Daniel Dedman - Academia.edu (original) (raw)
Papers by Daniel Dedman
medRxiv (Cold Spring Harbor Laboratory), May 15, 2024
We followed individuals between September 2020 and the latest available data from the day they fu... more We followed individuals between September 2020 and the latest available data from the day they fulfilled at least 365 days of prior observation (general population), additionally from day 91 after a SARS-Cov-2 negative test (comparator) or a COVID-19 record (exposed patients). We assessed postural orthostatic tachycardia syndrome (POTS) diagnoses/symptoms, myalgic encephalomyelitis / chronic fatigues syndrome (ME/CFS) diagnoses/symptoms, multi-inflammatory syndrome (MIS), and several autoimmune diseases. For contextualisation, we assessed any diabetes mellitus (DM). Meta-analysed crude incidence rate ratios (IRR) of outcomes measures after COVID-19 versus negative testing yield the ratios of absolute risks. Furthermore, incidence rates (IR) of the outcomes in the general population describe the total disease burden. We included 34'549'575 individuals of whom 2'521'812 had COVID-19, and 4'233'145 a first negative test. After COVID-19 compared to test negative patients, we observed IRRs of 1.24 (1.23-1.25), 1.22 (1.21-1.23), and 1.12 (1.04-1.21) for POTS symptoms, ME/CFS symptoms and diagnoses, respectively. In contrast, autoimmune diseases and DM did not yield higher rates after COVID-19. In individual general database populations, IRs of POTS and ME/CFS diagnoses were 17-1'477/100'000 person-years (pys) and 2-473/100'000 pys, respectively. IRs of MIS were lowest with IRs 0.4-16/100'000 pys, those of DM as a benchmark 8-86/100'000 pys. IRs largely depended on the care setting. In our unmatched comparison, we observed that, following COVID-19, POTS and ME/CFS yielded higher rates than after negative testing. In absolute terms, we observed POTS and ME/CFS diagnoses to have a similar disease burden as DM. Keywords COVID-19, postural orthostatic tachycardia syndrome, myalgic encephalomyelitis / chronic fatigues syndrome, ME/CFS, rheumatoid arthritis, juvenile idiopathic arthritis, systemic lupus erythematosus, inflammatory bowel disease, multiple inflammatory syndrome, PACS, PASC, post-COVID-19 conditions, PCC, post-acute sequelae of COVID-19, epidemiology, disease burden, network study, cohort study, SARS-Cov-2 WHAT IS ALREADY KNOWN ON THIS TOPIC • Observational research suggested positive associations between COVID-19 and so called post-acute COVID-19 conditions, whose spectrum is yet to be established • Basic research suggested pathways that link COVID-19 with autoimmune-and inflammatory diseases such as postural orthostatic tachycardia syndrome (POTS), myalgic encephalomyelitis / chronic fatigues syndrome (ME/CFS), multiple inflammatory syndrome (MIS), and autoimmune diseases WHAT THIS STUDY ADDS • After COVID-19, the rates of POTS symptoms and ME/CFS symptoms/diagnoses was higher than those after negative testing • After COVID-19 versus negative testing, rates of ME/CFS diagnoses were increased in the working age group and rates of symptoms of POTS and ME/CFS were increased in children and elderly • Disease burdens of POTS and ME/CFS diagnoses in the general population were higher among women than among men and overall similar to that of diabetes mellitus .
Incidence of Post-Acute COVID-19 Symptoms in 7 Countries: An International Network Cohort Study
Research Square (Research Square), Apr 10, 2024
Prior evidence has suggested the multisystem symptomatic manifestations of post-acute COVID-19 co... more Prior evidence has suggested the multisystem symptomatic manifestations of post-acute COVID-19 condition (PCC). Here we conducted a network cluster analysis of 24 WHO proposed symptoms to identify potential latent subclasses of PCC. Individuals with a positive test of or diagnosed with SARS-CoV-2 after 09/2020 and with at least one symptom within ≥ 90 to 365 days following infection were included. Sub-analyses were conducted among people with ≥ 3 different symptoms. Summary characteristics were provided for each cluster. All analyses were conducted separately in 9 databases from 7 countries, including data from primary care, hospitals, national health claims and national health registries, allowing to validate clusters across the different healthcare settings. 787,078 persons with PCC were included. Single-symptom clusters were common across all databases, particularly for joint pain, anxiety, depression and allergy. Complex clusters included anxiety-depression and abdominalgastrointestinal symptoms. Substantial heterogeneity within and between PCC clusters was seen across healthcare settings. Current de nitions of PCC should be critically reviewed to re ect this variety in clinical presentation.
