Brighton and Sussex University Hospitals NHS Trust
Recent publications
Background Tuberous sclerosis complex (TSC)–associated neuropsychiatric disorders (TAND) is an umbrella term for the behavioural, psychiatric, intellectual, academic, neuropsychological and psychosocial manifestations of TSC. Although TAND affects 90% of individuals with TSC during their lifetime, these manifestations are relatively under-assessed, under-treated and under-researched. We performed a comprehensive scoping review of all TAND research to date (a) to describe the existing TAND research landscape and (b) to identify knowledge gaps to guide future TAND research. Methods The study was conducted in accordance with stages outlined within the Arksey and O’Malley scoping review framework. Ten research questions relating to study characteristics, research design and research content of TAND levels and clusters were examined. Results Of the 2841 returned searches, 230 articles published between 1987 and 2020 were included (animal studies = 30, case studies = 47, cohort studies = 153), with more than half published since the term TAND was coined in 2012 (118/230; 51%). Cohort studies largely involved children and/or adolescents (63%) as opposed to older adults (16%). Studies were represented across 341 individual research sites from 45 countries, the majority from the USA (89/341; 26%) and the UK (50/341; 15%). Only 48 research sites (14%) were within low–middle income countries (LMICs). Animal studies and case studies were of relatively high/high quality, but cohort studies showed significant variability. Of the 153 cohort studies, only 16 (10%) included interventions. None of these were non-pharmacological, and only 13 employed remote methodologies (e.g. telephone interviews, online surveys). Of all TAND clusters, the autism spectrum disorder–like cluster was the most widely researched (138/230; 60%) and the scholastic cluster the least (53/200; 27%). Conclusions Despite the recent increase in TAND research, studies that represent participants across the lifespan, LMIC research sites and non-pharmacological interventions were identified as future priorities. The quality of cohort studies requires improvement, to which the use of standardised direct behavioural assessments may contribute. In human studies, the academic level in particular warrants further investigation. Remote technologies could help to address many of the TAND knowledge gaps identified.
Background Outdoor swimming is increasingly popular, with enthusiasts claiming benefits to mental health. However, there is limited research into its effectiveness as an intervention for people with depression and/or anxiety. We aimed to establish recruitment rates and explore potential benefits, for a sea swimming course offered to people with depression and/or anxiety. Methods This was a singlearm, unblinded feasibility study. 61 participants, were recruited to an eight-session sea-swimming course. Attendance rates were recorded. Self-administered questionnaires were completed at baseline, post-course and at three-month follow-up. Free-text descriptions of thoughts about the course were collected using surveys, and 14 participants kept a diary. Results 53 participants (47 female, 5 male, 1 non-binary) were included in the final analysis. Overall attendance was 90.1%. There were reductions showing large effect (between d = 1.4 to 1.7) in the severity scores of both depression and anxiety between the beginning and end of the course. While severity scores marginally increased at three-month follow-up, a reduction from baseline scores for depression, anxiety (d = 1.2 and 1.4, respectively) and functioning scores (d = 0.8) remained. The qualitative analysis identified that ‘confronting challenges', ‘becoming a community’ and ‘appreciating the moment’ were key to the impact, or the 'mechanisms', that resulted in participants experiencing the 'outcomes' of ‘immediate positive changes in mood’, ‘improved mental and physical health’ and ‘increased motivation to swim’. Conclusions This study provides preliminary support for the engagement and acceptability of sea swimming as a novel intervention for depression and/or anxiety. Participants reported positive changes in mental health, indicating the intervention's potential as a public health resource. There was a clear gender difference, which requires further exploration. Larger scale trials are warranted.
