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Our study demonstrates the use of the Walter–Elwood method in double-peak seasonal variation. The concept of the geometrical model for analysing cyclic variation is described. Monte Carlo simulation procedures are used to compare the performance of the Walter–Elwood and negative binomial regression methods with double-peak seasonality, in both a comparison between the two methods and a power analysis. The results of 10,000 independent Monte Carlo simulations showed that the Walter– Elwood method and the negative binomial regression analysis identified the same peak in 9,956 samples, indicating that the power of both methods is similar in analysing double-peak cyclic trends. Additionally, two epidemiological applications of double-peak seasonality are presented, which were analysed using the Walter–Elwood method. Further, this is the first study to describe the power of the Walter-Elwood method for double peak seasonality. In conclusion, double-peak seasonality could be investigated with the Walter–Elwood method in ecological studies when only the population at risk is available and there is no other variable. [ABSTRACT FROM AUTHOR]

Introduction: Nutritional medicine plays a key role in disease prevention and treatment, and we pharmacists must consider our contribution beyond our role in dispensing. Apart from the Dietary Approaches to Stop Hypertension (DASH) diet1, there is a paucity of data on the benefits of nutritional interventions in hypertension with no clear recommendation on potassium in the NICE guidelines. Potassium has been an area of interest in clinical medicine over the decades because of its effect on cardiovascular disease. However, its mechanism of action is poorly understood, and it is unclear it differs between different ethnic groups. Dietary potassium decreases blood pressure (BP) but can also stimulate aldosterone production2. However, the magnitude of potassium-dependent regulation of aldosterone secretion in humans is not fully characterised and it is not clear whether this is mediated by activation of the renin-angiotensin-aldosterone system (RAAS) as a result of a reduction in BP or other mechanisms. Aim: To perform a (1) systematic review and meta-analysis of clinical trials assessing effects of potassium on plasma aldosterone and renin in adult individuals alongside a (2) cross-sectional multi-ethnic study to explore the relationship between potassium intake and aldosterone in hypertension. Methods: (1) This study was carried out in accordance with PRISMA guidelines3. The full protocol can be found on the PROSPERO database. (2) Self-defined black or white hypertensives were recruited from the hypertension outpatient clinic at St. Thomas' Hospital and had aldosterone, renin and a 24-hour urinary potassium collected. The systematic review and meta-analysis on already approved clinical trials and did not require ethnical approval. The cross-sectional study was approved by the local Research Ethics Committee in the UK and written informed consent was obtained from all patients. Results: 6395 articles were retrieved, and 124 full-text articles were assessed for eligibility. 36 met the prespecified inclusion/exclusion criteria. Potassium supplementation caused a significant decrease in systolic BP (- 3.69 mmHg [-4.91, -2.46], P<0.001) and increase in serum potassium (+0.37 [0.23, 0.52] mmol/L, P<0.001). There was an increase in plasma aldosterone (standardised difference 0.414 [0.291, 0.537], P<0.001) but no effect on plasma renin activity (+0.033 [-0.07, 0.14], P=0.538]. Meta-regression showed a significant positive correlation between change in plasma aldosterone and change in serum potassium (P<0.001). (2) In 469 subjects (72% black), there was a positive association between the measured 24-hour potassium excretion and aldosterone in black (β = 0.200, P = 0.014) but not in white individuals (P = 0.531). Discussion/Conclusion: Potassium supplementation increases plasma aldosterone but not renin. The increase in aldosterone correlates with the raise in serum potassium. In subjects with hypertension, potassium intake is related with aldosterone concentration only in black subjects. Overall, the data supports a RAAS-independent potassium regulation of aldosterone which could be particularly relevant in African origin subjects. Limitations: 1. the systematic review results could not be stratified by ethnicity because most of the studies were performed in Caucasian subjects, 2. Use of background therapy in some studies, variable doses of potassium supplementation and duration of supplementation. References: 1. Filippou CD, Tsioufis CP, Thomopoulos CG, Mihas CC, Dimitriadis KS, Sotiropoulou LI, Chrysochoou CA, Nihoyannopoulos PI, Tousoulis DM. Dietary Approaches to Stop Hypertension (DASH) Diet and Blood Pressure Reduction in Adults with and without Hypertension: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Adv Nutr. 2020 Sep 1;11(5):1150-1160. doi: 10.1093/advances/nmaa041. PMID: 32330233; PMCID: PMC7490167. 2. Kotchen TA. Effets du potassium sur la rénine et sur l'aldostérone [Effects of potassium on renin and aldosterone]. Arch Mal Coeur Vaiss. 1984 Apr;77 Spec No:87-91. French. PMID: 6428366. 3. Page M J, McKenzie J E, Bossuyt P M, Boutron I, Hoffmann T C, Mulrow C D et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews BMJ 2021; 372 :n71 doi:10.1136/bmj.n71 [ABSTRACT FROM AUTHOR]