Drug Safety
Introduction Individual case reports are the main asset in pharmacovigilance signal management. S... more Introduction Individual case reports are the main asset in pharmacovigilance signal management. Signal validation is the first stage after signal detection and aims to determine if there is sufficient evidence to justify further assessment. Throughout signal management, a prioritization of signals is continually made. Routinely collected health data can provide relevant contextual information but are primarily used at a later stage in pharmacoepidemiological studies to assess communicated signals. Objective The aim of this study was to examine the feasibility and utility of analysing routine health data from a multinational distributed network to support signal validation and prioritization and to reflect on key user requirements for these analyses to become an integral part of this process. Methods Statistical signal detection was performed in VigiBase, the WHO global database of individual case safety reports, targeting generic manufacturer drugs and 16 prespecified adverse events. During a 5-day study-a-thon, signal validation and prioritization were performed using information from VigiBase, regulatory documents and the scientific literature alongside descriptive analyses of routine health data from 10 partners of the European Health Data and Evidence Network (EHDEN). Databases included in the study were from the UK, Spain, Norway, the Netherlands and Serbia, capturing records from primary care and/or hospitals. Results Ninety-five statistical signals were subjected to signal validation, of which eight were considered for descriptive analyses in the routine health data. Design, execution and interpretation of results from these analyses took up to a few hours for each signal (of which 15-60 minutes were for execution) and informed decisions for five out of eight signals. The impact of insights from the routine health data varied and included possible alternative explanations, potential public health and clinical impact and feasibility of follow-up pharmacoepidemiological studies. Three signals were selected for signal assessment, two of these decisions were supported by insights from the routine health data. Standardization of analytical code, availability of adverse event phenotypes including bridges between different source vocabularies, and governance around the access and use of routine health data were identified as important aspects for future development. Conclusions Analyses of routine health data from a distributed network to support signal validation and prioritization are feasible in the given time limits and can inform decision making. The cost-benefit of integrating these analyses at this stage of signal management requires further research. O. Gauffin et al.
BMJ open, Feb 1, 2024
Pooling of primary care electronic health record (EHR) data on Huntington's disease (HD) and canc... more Pooling of primary care electronic health record (EHR) data on Huntington's disease (HD) and cancer: establishing comparability of two large UK databases. BMJ Open 2024;14:e070258.
Legionnaires' disease surveillance: England and Wales, 1993
PubMed, Sep 16, 1994
One hundred and twenty-nine cases of legionnaires' disease were reported in England and Wales in ... more One hundred and twenty-nine cases of legionnaires' disease were reported in England and Wales in 1993. Twenty-two of the cases died. Sixty-six cases (51%) were associated with travel (in the United Kingdom or abroad), six were associated with a stay in hospital, and the remaining 57 were thought to have acquired infection in the community. Two community and two hospital outbreaks were recognised in England and Wales and four outbreaks were detected in travellers from the United Kingdom to Spain, Greece, and the United States. One hundred and six cases (82%) were not known to have been associated with outbreaks, and 51 (40%) of these were not associated with travel or hospitals.