Context: Despite improvement in the treatment of multiple myeloma (MM), a significant number of patients do not respond to the existing drug regimens. Objective: In this meta-analysis, we will assess the efficacy of daratumumab in combination with other drug regimens used in the treatment of MM. Design: Meta-analysis. Methods: A literature search was performed on PubMed, Embase, Web of Science, Cochrane, and clinicaltrials.gov with Mesh and Emtree terms, “daratumumab” and “multiple myeloma,” from the inception of data to 27 March 2022. R software was used to conduct the meta-analysis. Interventions: Daratumumab versus control. Main Outcome Measures: Pooled hazard ratio (HR) of progression-free survival (PFS), relative risk (RR) of overall response (OR), and RR of complete response (CR). Results: A total of 4,564 articles were screened, and 9 randomized clinical trials (RCTs, N=4,725) were included. All patients were adults (>18 years). Daratumumab was given to 2,481 patients in combination with regimens including lenalidomide + dexamethasone (N=649), pomalidomide + dexamethasone (N=151), bortezomib + dexamethasone (N=377), bortezomib + melphalan + prednisone (N=350), bortezomib + thalidomide + dexamethasone (N=543), carfilzomib + dexamethasone (N=312), and lenalidomide + bortezomib + dexamethasone (N=99), whereas no daratumumab was given to 2,244 patients. In relapsed/refractory multiple myeloma (RRMM) patients (N=2,001), RR of OR was 1.25 (95% CI=1.17–1.32, I²=32%), CR was 2.46 (95% CI=2.02–3, I²=31%), and HR of PFS was 0.59 (95% CI=0.50–0.69, I2=70%), all in favor of daratumumab versus the control. In stem cell transplant (SCT)-eligible patients (N=1,281), RR of OR was 1.05 (95% CI=1–1.09, I²=33%), CR was 1.4 (95% CI=1.16–1.69, I²=32%), and HR of PFS was 0.58 (95% CI=0.49–0.69, I²=0%), all in favor of daratumumab versus the control as induction and consolidation therapy. In SCT-ineligible patients (N=1,443), RR of OR was 1.18 (95% CI=1.10–1.27, I²=61%), CR was 1.86 (95% CI=1.6–2.15, I²=0%), and HR of PFS was 0.59 (95% CI=0.52–0.68, I²=61%), all in favor of daratumumab versus the control as first therapy. Conclusions: The addition of daratumumab to current regimens significantly improved PFS and response rates in patients with RRMM, SCT-eligible MM, or SCT-ineligible MM. More RCTs are needed to confirm these results.
Objective: We aimed to evaluate the usability and acceptability of a co-designed mobile health (mHealth) application (PrEP-EmERGE) within a digital health pathway to support HIV pre-exposure prophylaxis (PrEP). Methods: This was a cross-sectional study to evaluate the usability and acceptability of the PrEP-EmERGE app. Data were collected via an online survey sent to all PrEP EmERGE users in September 2021. Usability was assessed with a validated usability tool, the System Usability Scale (SUS). Acceptability was assessed using modified patient-reported experience measures (PREMs). Quantitative data were analysed using descriptive and/or inferential statistics and qualitative data (free text responses) using thematic analysis. Results: In total, 81/133 (61%) active PrEP EmERGE users completed the online survey, which was available directly from their PrEP EmERGE app: 78/81 (96%) identified as cis-male, 74/81 (91%) reported their ethnicity as 'white', 69/81 (85%) reported daily PrEP use, 7/81 (9%) reported using an event-based dosing schedule, and 5/81 (6%) were switching between dosing schedules. Overall, the median SUS score was 78/100 (interquartile range: 70-92). There were no differences in median SUS scores by PrEP dosing schedules (p = 0.78) or months of experience of using the app (p = 0.31). Overall, 73/81 (90%) would recommend the PrEP EmERGE app to a friend and 78/81 (96%) rated their satisfaction of the app as excellent, good or satisfactory. The free text responses generated three key themes: accessibility (for results and information); autonomy [taking responsibility for their (sexual) health] and func-tionality (including technical recommendations for app development and the digital health pathway). Conclusions: Innovative, co-designed digital health pathways, such as PrEP EmERGE can help sexual health services to manage increasing numbers of people accessing PrEP – ensuring that they retain access for those who need to be seen face-to-face. We report high levels of acceptability and usability during the first 4 months of this novel pathway