BackgroundObsessive–compulsive disorder (OCD) is often co-morbid with depression. Using the methods of network analysis, we computed two networks that disclose the potentially causal relationships among symptoms of these two disorders in 408 adult patients with primary OCD and co-morbid depression symptoms.MethodWe examined the relationship between the symptoms constituting these syndromes by computing a (regularized) partial correlation network via the graphical LASSO procedure, and a directed acyclic graph (DAG) via a Bayesian hill-climbing algorithm.ResultsThe results suggest that the degree of interference and distress associated with obsessions, and the degree of interference associated with compulsions, are the chief drivers of co-morbidity. Moreover, activation of the depression cluster appears to occur solely through distress associated with obsessions activating sadness – a key symptom that ‘bridges’ the two syndromic clusters in the DAG.ConclusionsBayesian analysis can expand the repertoire of network analytic approaches to psychopathology. We discuss clinical implications and limitations of our findings. [ABSTRACT FROM PUBLISHER]

Objectives: Depression in older people is commonly under diagnosed and is associated with increased morbidity and mortality. Because older people currently occupy 65% of acute hospital beds, it is crucial for them to be properly assessed for depression to optimise their medical care. The aim of this study was to identify potential risk factors for depression in the medically ill in order to improve their inpatient care.Methods: This was a 2-year observational study of consequent referrals to the Newcastle Liaison Team for Older Adults. Out of a total number of 1586 referred patients, 1197 were included in the final analysis of data. Information about their age, main medical history, cognitive impairment and use of antidepressants was collected. All subjects were screened for dementia, depression and delirium. Proportions were compared using the chi-squared test. Clinical depression as a binary variable was modelled using logistic regression.Results: Higher risk for depression was associated with pain (odds ratio (OR) = 1.76; p = 0.033) and a previous history of depression (OR = 2.22; p < 0.001). Cognitive impairment (OR = 0.44, p < 0.001) and delirium (OR = 0.49; p < 0.001) decreased the likelihood for having depression. Subjective feelings of emptiness, being unhappy and depressed alone (R2  = 37.4%) and cognitive impairment (R2  = 39.5%) were the best multivariable model to explain depression in medically ill people.Conclusion: Dysphoric mood results in depression in older people with medical health problems. Copyright © 2016 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

The age-sex distributions and temporal trends in incidence of leukaemia and lymphoma from the Manchester Children's Tumour Registry (MCTR), 1954-1998, are reported. This 45-year study includes 1795 children, all of whom had a histologically and/or cytologically verified leukaemia or lymphoma. At the time of their diagnoses all the children were under 15 years of age and were resident in a geographically defined area of northwest England covered by the MCTR. Log-linear modelling identified significant linear increases in acute lymphoblastic leukaemia (ALL) (average annual increase 0.7%; P= 0.005) and in Hodgkin's disease (HD) (1.2%, P=0.04), but not in acute myeloid leukaemia (AML), nor in non-Hodgkin's lymphoma (NHL). The increase in ALL was most pronounced amongst males, aged 1-4 years, and is likely to be due to precursor B-cell leukaemias. The increases in ALL and HD are discussed in relation to current hypotheses suggesting a role for infection. Additionally, a non-linear cohort effect was identified for NHL (P= 0.008), which may indicate the involvement of environmental factors other than infection. [ABSTRACT FROM AUTHOR]

Previous studies of space-time clustering in childhood leukaemia have produced equivocal and inconsistent results. To address this issue we have used Manchester Children's Tumour Registry leukaemia data in space-time clustering analyses. Knox tests for space-time interactions between cases were applied with fixed thresholds of close in space, <5 km and close in time <1 year apart. Addresses at birth as well as diagnosis were utilized. Tests were repeated replacing geographical distance with distance to the Nth nearest neighbour. N was chosen such that the mean distance was 5 km. Data were also examined by a second order procedure based on K-functions. All methods showed highly significant evidence of space-time clustering based on place of birth and time of diagnosis, particularly for all leukaemias aged 0-14 and 0-4 years, and acute lymphoblastic leukaemia (ALL) 0-4 years. Some results based on location at diagnosis were significant but mainly gave larger P-values. The results are consistent with an infectious hypothesis. Furthermore, we found an excess of male cases over females involved in space-time pairs. We suggest this may be related to genetic differences in susceptibility to infection between males and females. These findings provide the basis for future studies to identify possible infectious agents. [ABSTRACT FROM AUTHOR]