Influenza surveillance in England and Wales: October 1996 to June 1997
PubMed, Dec 12, 1997
This report summarises information collected for the surveillance of influenza in England and Wal... more This report summarises information collected for the surveillance of influenza in England and Wales during the winter of 1996/97. Consultations for 'influenza and influenza-like illness' with sentinel general practitioners in England and Wales began to increase towards the end of November and peaked at the start of January. In England, consultations for 'aggregated respiratory disease' (ARD) began to increase a little earlier, perhaps as a result of increased respiratory syncytial virus activity, but also peaked in early January. Influenza A (H3N2) viruses were first detected in early October, but rarely until November, and activity peaked in early January, coinciding with the peak in consultations for flu-like illness. A few influenza B viruses were detected in late November and early December, and substantial activity was recorded in mid-January. Approximately equal numbers of influenza A(H3N2) and B viruses were identified over the winter as a whole, and circulating strains were antigenically similar to those included in the vaccine for 1996/97. Although influenza activity was 'moderate' in terms of consultations and laboratory confirmed infections, a large peak in death registrations occurred at the same time as influenza A(H3N2) virus activity peaked. The number of deaths during the winter was similar to that seen in 1989/90, when the last severe influenza epidemic occurred in England and Wales.
Epidemiology and Infection, Aug 1, 1998
Data from the national surveillance scheme for general outbreaks of intestinal disease, and the n... more Data from the national surveillance scheme for general outbreaks of intestinal disease, and the national laboratory reporting scheme were used to describe the epidemiology of small round structured virus (SRSV) infections in England and Wales. Between 1990 and 1995, there were 7492 laboratory reports of SRSV. Rates of reported illness were highest among infants, young children and the elderly. During 1992-5, some 707 SRSV outbreaks were reported. Outbreaks in hospital wards and residential facilities for the elderly accounted for 76% of the total, and annual numbers increased more than sixfold over the study period. There were wide regional variations in the numbers of SRSV outbreaks and laboratory reports. Both sporadic cases and outbreaks in the community are likely to be underestimated, but these passive surveillance systems provide an insight into the burden of SRSV infection among the institutionalized elderly.
Influenza activity in Europe, 1997/98
Weekly releases (1997–2007), Jan 8, 1998
Work package 4: bisphosphonate use and bone mineral density
Work package 2: the relationship between bisphosphonate use and incident symptomatic (clinical) osteoporotic fractures
Work package 1: the association between the use of bisphosphonates and the progression of kidney disease
Additional results from work package 1
Journal of Bone and Mineral Research, 2017
Oral Bisphosphonates (oBP) have been associated with reduced fractures and mortality. However, th... more Oral Bisphosphonates (oBP) have been associated with reduced fractures and mortality. However, their risks and benefits are unclear in patients with moderate-severe CKD. This study examined the association between oBP and all-cause mortality in G3B-5D CKD. This is a population-based cohort study including all subjects with an eGFR<45/ml/min/1.73m 2 aged 40+ years from the UK Clinical Practice Research Datalink (CPRD) and the Catalan Information System for Research in Primary Care (SIDIAP). Previous and current users of other anti-osteoporosis drugs were excluded. oBP use was modelled as a time-varying exposure to avoid immortal time bias. Treatment episodes in oBP users were created by This article is protected by copyright. All rights reserved. Accepted Article concatenating prescriptions until patients switched or stopped therapy or were censored or died. A washout period of 180 days was added to (date of last prescription +180 days). Propensity scores (PS) were calculated using pre-specified predictors of mortality including age, gender, baseline eGFR, socioeconomic status, co-morbidities, previous fracture, comedications and number of hospital admissions in the previous year. Cox models were used for PS adjustment before and after PS trimming (the first and last quintiles). In the CPRD, of 19,351 oBP users and 210,954 non-oBP users, 5,234 (27%) and 85,105 (40%) deaths were recorded over 45,690 and 915,867 person-years of follow-up, respectively. oBP users had 8% lower mortality risk compared to non-oBP users (HR 0.92, 95% CI 0.89-0.95). Following PS trimming, this became non-significant (HR 0.98, 95% CI 0.94-1.04). In the SIDIAP, of 4,146 oBP users 86,127 non-oBP users, 1,330 (32%) and 36,513 (42%) died, respectively. oBP were not associated with mortality in PS adjustment and trimming (HR 1.04, 95% CI 0.99-1.1 and HR 0.95, 95% CI 0.89-1.01). In this observational, patient-based cohort study, oBP were not associated with increased mortality amongst patients with moderate-severe CKD. However, further studies are needed on other effects of oBP in CKD patients.