Background: No detailed data on left bundle branch block (LBBB) and permanent pacemaker implantation (PPI) exist from randomised clinical trials comparing the ACURATE neo and CoreValve Evolut devices. Aims: Our aim was to assess the incidence and impact of new LBBB and PPI with self-expanding prostheses from a powered randomised comparison. Methods: From the SCOPE 2 trial, 648 patients with no previous pacemaker were analysed for PPI at 30 days, and 426 patients without previous LBBB were adopted for analysis of LBBB at 30 days. Results: At 30 days, 16.5% of patients required PPI; rates were higher in CoreValve Evolut compared to ACURATE neo recipients (21.0% vs 12.3%; p=0.004). Previous right bundle branch block (odds ratio [OR] 6.11, 95% confidence interval [CI]: 3.19-11.73; p<0.001) was associated with an increased risk of PPI at 30 days, whereas the use of the ACURATE neo (OR 0.50, 95% CI: 0.31-0.81; p=0.005) was associated with a decreased risk. One-year mortality was similar in patients with and without new PPI. A total of 9.4% of patients developed persistent LBBB at 30 days, with higher incidences in CoreValve Evolut recipients (13.4% vs 5.5%; p=0.007). New LBBB at 30 days was associated with lower ejection fraction at 1 year (65.7%±11.0 vs 69.1%±7.6; p=0.041). Conclusions: New LBBB and PPI rates were lower in ACURATE neo compared to CoreValve Evolut recipients. The ACURATE neo valve was associated with a lower risk of PPI at 30 days. No effect on 1-year mortality was determined for PPI at 30 days, while LBBB at 30 days was associated with reduced ejection fraction at 1 year.
Spontaneous bacterial peritonitis (SBP) is associated with high morbidity and mortality.¹ This study aimed to assess outcomes in patients with an index presentation of SBP over a 13-year period in Southeast England.This retrospective cohort study collected data on all patients admitted with SBP from June 2006-May 2019. Patient records were reviewed and divided into period 1 (June 2006-November 2012) and period 2 (December 2012-May 2019), to assess differences, if any, in outcomes. The primary outcome was overall mortality. Cox proportional hazards regression and Kaplan-Meier survival analysis were performed. During the study period, 185 patients were hospitalised with SBP, 66%(n=123/185) being male, mean±SD age 57.9±13.3 years with alcohol being the most common cause of cirrhosis (76%, n=140/185). Mean MELD and UKELD scores were 24.0±7.1 and 59.6±7.0 respectively. In 22%(n=40/185) SBP was the index presentation of cirrhosis. Overall mortality was 85%(n=157/184), 1, 2 and 3-year survival being 34%, 28% and 25% respectively. Independent predictors of overall mortality were age (HR 1.028, 95% CI 1.011–1.045, p=0.001), serum creatinine (HR 1.003, 95% CI 1.000–1.005, p=0.018), positive ascitic fluid culture (HR 1.709, 95% CI 1.161–2.514, p=0.007) and hepatic encephalopathy (HR 1.703, 95% CI 1.040–2.789, p=0.034). Inpatient mortality was 35%(n=64/185), independent predictors being serum creatinine (HR 1.003, 95% CI 1.000–1.006, p=0.037), smoker on admission (HR 2.023, 95% CI 1.114–3.673, p=0.021) and ascitic fluid neutrophil count (HR 1.0001, 95% CI 1.0000–1.0002, p=0.006). Of those surviving hospitalisation, 78%(n=93/120) died during a median follow-up of 11.5 months (IQR 39.6). Comparing period 1 vs. period 2, follow-up duration (months, IQR) was similar (3.7, 21.8 vs. 2.2, 25.1, p=0.298). The latter however had lower serum sodium (mmol/L) (130.3±7.3 vs. 133.3±6.3, p=0.003) and ascitic fluid albumin (g/L) (6.2±3.4 vs. 10.8±5.5, p<0.001), higher ascitic fluid neutrophil count (cells/mm³, IQR) (650, 2286 vs. 400, 850, p<0.001), were more likely to receive intravenous albumin (86%(n=80/93) vs. 57%(n=52/92), p<0.001) and more likely to have hepatorenal syndrome (55%(n=51/93) vs. 33%(n=30/92), p=0.002). Prevalence of drug-resistant bacteria was 45% vs. 38% (period 1 vs. period 2 respectively) (p=0.521). Mortality overall and in those surviving hospitalisation was greater in period 1, 96%(n=87/91) vs. 75%(n=70/93), p<0.001 and 93%(n=54/58) vs. 63%(n=39/62), p<0.001 respectively. SBP continues to be associated with high mortality, serum creatinine being an independent predictor of both overall and inpatient mortality. However, mortality appears to have declined over the last 13 years, despite more severe initial presentations. Reference • Aithal G, Palaniyappan N, China L, Härmälä S, Macken L, Ryan J et al. Guidelines on the management of ascites in cirrhosis. Gut. 2020; 70 (1):9–29.