Background:Earlier studies have shown raised risks of leukaemia and non-Hodgkin lymphoma in children, teenagers and young adults resident either at birth or diagnosis in Seascale. Some increases in cancer risk in these age groups have also been noted among those living around Dounreay. We aimed to update previous analyses relating to areas close to these nuclear installations by considering data from an additional 16 years of follow-up.Methods:Cross-sectional analyses compared cancer incidence rates for 1963-2006 among those aged 0-24 years at diagnosis living in geographically specified areas around either Sellafield or Dounreay with general population rates. Cancer incidence for the period 1971-2006 among the cohort of Cumbrian births between 1950 and 2006 was compared to national incidence for 1971-2006 using person-years analysis. Cancer among those born in the postcode sector closest to Dounreay was compared with that among those born in the three adjoining postcode sectors. Analyses considered both cancer overall and ICD-O-3 defined diagnostic subgroups including leukaemia, central nervous system tumours and other malignancies.Results:Apart from previously reported raised risks, no new significantly increased risks for cancer overall or any diagnostic subgroup were found among children or teenagers and young adults living around either nuclear installation. Individuals born close to the installations from 1950 to 2006 were not shown to be at any increased risk of cancer during the period 1971 to date.Conclusions:Analysis of recent data suggests that children, teenagers and young adults currently living close to Sellafield and Dounreay are not at an increased risk of developing cancer. Equally, there is no evidence of any increased cancer risk later in life among those resident in these areas at birth. [ABSTRACT FROM AUTHOR]

Background:Despite marked improvements in childhood leukaemia survival, 20% still die within 5 years of diagnosis. The aim of this study was to evaluate the relationship between socioeconomic status, as assessed by paternal occupation at birth, and survival from childhood leukaemia in children, using data from the Northern Region Young Persons Malignant Disease Registry.Methods:All 1007 cases of leukaemia in children aged 0-14 years, diagnosed between 1968 and 2010 and registered with the Registry were studied. Paternal occupational social class at the time of the child's birth was obtained and analysed in relation to survival using Cox-proportional regression.Results:Compared with the most advantaged group (I/II), those in the middle group (IIIN/M) had a 68% increased risk of death, while those in the least advantaged group (IV/V) had 86% higher risk for acute lymphoblastic leukaemia. While the survival advantage of children in class I/II was apparent from the time of diagnosis, survival for children in groups IIIN/M and IV/V were comparable until 3-4 years after diagnosis, when they began to minimally diverge.Conclusion:The existence of such socioeconomic disparities cannot be attributed to accessibility to health care in the United Kingdom. Further research into the likely factors underlying these disparities is required. [ABSTRACT FROM AUTHOR]

Background and study aims: Increasing colonoscopy withdrawal time (CWT) is thought to be associated with increasing adenoma detection rate (ADR). Current English guidelines recommend a minimum CWT of 6 minutes. It is known that in the Bowel Cancer Screening Programme (BCSP) in England there is wide variation in CWT. The aim of this observational study was to examine the relationship between CWT and ADR. Patients and methods: The study examined data from 31 088 colonoscopies by 147 screening program colonoscopists. Colonoscopists were grouped in four levels of mean CWT (<7, 7-8.9, 9-10.9, and⩾11 minutes). Univariable andmultivariable analysis (binary logistic and negative binomial regression) were used to explore the relationship between CWT, ADR, mean number of adenomas and number of right-sided and advanced adenomas. Results: In colonoscopists with a mean CWT<7 minutes, the mean ADR was 42.5% compared with 47.1% in the⩾11-minute group (P<0.001). The mean number of adenomas detected per procedure increased from 0.77 to 0.94, respectively (P<0.001). The increase in adenoma detection was mainly of subcentimeter or proximal adenomas; there was no increase in the detection of advanced adenomas. Regression models showed an increase in ADR from 43% to 46.5% for mean CWT times ranging from 6 to 10 minutes. Conclusions: This study demonstrates that longer mean withdrawal times are associated with increasing adenoma detection, mainly of small or right-sided adenomas. However, beyond 10 minutes the increase in ADR is minimal. Mean withdrawal times longer than 6 minutes are not associated with increased detection of advanced adenomas. Withdrawal time remains an important quality metric of colonoscopy. [ABSTRACT FROM AUTHOR]