Oral bisphosphonate use and risk of acute Kidney Injury, gastrointestinal events and hypocalcaemia in patients with moderate-advanced chronic kidney disease: a population-based cohort study
Journal of Bone and Mineral Research, 2017
Value in Health, Nov 1, 2013
A495 treated. The savings mainly resulted from shorter operating time (13 Minutes) and decreased ... more A495 treated. The savings mainly resulted from shorter operating time (13 Minutes) and decreased hospital stay (0.7 days). ConClusions: Although the instrument cost is higher for the ultrasonic device, the total procedural cost is lower compared to electrosurgery. Utilization of the Harmonic® ultrasonic device in laparoscopic cholecystectomy can lead to substantial cost savings for US hospitals. PGI16 MortalIty and MedIcal costs assocIated wIth lIver-related dIseases aMonG PatIents wIth hePatItIs c vIrus(hcv) InfectIon In taIwan
Biochemical Journal, 1992
Ferritin has been isolated and its subunit composition, iron and aluminium content determined in ... more Ferritin has been isolated and its subunit composition, iron and aluminium content determined in the cerebral cortex and cerebellum of normal individuals and in the cerebral cortex of Alzheimer's-disease and renal-dialysis patients. An e.l.i.s.a. for ferritin has been developed and the ferritin, non-haem iron and aluminium content of the parietal cortex were determined in normal individuals and Alzheimer's-disease patients. It was found that ferritin from the cerebral cortex and cerebellum of normal individuals had a high H-subunit content, similar to that of heart ferritin. The subunit composition of ferritin isolated from the cerebral cortex was not significantly altered in Alzheimer's-disease or renal-dialysis patients. Ferritin from the cerebral cortex of normal individuals had only approx. 1500 atoms of iron per molecule and the iron content of ferritin was not significantly changed in Alzheimer's-disease or renal-dialysis patients. Ferritin isolated from the ce...
597The value of repeat serum PSA measurements in the detection of prostate cancer — Experience from the UK protect study
European Urology Supplements, 2005
Journal of Epidemiology & Community Health, 2001
Background and objective: The optimum management of localised prostate cancer is unclear, with no... more Background and objective: The optimum management of localised prostate cancer is unclear, with no evidence from randomised controlled trials comparing the treatment options: surgery, radiotherapy or monitoring ('watchful waiting'). We have used routine data to examine patterns of utilisation of one of these treatments, radical prostatectomy, in NHS hospitals. Methods: Numbers of radical prostatectomies performed in English NHS hospitals were obtained from the Hospital Episode Statistics database for 1991-1997. Directly age-standardised operation rates were calculated for NHS regions and ward deprivation quintiles. The relative risk of admission for radical prostatectomy was calculated by ward deprivation quintile. Findings: There was a 14-fold increase in surgery, and a five-fold increase in the number of Trusts undertaking surgery, over the study period. By 1997 under half of all operations occurred in Trusts where surgeons operated more than once a month. Rates of surgery were greatest in the South East and Northern and Yorkshire NHS regions. In NHS regions outside London risk of surgery in an NHS hospital was significantly greater for men living in aZuent areas (RR=1.6, 95% confidence interval 1.3 to 1.9, P TREND <0.001), in London this trend was reversed (RR=0.2, 95% confidence interval 0.1 to 0.6, P TREND <0.001). Interpretation: In the absence of evidence of eVectiveness, use of radical prostatectomy has increased dramatically in England in recent years. This increase in surgery, and local variations in its development, probably reflects a combination of access to PSA testing, particularly through the private sector, and urologists' preferences. By 1997 most operations were still being performed in 'low-volume' hospitals, which may have implications for quality of care and subsequent outcome. Rational development of care for men with early prostate cancer should be informed ideally by a randomised trial of treatment options, or, at a minimum, by the routine collection of outcome data.