Background: Climate change has significant implications for health, yet healthcare provision itself contributes significant greenhouse gas emission. Medical students need to be prepared to address impacts of the changing environment and fulfil a key role in climate mitigation. Here we evaluate the effectiveness of an online module on climate-change and sustainability in clinical practice designed to achieve learning objectives adapted from previously established sustainable healthcare priority learning outcomes. Methods: A multi-media, online module was developed, and 3rd and 4th year medical students at Brighton and Sussex Medical School were invited to enrol. Students completed pre- and post-module questionnaires consisting of Likert scale and white space answer questions. Quantitative and qualitative analysis of responses was performed. Results: Forty students enrolled and 33 students completed the module (83% completion rate). There was a significant increase in reported understanding of key concepts related to climate change and sustainability in clinical practice (p < 0.001), with proportion of students indicating good or excellent understanding increasing from between 2 - 21% students to between 91 - 97% students. The majority (97%) of students completed the module within 90 min. All students reported the module was relevant to their training. Thematic analysis of white space responses found students commonly reported they wanted access to more resources related to health and healthcare sustainability, as well as further guidance on how to make practical steps towards reducing the environmental impact within a clinical setting. Conclusion: This is the first study to evaluate learner outcomes of an online module in the field of sustainable health and healthcare. Our results suggest that completion of the module was associated with significant improvement in self-assessed knowledge of key concepts in climate health and sustainability. We hope this approach is followed elsewhere to prepare healthcare staff for impacts of climate change and to support improving the environmental sustainability of healthcare delivery. Trial registration: Study registered with Brighton and Sussex Medical School Research Governance and Ethics Committee (BSMS RGEC). Reference: ER/BSMS3576/8, Date: 4/3/2020.
Aims Post-infarction ventricular septal defect (PIVSD) is a mechanical complication of acute myocardial infarction (AMI) with a poor prognosis. Surgical repair is the mainstay of treatment, although percutaneous closure is increasingly undertaken. Methods and resuts Patients treated with surgical or percutaneous repair of PIVSD (2010–2021) were identified at 16 UK centres. Case note review was undertaken. The primary outcome was long-term mortality. Patient groups were allocated based upon initial management (percutaneous or surgical). Three-hundred sixty-two patients received 416 procedures (131 percutaneous, 231 surgery). 16.1% of percutaneous patients subsequently had surgery. 7.8% of surgical patients subsequently had percutaneous treatment. Times from AMI to treatment were similar [percutaneous 9 (6–14) vs. surgical 9 (4–22) days, P = 0.18]. Surgical patients were more likely to have cardiogenic shock (62.8% vs. 51.9%, P = 0.044). Percutaneous patients were substantially older [72 (64–77) vs. 67 (61–73) years, P < 0.001] and more likely to be discussed in a heart team setting. There was no difference in long-term mortality between patients (61.1% vs. 53.7%, P = 0.17). In-hospital mortality was lower in the surgical group (55.0% vs. 44.2%, P = 0.048) with no difference in mortality after hospital discharge (P = 0.65). Cardiogenic shock [adjusted hazard ratio (aHR) 1.97 (95% confidence interval 1.37–2.84), P < 0.001), percutaneous approach [aHR 1.44 (1.01–2.05), P = 0.042], and number of vessels with coronary artery disease [aHR 1.22 (1.01–1.47), P = 0.043] were independently associated with long-term mortality. Conclusion Surgical and percutaneous repair are viable options for management of PIVSD. There was no difference in post-discharge long-term mortality between patients, although in-hospital mortality was lower for surgery.