Background: Cancer is the second most common cause of death in children in the developed world. The study investigated patterns and trends in survival from childhood cancer in patients from northern England diagnosed 1968-2005.Methods: Five-year survival was analysed using Kaplan-Meier estimation for four successive time periods. Cox regression analysis was used to explore associations with age and demographic factors.Results: The study included 2958 cases (1659 males and 1299 females). Five-year survival for all cancers improved significantly from 39% in 1968-1977 to 79% in 1998-2005 (P<0.001). Five-year survival for leukaemia increased from 24% to 81% (P<0.001), lymphoma from 46% to 87% (P<0.001), central nervous system tumours from 43% to 73% (P<0.001), bone tumours from 21% to 75% (P<0.001), soft tissue sarcoma from 30% to 58% (P<0.001) and germ cell tumours from 59% to 97% (P<0.001). Survival was worse for cases of acute lymphoblastic leukaemia (P<0.001) and astrocytoma (P<0.001) aged 10-14 years compared with 0-4-year olds.Conclusion: There were marked improvements in survival over a 38-year time span. Future work should examine factors that could influence further improvement in survival such as diagnosis delays. [ABSTRACT FROM AUTHOR]

There is a paucity of population-based studies examining incidence and survival trends in childhood bone tumours. We used high quality data from four population-based registries in England. Incidence patterns and trends were described using Poisson regression. Survival trends were analysed using Cox regression. There were 374 cases of childhood (ages 0-14 years) bone tumours (206 osteosarcomas, 144 Ewing sarcomas, 16 chondrosarcomas, 8 other bone tumours) registered in the period 1981-2002. Overall incidence (per million person years) rates were 2.63 (95% confidence interval (CI) 2.27-2.99) for osteosarcoma, 1.90 (1.58-2.21) for Ewing sarcoma and 0.21 (0.11-0.31) for chondrosarcoma. Incidence of Ewing sarcoma declined at an average rate of 3.1% (95% CI 0.6-5.6) per annum (P=0.04), which may be due to tumour reclassification, but there was no change in osteosarcoma incidence. Survival showed marked improvement over the 20 years (1981-2000) for Ewing sarcoma (hazard ratio (HR) per annum=0.95 95% CI 0.91-0.99; P=0.02). However, no improvement was seen for osteosarcoma patients (HR per annum=1.02 95% CI 0.98-1.05; P=0.35) over this time period. Reasons for failure to improve survival including potential delays in diagnosis, accrual to trials, adherence to therapy and lack of improvement in treatment strategies all need to be considered. [ABSTRACT FROM AUTHOR]

The incidence, survival patterns, and presenting symptoms of children with medulloblastoma were studied. Data were ascertained from the Manchester Tumour Registry which is population-based and has collected data on all childhood malignancies in northwest England since 1954. Incidence rates standardized to the European standard population were calculated and Poisson regression models were used to examine temporal changes in the incidence rates during the period 1954 to 1997. Kaplan-Meier survival curves were derived and used to study changes in survival patterns. World-standardized incidence rates were 5.5 per million child years in males and 3.4 per million child years in females. Incidence rates increased from the 1950s to the 1980s but have declined recently. The 5-year survival rate has improved from 29 to 58% with similar rates for males and females. The 1-year survival rate has also improved, but females had worse survival at this point (58%) than males (75%). The type of symptom or sign at presentation is strongly affected by age, with 10 of the 22 recorded symptoms or signs showing significant age differences. The older the child is, the more likely is the presentation to show pressure features of headache, vomiting, and ophthalmic signs. Younger children present with non-specific features such as lethargy, behavioural disturbance, or increasing head size. Ataxia is seen in about 75% of children across the age range. [ABSTRACT FROM AUTHOR]

Cancer patients aged 15-24 years have distinct special needs. High quality cancer statistics are required for service planning. Data presented by primary site are inappropriate for this age group. We have developed a morphology-based classification and applied it to national cancer registration data for England 1979-1997. The study included 25,000 cancers and 134 million person-years at risk. Rates for each diagnostic group by age, sex and time period (1979-83, 1984-87, 1988-92, 1993-1997) were calculated. Overall rates in 15-19 and 20-24-year-olds were 144 and 226 per million person-years respectively. Lymphomas showed the highest rates in both age groups. Rates for leukaemias and bone tumours were lower in 20-24 year olds. Higher rates for carcinomas, central nervous system tumours, germ-cell tumours, soft tissue sarcomas and melanoma were seen in the older group. Poisson regression showed incidence increased over the study period by an average of 1.5% per annum (P<0.0001). Significant increases were seen in non-Hodgkins lymphoma (2.3%), astrocytoma (2.3%), germ-cell tumours (2.3%), melanoma (5.1%) and carcinoma of the thyroid (3.5%) and ovary (3.0%). Cancers common in the elderly are uncommon in adolescents and young adults. The incidence of certain cancers in the latter is increasing. Future studies should be directed towards aetiology. [ABSTRACT FROM AUTHOR]