Contextualising adverse events of special interest to characterise the baseline incidence rates in 24 million patients with COVID-19 across 26 databases: a multinational retrospective cohort study
eClinicalMedicine
medRxiv (Cold Spring Harbor Laboratory), May 15, 2024
We followed individuals between September 2020 and the latest available data from the day they fu... more We followed individuals between September 2020 and the latest available data from the day they fulfilled at least 365 days of prior observation (general population), additionally from day 91 after a SARS-Cov-2 negative test (comparator) or a COVID-19 record (exposed patients). We assessed postural orthostatic tachycardia syndrome (POTS) diagnoses/symptoms, myalgic encephalomyelitis / chronic fatigues syndrome (ME/CFS) diagnoses/symptoms, multi-inflammatory syndrome (MIS), and several autoimmune diseases. For contextualisation, we assessed any diabetes mellitus (DM). Meta-analysed crude incidence rate ratios (IRR) of outcomes measures after COVID-19 versus negative testing yield the ratios of absolute risks. Furthermore, incidence rates (IR) of the outcomes in the general population describe the total disease burden. We included 34'549'575 individuals of whom 2'521'812 had COVID-19, and 4'233'145 a first negative test. After COVID-19 compared to test negative patients, we observed IRRs of 1.24 (1.23-1.25), 1.22 (1.21-1.23), and 1.12 (1.04-1.21) for POTS symptoms, ME/CFS symptoms and diagnoses, respectively. In contrast, autoimmune diseases and DM did not yield higher rates after COVID-19. In individual general database populations, IRs of POTS and ME/CFS diagnoses were 17-1'477/100'000 person-years (pys) and 2-473/100'000 pys, respectively. IRs of MIS were lowest with IRs 0.4-16/100'000 pys, those of DM as a benchmark 8-86/100'000 pys. IRs largely depended on the care setting. In our unmatched comparison, we observed that, following COVID-19, POTS and ME/CFS yielded higher rates than after negative testing. In absolute terms, we observed POTS and ME/CFS diagnoses to have a similar disease burden as DM. Keywords COVID-19, postural orthostatic tachycardia syndrome, myalgic encephalomyelitis / chronic fatigues syndrome, ME/CFS, rheumatoid arthritis, juvenile idiopathic arthritis, systemic lupus erythematosus, inflammatory bowel disease, multiple inflammatory syndrome, PACS, PASC, post-COVID-19 conditions, PCC, post-acute sequelae of COVID-19, epidemiology, disease burden, network study, cohort study, SARS-Cov-2 WHAT IS ALREADY KNOWN ON THIS TOPIC • Observational research suggested positive associations between COVID-19 and so called post-acute COVID-19 conditions, whose spectrum is yet to be established • Basic research suggested pathways that link COVID-19 with autoimmune-and inflammatory diseases such as postural orthostatic tachycardia syndrome (POTS), myalgic encephalomyelitis / chronic fatigues syndrome (ME/CFS), multiple inflammatory syndrome (MIS), and autoimmune diseases WHAT THIS STUDY ADDS • After COVID-19, the rates of POTS symptoms and ME/CFS symptoms/diagnoses was higher than those after negative testing • After COVID-19 versus negative testing, rates of ME/CFS diagnoses were increased in the working age group and rates of symptoms of POTS and ME/CFS were increased in children and elderly • Disease burdens of POTS and ME/CFS diagnoses in the general population were higher among women than among men and overall similar to that of diabetes mellitus .
Incidence of Post-Acute COVID-19 Symptoms in 7 Countries: An International Network Cohort Study
Research Square (Research Square), Apr 10, 2024
Prior evidence has suggested the multisystem symptomatic manifestations of post-acute COVID-19 co... more Prior evidence has suggested the multisystem symptomatic manifestations of post-acute COVID-19 condition (PCC). Here we conducted a network cluster analysis of 24 WHO proposed symptoms to identify potential latent subclasses of PCC. Individuals with a positive test of or diagnosed with SARS-CoV-2 after 09/2020 and with at least one symptom within ≥ 90 to 365 days following infection were included. Sub-analyses were conducted among people with ≥ 3 different symptoms. Summary characteristics were provided for each cluster. All analyses were conducted separately in 9 databases from 7 countries, including data from primary care, hospitals, national health claims and national health registries, allowing to validate clusters across the different healthcare settings. 787,078 persons with PCC were included. Single-symptom clusters were common across all databases, particularly for joint pain, anxiety, depression and allergy. Complex clusters included anxiety-depression and abdominalgastrointestinal symptoms. Substantial heterogeneity within and between PCC clusters was seen across healthcare settings. Current de nitions of PCC should be critically reviewed to re ect this variety in clinical presentation.