Objective Older people and people with complex needs often require both health and social care services, but there is limited insight into individual journeys across these services. To help inform joint health and social care planning, we aimed to assess the relationship between hospital admissions and domiciliary care receipt. Design Retrospective cohort study, using linked data on primary care activity, hospital admissions and social care records. Setting London Borough of Barking and Dagenham, England. Participants Adults aged 19 and over who lived in the area on 1 April 2018 and who were registered at a general practice in East London between 1 April 2018 and 31 March 2020 (n=140 987). Outcome measures The outcome was initiation of domiciliary care. We estimated the rate of hospital-associated care package initiation, and of care packages unrelated to hospital admission. We also described the characteristics of hospital admissions that preceded domiciliary care, including primary diagnosis codes. Results 2041/140 987 (1.4%) participants had a domiciliary care package during a median follow-up of 1.87 years. 32.6% of packages were initiated during a hospital stay or within 7 days of discharge. The rate of new domiciliary care packages was 120 times greater (95% CI 110 to 130) during or after a hospital stay than at other times, and this association was present for all age groups. Primary admission reasons accounting for the largest number of domiciliary care packages were hip fracture, pneumonia, stroke, urinary tract infection, septicaemia and exacerbations of long-term conditions (chronic obstructive pulmonary disease and heart failure). Admission reasons with the greatest likelihood of a subsequent domiciliary care package were fractures and strokes. Conclusion Hospitals are a major referral route into domiciliary care. While patients admitted due to new and acute illnesses account for many domiciliary care packages, exacerbations of long-term conditions and age-related and frailty-related conditions are also important drivers.
Oestrogen plays a vital role in the maintaining a normal vulvovaginal epithelium, vaginal lubrication, as well a healthy microbiome to ensure an acidic pH. The decrease in oestrogen levels in women going through the menopause results in both physiological and physical changes of the genitourinary system, and more specifically the vulva. We conducted a literature review on the effects of low oestrogen levels on the physiology and function of the vulva and the vulvovaginal epithelium. The genitourinary syndrome of menopause is the term used to describe the signs and symptoms of a low oestrogen state. This article will discuss the signs and symptoms of this condition, as well as the different management options available. Other vulval dermatoses that can be affected by hypoestrogenism will be also reviewed.
COVID-19 has further exacerbated trends of widening health inequalities in the UK. Shockingly, the number of years of life lived in general good health differs by over 18 years between the most and least deprived areas of England. Poor diets and obesity are established major risk factors for chronic cardiometabolic diseases and cancer, as well as severe COVID-19. For doctors to provide the best care to their patients, there is an urgent need to improve nutrition education in undergraduate medical school training. With this imperative, the Association for Nutrition established the Inter-Professional Working Group on Medical Education (AfN IPG) to develop a new, modern undergraduate nutrition curriculum for medical doctors. The AfN IPG brought together expertise from nutrition, dietetic and medical professionals, representing the National Health Service, royal colleges, medical schools and universities, government public health departments, learned societies, medical students and nutrition educators. The curriculum was developed with the key objective of being implementable through integration with the current undergraduate training of medical doctors. Through an iterative and transparent consultative process, 13 key nutritional competencies, to be achieved through mastery of 11 graduation fundamentals, were established. The curriculum to facilitate the achievement of these key competencies is divided into eight topic areas, each underpinned by a learning objective statement and teaching points detailing the knowledge and skills development required. The teaching points can be achieved through clinical teaching and a combination of facilitated learning activities and practical skills acquisition. Therefore, the nutrition curriculum enables mastery of these nutritional competencies in a way that will complement and strengthen medical students’ achievement of the General Medical Council Outcomes for Graduates. As nutrition is an integrative science, the AfN IPG recommends the curriculum is incorporated into initial undergraduate medical studies before specialist training. This will enable our future doctors to recognise how nutrition is related to multiple aspects of their training, from physiological systems to patient-centred care, and acquire a broad, inclusive understanding of health and disease. In addition, it will facilitate medical schools to embed nutrition learning opportunities within the core medical training, without the need to add in a large number of new components to an already crowded programme or with additional burden to teaching staff. The undergraduate nutrition curriculum for medical doctors is designed to support medical schools to create future doctors who will understand and recognise the role of nutrition in health. Moreover, it will equip front-line staff to feel empowered to raise nutrition-related issues with their patients as a fundamental part of enhanced care and to appropriately refer on for nutrition support with a registered nutritionist (RNutr)/registered associate nutritionist (ANutr) or a registered dietitian (RD) where this is likely to be beneficial.