Objective: To investigate recent time trends of some selected and common neoplasms of the blood and lymphatic tissues.Methods: A specialist population-based register of hematological and related neoplasms was set up in parts of the UK in 1984. Secular changes over the first 10 years were investigated using log-linear Poisson modeling. The results are presented in tabular and graphical form.Results: The analyses of 26,899 cases revealed a decline in incidence of acute myeloid leukaemia (AML), the myeloproliferative disorders (MPD) including chronic myeloid leukaemia (CML) and, in males only, Hodgkin's disease (HD). No secular trends for acute lymphoblastic leukaemia (ALL) were observed at any age. A marked increase in incidence in non-Hodgkin's disease (NHL) and the pre-leukemia group of myeloid dysplasias (MDS) was found.Conclusions: The rise in MDS and decline in AML and related conditions are most likely to reflect diagnostic changes. Changes in NHL may reflect, in part, a similar phenomena, but an underlying upward trend cannot be excluded. The decline in HD is in one gender only and the significance of this remains to be investigated. [ABSTRACT FROM AUTHOR]

Background: The incidence of insulin-dependent diabetes mellitus (IDDM) incidence varies between and within countries. The origins of this variation are disputed, but they involve both genetic and non-genetic influences. To explore the role of environmental factors in the aetiology of IDDM we have examined the incidence in small geographical areas and related it to variables derived from national censuses.Methods: This is an ecological analysis of incidence data from a register of children with IDDM covering the counties of West Yorkshire, North Yorkshire and Humberside in the north of England. All children aged < or = 16, diagnosed with IDDM between 1978 and 1990 were eligible for inclusion. Spatial variation in incidence between electoral wards was investigated using Poisson regression, in relation to socioeconomic status, population density, urban-rural status and measures of geographical isolation. Ward child populations varied in size from 84 to 7197 (mean = 1545).Results: Rates were significantly lower in wards of high population density and with many overcrowded houses. The rate ratio for areas in the upper half of the childhood density distribution was 0.88 (95% confidence interval (CI): 0.78-0.99) and for the two upper tertiles of household overcrowding the rate ratios were 0.84 (95% CI: 0.74-0.95) and 0.68 (95% CI: 0.58-0.79) respectively.Conclusions: The incidence of childhood IDDM was associated with environmental factors including population density and overcrowded homes. A possible inference from these data is that patterns of infection are involved in the occurrence of IDDM. Analytical epidemiological studies will be needed to investigate these ideas further. [ABSTRACT FROM AUTHOR]

Background: Various methods of analysis have been used to study age-period-cohort models. The main aim of this paper is to illustrate and compare three such methods. Those of Clayton and Schifflers, Robertson and Boyle, and De Carli and La Vecchia. The main differences between these methods lie in their approach to distinguish between linear-period and linear-cohort effects. Clayton and Schifflers do not attempt to solve this identification problem, whereas Robertson and Boyle, and De Carli and La Vecchia attempt to tackle this question.Methods: In order to study the assumptions and problems of these methods, we analysed data from 2678 subjects aged 30-84 in Yorkshire, UK, who were diagnosed with non-Hodgkin's lymphoma (NHL) during the period 1978-1991. Loglinear Poisson models were used to examine the effects of age, period and cohort.Results: All three methods of analysis agree that, after stratification for sex and county, the age-standardized rate has been increasing at about 5% per year. The Robertson-Boyle method differed from the Clayton-Schifflers method in showing a significant non-linear cohort effect, and a significant county-cohort interaction. The method of De Carli-La Vecchia agreed more closely with Clayton-Schifflers than with Robertson-Boyle.Conclusions: The linear increase in incidence would lead to a doubling of the number of cases within 15 years. There is controversy over whether the identification problem can be solved and should be solved. Many authors would not rely on the results of the methods of Robertson and Boyle, or De Carli and La Vacchia. [ABSTRACT FROM AUTHOR]

Background: Analysing data from the Epidemiologic Catchment Area (ECA) study, Weissman and colleagues reported that panic disorder was strongly associated with suicide attempt. However, they did not control optimally for comorbid disorders known to increase suicide risk.Method: Reanalysing the ECA data, we controlled for comorbid disorders in the aggregate rather than one at a time when we estimated the association between panic disorder and suicide attempt.Results: Panic disorder was not associated with an increased risk of suicide attempt.Conclusions: Comorbid conditions strongly influence whether people with panic disorder are at especial risk of suicide attempt. [ABSTRACT FROM AUTHOR]

A response from the authors of the article "Updated investigations of cancer excesses in individuals born or resident in the vicinity of Sellafield and Dounreay" in the 2014 issue is presented.