Drug Safety
Introduction Individual case reports are the main asset in pharmacovigilance signal management. S... more Introduction Individual case reports are the main asset in pharmacovigilance signal management. Signal validation is the first stage after signal detection and aims to determine if there is sufficient evidence to justify further assessment. Throughout signal management, a prioritization of signals is continually made. Routinely collected health data can provide relevant contextual information but are primarily used at a later stage in pharmacoepidemiological studies to assess communicated signals. Objective The aim of this study was to examine the feasibility and utility of analysing routine health data from a multinational distributed network to support signal validation and prioritization and to reflect on key user requirements for these analyses to become an integral part of this process. Methods Statistical signal detection was performed in VigiBase, the WHO global database of individual case safety reports, targeting generic manufacturer drugs and 16 prespecified adverse events. During a 5-day study-a-thon, signal validation and prioritization were performed using information from VigiBase, regulatory documents and the scientific literature alongside descriptive analyses of routine health data from 10 partners of the European Health Data and Evidence Network (EHDEN). Databases included in the study were from the UK, Spain, Norway, the Netherlands and Serbia, capturing records from primary care and/or hospitals. Results Ninety-five statistical signals were subjected to signal validation, of which eight were considered for descriptive analyses in the routine health data. Design, execution and interpretation of results from these analyses took up to a few hours for each signal (of which 15-60 minutes were for execution) and informed decisions for five out of eight signals. The impact of insights from the routine health data varied and included possible alternative explanations, potential public health and clinical impact and feasibility of follow-up pharmacoepidemiological studies. Three signals were selected for signal assessment, two of these decisions were supported by insights from the routine health data. Standardization of analytical code, availability of adverse event phenotypes including bridges between different source vocabularies, and governance around the access and use of routine health data were identified as important aspects for future development. Conclusions Analyses of routine health data from a distributed network to support signal validation and prioritization are feasible in the given time limits and can inform decision making. The cost-benefit of integrating these analyses at this stage of signal management requires further research. O. Gauffin et al.
BMJ open, Feb 1, 2024
Pooling of primary care electronic health record (EHR) data on Huntington's disease (HD) and canc... more Pooling of primary care electronic health record (EHR) data on Huntington's disease (HD) and cancer: establishing comparability of two large UK databases. BMJ Open 2024;14:e070258.
Legionnaires' disease surveillance: England and Wales, 1993
PubMed, Sep 16, 1994
One hundred and twenty-nine cases of legionnaires' disease were reported in England and Wales in ... more One hundred and twenty-nine cases of legionnaires' disease were reported in England and Wales in 1993. Twenty-two of the cases died. Sixty-six cases (51%) were associated with travel (in the United Kingdom or abroad), six were associated with a stay in hospital, and the remaining 57 were thought to have acquired infection in the community. Two community and two hospital outbreaks were recognised in England and Wales and four outbreaks were detected in travellers from the United Kingdom to Spain, Greece, and the United States. One hundred and six cases (82%) were not known to have been associated with outbreaks, and 51 (40%) of these were not associated with travel or hospitals.