Primary cholangiocarcinoma (malignancy of the bile ducts) is potentially a treatable malignancy via surgery. It presents with a derangement in the liver function blood test results, which results in raised bilirubin. It may also be accompanied by the complaint of itching of skin, dark urine, and light color stool. Bile duct metastasis from primary colorectal cancer, although a very rare condition presents with similar symptomatology and blood test results. Immunohistochemistry staining of tissue biopsy has significantly improved differentiation, detection, and hence plan management of both malignancies (cholangiocarcinoma and bile duct metastasis from primary colorectal cancer). The role of endoscopic retrograde cholangiopancreatography (ERCP) is important with the insertion of a stent towards symptom relief when palliative management is indicated in patients with an incurable disease.
Background Despite operative and adjuvant therapies, glioblastoma remains incurable, with the extent of resection being one of few treatments that can improve survival. To improve resection, operative adjuncts are used, with neuronavigation and 5-aminolevulinic acid (5-ALA) recommended as a standard of care in those aimed for maximal safe resection. Despite the standards, meta-analysis concluded that the impact of 5-ALA on the extent of surgical resection is of low quality due to bias in reporting tumour location and additional image guidance used, factors impacting on extent of resection as well as short-term neurological outcomes being uncertain. Therefore we aimed to evaluate the availability and use of 5-ALA and other adjuncts and compare surgical outcomes of 5-ALA-guided versus non-5-ALA-guided resections. Material and Methods A multicenter prospective observational cohort study was conducted across 27 out of 31 available centres in the UK and Ireland from 6 January until 19 March 2020. Inclusion criteria included adults with first diagnosis, supratentorial glioblastoma undergoing resection. Primary outcomes included: i) the availability and use of surgical adjuncts and ii) complete resection of enhancing tissue (CRET). Secondary outcomes included adverse events, new onset of postoperative neurological deficit and post-operative neurological function. Descriptive and inferential statistics were used for analysis with a p-value <0.05 deemed significant. Results 232 consecutive cases were identified. 142/232 cases were aimed for maximal safe resection subsequently divided into 5-ALA-guided (n=92) versus non-5-ALA-guided (n=50) resections. 5-ALA and neuronavigation were available across all centres. Neuronavigation and 5-ALA were used in 91% (n=129/142) and 65% (n=92/142) of cases aimed for maximal safe resection whereas 83% (n=75/90) and 49% (n=44/90) for debulk surgery. 35 unique combinations of surgical adjuncts were used in 232 operations. 5-ALA-guided resection yielded a higher percentage of CRET than without (55% versus 28%, p < 0.01). The two groups showed no difference in adverse events (p=0.98), new onset of neurological deficit (p=0.88) nor neurological function (p=0.7). A logistic regression analysis showed that 5-ALA was an important predictor of CRET regardless of additional adjuncts used (OR 2.4, CI 0.96-5.97, P = 0.05), tumour location and molecular characterisation (OR 3.48, CI 1.61-7.51, P <0.01). Conclusion Firstly, we showed that 5-ALA is not always used for glioblastoma aimed for CRET. Secondly, we report a great heterogeneity of adjuncts used for resection, possibly explained by a lack of high-quality evidence and surgeon training. Thirdly we demonstrate that 5-ALA-guided resection leads to higher percentage of CRET regardless of other adjuncts used, tumour location and molecular characterisation.