A letter to the editor is presented in response to an article on the prevalence of polydipsia in the mentally handicapped in the February 1991 issue.

Obsessive-compulsive disorder is extremely rare among mentally retarded people. We report here a case of a mildly mentally retarded woman who exhibits contamination obsessions, compulsive hand-washing rituals, and avoidance. [ABSTRACT FROM AUTHOR]

Introduction Increasing colonoscopy withdrawal time has previously been shown to be associated with increasing adenoma detection rate (ADR). Current guidelines recommend a minimum withdrawal time of 6 min. The optimum mean withdrawal time for adenoma detection is not known. Methods The mean withdrawal time in negative complete colonoscopies (nc-CWT) was estimated for 147 colonoscopists in the NHS Bowel Cancer Screening Programme; colonoscopists were grouped in four levels of nc-CWT (<7, 7–8.9, 9–10.9 and ≤11 min). Logistic regression was used to analyse the relationship between CWT and ADR. Results The study examined data from 31,088 procedures by 147 colonoscopists undertaken between August 2006 and August 2009. The mean ADR in each group was 42.5% in colonoscopists with a mean nc-CWT <7 min, 45.5% in the 7–8.9-min group (p = 0.002 for difference compared to lowest nc-CWT group), 47.3% in the 9–10.9-min group (p < 0.001) and 47.1% in the ≤11-min group (p < 0.001). In multivariable analysis, the ADR of colonoscopists with an nc-CWT of around 10 min was 11% higher than those with an nc-CWT of around 6 min (p < 0.001). Both the proportion of adenomas less than 1 cm in size and the proportion of adenomas detected in the proximal colon increased for longer withdrawal times. Advanced adenoma detection was not affected by increasing withdrawal times. Conclusion Increasing average nc-CWT is shown to be associated with increasing ADR up to 10 min. Beyond 10 min no significant further increase in adenoma yield is seen. This is evidence of the ‘ceiling effect’ of withdrawal time on adenoma detection. Inadequate bowel preparation quality increases mean withdrawal time in complete colonoscopies but this is not associated with any change in ADR. The increase in adenoma detection as a result of longer withdrawal is due to detection of more small and right sided lesions, no increase in detection of large or advanced adenomas is seen. We recommend, on the basis of the findings of this study, that the optimal average nc-CWT per colonoscopist for screening colonoscopy is around 10 min. [ABSTRACT FROM PUBLISHER]

Introduction Colonoscopy is a central investigation in all colorectal cancer (CRC) screening strategies. Success of CRC screening is dependent on the quality of colonoscopy. The NHS Bowel Cancer Screening Programme (BCSP) offers biennial faecal occult blood testing to adults aged 60–74 years. Colonoscopy is offered to individuals with a positive faecal occult blood (FOB) test. All colonoscopists practicing within the screening programme are required to meet predefined standards through summative assessment and are subject to ongoing quality assurance. In this study we examine the quality of colonoscopy in the NHS BCSP and describe the measures taken by the BCSP to achieve high quality colonoscopy. Comparison of current quality indicators with existing quality standards and evidence from the UK pilot study of FOB screening will be undertaken. Methods The NHS BCSP national database prospectively collects detailed data on all screening colonoscopies. Data from the first 3 years of the programme (August 2006 to August 2009) were analysed. Colonoscopy quality indicators (adenoma detection rate, polyp detection rate, colonoscopy withdrawal time, caecal intubation rate, rectal retroversion rate, polyp retrieval rate, mean sedation doses, patient comfort scores, bowel preparation quality and adverse event incidence) were calculated for this period. All screening centres were contacted directly to verify adverse event data. Results In the study period, 2,269,983 individuals returned FOB tests and 36,460 colonoscopies were performed. Mean caecal intubation rate was 95.2% and mean withdrawal time for normal procedures was 9.2 min. The mean adenoma detection rate (ADR) per colonoscopist was 46.5%. ADR did not differ between prevalent and incident rounds (p = 0.90). Patient comfort scores were high and adverse event rates low. Conclusion The NHS Bowel Cancer Screening Programme provides high quality colonoscopy as demonstrated by high caecal intubation rate, adenoma detection rate and comfort scores and low adverse event rate. This quality is achieved by ensuring that BCSP colonoscopists are trained to a high standard and that these standards are maintained through ongoing quality assurance measures. [ABSTRACT FROM PUBLISHER]