Influenza surveillance in England and Wales: October 1996 to June 1997
PubMed, Dec 12, 1997
This report summarises information collected for the surveillance of influenza in England and Wal... more This report summarises information collected for the surveillance of influenza in England and Wales during the winter of 1996/97. Consultations for 'influenza and influenza-like illness' with sentinel general practitioners in England and Wales began to increase towards the end of November and peaked at the start of January. In England, consultations for 'aggregated respiratory disease' (ARD) began to increase a little earlier, perhaps as a result of increased respiratory syncytial virus activity, but also peaked in early January. Influenza A (H3N2) viruses were first detected in early October, but rarely until November, and activity peaked in early January, coinciding with the peak in consultations for flu-like illness. A few influenza B viruses were detected in late November and early December, and substantial activity was recorded in mid-January. Approximately equal numbers of influenza A(H3N2) and B viruses were identified over the winter as a whole, and circulating strains were antigenically similar to those included in the vaccine for 1996/97. Although influenza activity was 'moderate' in terms of consultations and laboratory confirmed infections, a large peak in death registrations occurred at the same time as influenza A(H3N2) virus activity peaked. The number of deaths during the winter was similar to that seen in 1989/90, when the last severe influenza epidemic occurred in England and Wales.
Epidemiology and Infection, Aug 1, 1998
Data from the national surveillance scheme for general outbreaks of intestinal disease, and the n... more Data from the national surveillance scheme for general outbreaks of intestinal disease, and the national laboratory reporting scheme were used to describe the epidemiology of small round structured virus (SRSV) infections in England and Wales. Between 1990 and 1995, there were 7492 laboratory reports of SRSV. Rates of reported illness were highest among infants, young children and the elderly. During 1992-5, some 707 SRSV outbreaks were reported. Outbreaks in hospital wards and residential facilities for the elderly accounted for 76% of the total, and annual numbers increased more than sixfold over the study period. There were wide regional variations in the numbers of SRSV outbreaks and laboratory reports. Both sporadic cases and outbreaks in the community are likely to be underestimated, but these passive surveillance systems provide an insight into the burden of SRSV infection among the institutionalized elderly.
Influenza activity in Europe, 1997/98
Weekly releases (1997–2007), Jan 8, 1998
Work package 4: bisphosphonate use and bone mineral density
Work package 2: the relationship between bisphosphonate use and incident symptomatic (clinical) osteoporotic fractures
Work package 1: the association between the use of bisphosphonates and the progression of kidney disease
Additional results from work package 1
Journal of Bone and Mineral Research, 2017
Oral Bisphosphonates (oBP) have been associated with reduced fractures and mortality. However, th... more Oral Bisphosphonates (oBP) have been associated with reduced fractures and mortality. However, their risks and benefits are unclear in patients with moderate-severe CKD. This study examined the association between oBP and all-cause mortality in G3B-5D CKD. This is a population-based cohort study including all subjects with an eGFR<45/ml/min/1.73m 2 aged 40+ years from the UK Clinical Practice Research Datalink (CPRD) and the Catalan Information System for Research in Primary Care (SIDIAP). Previous and current users of other anti-osteoporosis drugs were excluded. oBP use was modelled as a time-varying exposure to avoid immortal time bias. Treatment episodes in oBP users were created by This article is protected by copyright. All rights reserved. Accepted Article concatenating prescriptions until patients switched or stopped therapy or were censored or died. A washout period of 180 days was added to (date of last prescription +180 days). Propensity scores (PS) were calculated using pre-specified predictors of mortality including age, gender, baseline eGFR, socioeconomic status, co-morbidities, previous fracture, comedications and number of hospital admissions in the previous year. Cox models were used for PS adjustment before and after PS trimming (the first and last quintiles). In the CPRD, of 19,351 oBP users and 210,954 non-oBP users, 5,234 (27%) and 85,105 (40%) deaths were recorded over 45,690 and 915,867 person-years of follow-up, respectively. oBP users had 8% lower mortality risk compared to non-oBP users (HR 0.92, 95% CI 0.89-0.95). Following PS trimming, this became non-significant (HR 0.98, 95% CI 0.94-1.04). In the SIDIAP, of 4,146 oBP users 86,127 non-oBP users, 1,330 (32%) and 36,513 (42%) died, respectively. oBP were not associated with mortality in PS adjustment and trimming (HR 1.04, 95% CI 0.99-1.1 and HR 0.95, 95% CI 0.89-1.01). In this observational, patient-based cohort study, oBP were not associated with increased mortality amongst patients with moderate-severe CKD. However, further studies are needed on other effects of oBP in CKD patients.