Background Acute Leukaemias are haematological disorders characterised by the proliferation of immature white blood cells in the bone marrow and/or peripheral blood. Oral manifestations of leukaemia are common and may be the first sign of the disease. The clinical presentation of these Acute Leukaemias may include neutropenic sepsis, hyperviscocity and coagulopathy which confer a potential morbidity and mortality. Clinicians must be able to recognise this pattern of presentation. Case report We report a 34-year-old female who was referred to the Oral and Maxillofacial Surgery department with acute dental pain and pericoronitis. She subsequently had a simple dental extraction but re-presented with a bleeding socket that did not respond to local treatment. Investigation of this led to a diagnosis of Acute Promyelocytic Leukemia (APL). She was admitted under the care of the haematology team for urgent, life-saving, treatment. Conclusions Early diagnosis and treatment of the Acute Leukaemias can be life saving. The oral manifestations of disease are common and may be the first sign. Clinicians must be able to recognise this pattern of presentation and arrange urgent investigation and specialist management. Clinical/CPD relevance This case report discusses leukaemia and highlights the important role General Dental Practitioners can play in early diagnosis. We frame a safe approach to managing these patients in a typical case. Whilst this disease subtype is rare, the learning points can be universally applied.
Background Degenerative cervical myelopathy (DCM) is a poorly recognised form of spinal cord injury which arises when degenerative changes in the cervical spine injure the spinal cord. Timely surgical intervention is critical to preventing disability. Despite this, DCM is frequently undiagnosed, and may be misconstrued as normal ageing. For a disease associated with age, we hypothesised that the elderly may represent an underdiagnosed population. This study aimed to evaluate this hypothesis by comparing age-stratified estimates of DCM prevalence based on spinal cord compression (SCC) data with hospital-diagnosed prevalence in the UK. Methods We queried the UK Hospital Episode Statistics database for admissions with a primary diagnosis of DCM. Age-stratified incidence rates were calculated and extrapolated to prevalence by adjusting population-level life expectancy to the standardised mortality ratio of DCM. We compared these figures to estimates of DCM prevalence based on the published conversion rate of asymptomatic SCC to DCM. Results The mean prevalence of DCM across all age groups was 0.19% (0.17, 0.21), with a peak prevalence of 0.42% at age 50–54 years. This contrasts with estimates from SCC data which suggest a mean prevalence of 2.22% (0.436, 2.68) and a peak prevalence of 4.16% at age > 79 years. Conclusions To our knowledge, this is the first study to estimate the age-stratified prevalence of DCM and estimate underdiagnosis. There is a substantial difference between estimates of DCM prevalence derived from SCC data and UK hospital activity data. This is greatest amongst elderly populations, indicating a potential health inequality.
LINKED CONTENT This article is linked to Tergast et al papers. To view these articles, visit https://doi.org/10.1111/apt.17066 and https://doi.org/10.1111/apt.17168
Background: Most comparisons of arterial stiffness between ethnic groups focus on pulse wave velocity. This study used the cardio-ankle vascular index (CAVI) in European compared to Japanese individuals to investigate how cardiovascular risk factors affect arterial aging across geographic regions. Methods: Four hundred and ninety-four European and 1044 Japanese individuals underwent measurements of CAVI, blood pressure and information on cardiovascular risk factors. Both datasets included individuals with 0-5 cardiovascular risk factors. Results: Average CAVI was higher in the Japanese than the European group in every age category, with significant differences up to 75 years for males and 85 for females. The correlation of CAVI with age, controlled for cardiovascular risk factors, was slightly higher in Japanese females (r = 0.594 vs. Europeans r = 0.542) but much higher in European males (r = 0.710 vs. Japanese r = 0.511). There was a significant correlation between CAVI and total cardiovascular risk factors in the Japanese (r = 0.141, P < 0.001) but not the European group. On linear regression, average CAVI was significantly dependent on age, sex, diabetes, BMI, SBP and geographic region. When divided into 'healthy' vs. 'high risk', the healthy group had a steeper correlation with age for Europeans (r = 0.644 vs. Japanese r = 0.472, Fisher's Z P < 0.001), whereas in the high-risk group, both geographic regions had similar correlations. Conclusion: Japanese patient groups had higher arterial stiffness than Europeans, as measured by CAVI, controlling for cardiovascular risk factors. Europeans had greater increases in arterial stiffness with age in healthy individuals, particularly for males. However, cardiovascular risk factors had a greater impact on the Japanese group.
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Sherief Elsayed
  • Spinal Surgery
Chris Kingswood
  • Sussex Kidney Unit
Adam de Belder
  • Department of Cardiology
Subramanian Nachiappan
  • Department of Radiology
Benedict A Rogers
  • Department of Trauma and Orthopaedics
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