Introduction The aim of screening colonoscopy is twofold: Firstly to detect colorectal cancer, secondly to detect and remove adenomas. This study examines the influence of both patient factors (age, gender, body mass index (BMI), smoking, alcohol use, deprivation, geographical location) and colonoscopy factors (withdrawal time, bowel preparation quality, rectal retroversion, colonoscopist, intravenous antispasmodic use, sedation use, time of procedure) on the risk of detecting one or more adenomas, advanced adenomas and right sided adenomas during screening colonoscopy. Methods All patients undergoing colonoscopy in the NHS Bowel Cancer Screening Programme (BCSP) between August 2006 and August 2009 were included in this study. Demographic, lifestyle, procedural and histological data were retrieved from the national database. The relationships between patient and colonoscopy factors with adenoma detection were examined using univariable and multivariable analysis. Results 31 088 patients undergoing screening colonoscopy were included in the analysis. 14 423 had one or more adenomas (46.7%). The following factors increased the relative risk of adenoma detection at screening colonoscopy in both univariable and multivariable analysis (p value <0.001 in multivariable analysis unless otherwise stated): male gender, increasing age, current or previous smoking, current alcohol use, increasing withdrawal time, higher quality bowel preparation, intravenous antispasmodic use, earlier procedure start time (p=0.018) and increasing colonoscopist experience. Increasing level of deprivation was associated with a reduced risk of adenoma detection (p=0.007). Similar results are demonstrated for the effect of these factors on advanced adenoma and right sided adenoma detection. Rectal retroversion did not increase adenoma detection or rectal adenoma detection. Conclusion This is the largest study to examine the effect of both patient and colonoscopy factors on adenoma detection at colonoscopy following a positive FOB test. The known impact of smoking, alcohol use, and male gender on adenoma risk is also observed in this setting. The relative effect of colonoscopy factors is also demonstrated with caecal intubation, bowel preparation quality, withdrawal time, intravenous antispasmodic use, colonoscopist experience and earlier sessional start time significantly affecting the risk of adenoma detection. This study demonstrates the need for high quality colonoscopy to optimise adenoma detection. [ABSTRACT FROM PUBLISHER]

Objective To examine temporal trends in the incidence of primary thyroid cancers diagnosed in 0–49 year olds in parts of Great Britain (GB) during the period 1976–2005. We specifically aimed to analyse age, period and cohort effects. Design Population-based descriptive analysis of cancer registry data. Setting Parts of Great Britain. Participants Case data on thyroid cancer were obtained from four regional cancer registries in GB (i. Northern and Yorkshire, ii. North West, iii. Wales and iv. Scotland). Main outcome measures Age-standardised incidence rates (ASRs) and 95% CIs were calculated. Negative binomial regression was used to examine the effects of age, sex, drift (linear trend), non-linear period and non-linear cohort. Results The study analysed 4327 cases of thyroid cancer aged 0–49 years at diagnosis. For males, the overall ASR was 3.9 per million persons per year (95% CI 3.6 to to 4.1). For females, the overall ASR was 12.5 per million persons per year (95% CI 12.0 to to 12.9). The best fitting negative binomial regression model included age (p<0.001), sex (p<0.001) and drift (p<0.001). Non-linear period (p=0.42) and non-linear cohort (p=0.71) were not statistically significant. For males aged 0–14 years, the ASR increased from 0.2 per million persons per year in 1976–1986 to 0.6 per million persons per year in 1997–2005. For males aged 15–29 years and 30–49 years the ASRs increased from 1.9 to 3.2 and from 7.3 to 12.6 per million persons per year, respectively. For females aged 0–14 years, the ASR increased from 0.3 to 0.5 per million persons per year. For females aged 15–29 years and 30–49 years the ASRs increased from 7.0 to 12.3 and from 21.2 to 40.0 per million persons per year, respectively. Conclusions There has been a linear increase in the incidence of thyroid cancer, which has led to a doubling of the number of cases diagnosed over a 20 year time span. The reasons for this increase are not well understood, but it is consistent with findings from other countries. [ABSTRACT FROM AUTHOR]