Oral bisphosphonate use and risk of acute Kidney Injury, gastrointestinal events and hypocalcaemia in patients with moderate-advanced chronic kidney disease: a population-based cohort study
Journal of Bone and Mineral Research, 2017
Value in Health, Nov 1, 2013
A495 treated. The savings mainly resulted from shorter operating time (13 Minutes) and decreased ... more A495 treated. The savings mainly resulted from shorter operating time (13 Minutes) and decreased hospital stay (0.7 days). ConClusions: Although the instrument cost is higher for the ultrasonic device, the total procedural cost is lower compared to electrosurgery. Utilization of the Harmonic® ultrasonic device in laparoscopic cholecystectomy can lead to substantial cost savings for US hospitals. PGI16 MortalIty and MedIcal costs assocIated wIth lIver-related dIseases aMonG PatIents wIth hePatItIs c vIrus(hcv) InfectIon In taIwan
Biochemical Journal, 1992
Ferritin has been isolated and its subunit composition, iron and aluminium content determined in ... more Ferritin has been isolated and its subunit composition, iron and aluminium content determined in the cerebral cortex and cerebellum of normal individuals and in the cerebral cortex of Alzheimer's-disease and renal-dialysis patients. An e.l.i.s.a. for ferritin has been developed and the ferritin, non-haem iron and aluminium content of the parietal cortex were determined in normal individuals and Alzheimer's-disease patients. It was found that ferritin from the cerebral cortex and cerebellum of normal individuals had a high H-subunit content, similar to that of heart ferritin. The subunit composition of ferritin isolated from the cerebral cortex was not significantly altered in Alzheimer's-disease or renal-dialysis patients. Ferritin from the cerebral cortex of normal individuals had only approx. 1500 atoms of iron per molecule and the iron content of ferritin was not significantly changed in Alzheimer's-disease or renal-dialysis patients. Ferritin isolated from the ce...
597The value of repeat serum PSA measurements in the detection of prostate cancer — Experience from the UK protect study
European Urology Supplements, 2005
Journal of Epidemiology & Community Health, 2001
Background and objective: The optimum management of localised prostate cancer is unclear, with no... more Background and objective: The optimum management of localised prostate cancer is unclear, with no evidence from randomised controlled trials comparing the treatment options: surgery, radiotherapy or monitoring ('watchful waiting'). We have used routine data to examine patterns of utilisation of one of these treatments, radical prostatectomy, in NHS hospitals. Methods: Numbers of radical prostatectomies performed in English NHS hospitals were obtained from the Hospital Episode Statistics database for 1991-1997. Directly age-standardised operation rates were calculated for NHS regions and ward deprivation quintiles. The relative risk of admission for radical prostatectomy was calculated by ward deprivation quintile. Findings: There was a 14-fold increase in surgery, and a five-fold increase in the number of Trusts undertaking surgery, over the study period. By 1997 under half of all operations occurred in Trusts where surgeons operated more than once a month. Rates of surgery were greatest in the South East and Northern and Yorkshire NHS regions. In NHS regions outside London risk of surgery in an NHS hospital was significantly greater for men living in aZuent areas (RR=1.6, 95% confidence interval 1.3 to 1.9, P TREND <0.001), in London this trend was reversed (RR=0.2, 95% confidence interval 0.1 to 0.6, P TREND <0.001). Interpretation: In the absence of evidence of eVectiveness, use of radical prostatectomy has increased dramatically in England in recent years. This increase in surgery, and local variations in its development, probably reflects a combination of access to PSA testing, particularly through the private sector, and urologists' preferences. By 1997 most operations were still being performed in 'low-volume' hospitals, which may have implications for quality of care and subsequent outcome. Rational development of care for men with early prostate cancer should be informed ideally by a randomised trial of treatment options, or, at a minimum, by the routine collection of outcome data.
Contextualising adverse events of special interest to characterise the baseline incidence rates in 24 million patients with COVID-19 across 26 databases: a multinational retrospective cohort study
eClinicalMedicine