use, it is important to assess which factors need to be considered in classifying the exposure to radiofrequency fields (RF). A pilot study was performed in Sweden and in the UK 2002 to 2003 to test the feasibility of recruiting a cohort of mobile phone users from a random population sample and from mobile phone subscription lists for a prospective study. As one part of this pilot study, different factors were evaluated regarding possible influence on the output power of the phones. By local switch logging, information on calls made from predefined subscriptions or dedicated handsets were obtained and the output power of phones during calls made indoors and outdoors, in moving and stationary mode, and in rural as well in urban areas were compared. In this experiment, calls were either 1, 1.5 or 5 min long. The results showed that high mobile phone output power is more frequent in rural areas whereas the other factors (length of call, moving/stationary, indoor/outdoor) were of less importance. Urban and rural area should be considered in an exposure index for classification of the exposure to RF from mobile phones and may be assessed by first base station during mobile phone calls or, if this information is not available, possibly by using home address as a proxy.
To evaluate the presence of data elements related to diagnosis and treatment of malignant breast cancer in CPRD Aurum compared to those in the previously validated CPRD GOLD.
Females in CPRD Aurum or ...GOLD with a first-time code for malignant breast cancer, mastectomy, or ≥1 prescription for tamoxifen or aromatase inhibitors (2004-2019) were selected. We compared the presence of the codes for breast cancer diagnosis, surgeries (mastectomy, lumpectomy), tamoxifen and aromatase inhibitor prescriptions, radiation, chemotherapy, and supporting clinical codes (suspected breast cancer, lump symptoms, biopsy, lumpectomy, cancer care, referral/visit to specialist, palliative care). Age standardized incidence rates of breast cancer diagnosis in CPRD Aurum and GOLD were calculated.
There were 131,936 eligible patients in CPRD Aurum and 69,102 patients in GOLD. A similar proportion of patients in CPRD Aurum and GOLD had codes for breast cancer diagnosis, mastectomy, drug prescriptions, lump, biopsy, lumpectomy, chemotherapy, and cancer and palliative care coded in their electronic record during follow-up. However, suspected breast cancer, radiation, and referral/visits to specialists were coded more frequently in patients in CPRD Aurum compared to GOLD. Age-standardized incidence rates were similar for CPRD Aurum and GOLD.
Overall, there was consistency between data elements related to malignant breast cancer recorded in CPRD Aurum and GOLD, particularly for the most informative clinical details. These findings provide reassurance that breast cancer information recorded in CPRD Aurum is generally comparable to that recorded in the previously validated CPRD GOLD and support the use of CPRD Aurum for breast cancer research.
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