Objective Environmental factors are involved in the aetiology of type 1 diabetes. A particular role for infectious exposures has been postulated. Temporal and spatial variation in incidence would be consistent with this hypothesis. We aimed to test predictions of increasing incidence and spatial variation occurring among cases of type 1 diabetes in children (aged 0–14 years) that might arise as a result of environmental mechanisms. Design Population-based descriptive analysis of type 1 diabetes data. Setting Northeast England. Participants The study analysed 545 cases of type 1 diabetes diagnosed in children who were resident in a geographically defined region of northeast England during the period 1990–2007. Main Outcome Measures Age-specific and age-standardised incidence rates were calculated. Temporal trends were analysed using Poisson regression. Relationships between incidence rates and small area (census ward) population density and Townsend deprivation index (and its components) were analysed using negative binomial regression. Results Age-standardised incidence rates increased from 15.7 per 100 000 population in 1990–1995 to 27.9 per 100 000 population in 2002–2007. Furthermore, there was a regular 6-year cyclical pattern of plus or minus 25% in incidence rates (RR 1.25; 95% CI 1.11 to 1.41) and an overall increase of 4.8% per annum (95% CI 3.1 to 6.6). Lower incidence was associated with residence in wards that had higher levels of unemployment (RR per one percent increase in unemployment 0.97; 96% CI 0.95 to 0.99). Conclusions The results are consistent with the involvement of one or more environmental exposures in aetiology. A possible role for a specific infectious agent should be considered. [ABSTRACT FROM AUTHOR]

Objective To analyse the putative association between incidence of primary bone cancer diagnosed in 0–49 year olds in Great Britain (GB) in 1980–2005 and fluoride in drinking water. The analyses focussed on osteosarcoma and Ewing sarcoma. Design The study accessed multiple data sources including population census, digital boundary, postcode directory and fluoride monitoring at water supply zone level data. Incidence data from all 10 regional cancer registries were accessed and analysed by census ward. Residential postcode was used as a proxy for population distribution and the basis for making all census data compatible with 2001 census geography. Postcode distributions were also used to link water supply zones to census wards for England and Wales and postcode sectors for Scotland and enabled a fluoride level to be assigned to each census small-area in GB. Setting GB. Participants Data from patients (0 to 49 years) diagnosed with a primary bone cancer between 1980 and 2005 and registered with one of the 10 regional cancer registries in GB. Main outcome measure Negative binomial regression was used to examine the relationship between incidence rates and census small-area fluoride levels. These models were fitted to census small-area data aggregated into four age bands (0–14; 15–29; 30–49 and 0–49 years) and by gender with the logarithm of the “at risk” population as an offset. Results There were a total of 2566 osteosarcoma cases aged 0–49 years; 817 aged 0–14 years; 1315 aged 15–29 years and 434 aged 30–49 years. For Ewing sarcoma there were a total of 1650 cases aged 0–49 years; 659 aged 0–14 years; 800 aged 15–29 years and 191 aged 30–49 years. After adjustment for age and gender, no statistically significant association was found between osteosarcoma or Ewing sarcoma and fluoride levels in drinking water. For example, for osteosarcoma the RR for 1 ppm increase in fluoride level 0.993; 95% CI 0.843 to to 1.171 and for Ewing sarcoma RR 0.860; 95% CI 0.696 to to 1.064. Conclusion This is the first time the relationship between fluoride and bone cancer has been studied across the whole of GB at census ward level. No statistically significant associations between Ewing sarcoma or osteosarcoma and fluoride in drinking water were found. [ABSTRACT FROM AUTHOR]

Objective To investigate survival from cancer in children and young adults resident in the North of England. Methods Cases aged 0–24 years diagnosed with a primary malignancy during the period 1968–2005 were obtained from the Northern Region Young Persons' Malignant Disease Registry. Survival rates at five years were calculated using Kaplan- Meier estimation, for each diagnostic group, within four successive time periods 1968–1977, 1978–1987, 1988–1997 and 1998–2005. Cox regression analysis was used to investigate factors that may influence survival. Analyses were carried out separately by gender and age group (0–14, 15–24 years). Results There were a total of 5917 cancer cases; 2958 aged 0–14 years (1659 males, 1299 females) and 2949 aged 15–24 years (1592 males, 1357 females). For childhood cancer (aged 0–14) five year survival rates for all cancers improved significantly (<0.0001) from 39% in 1968-1977 to 60% in 1978-1987, 75% in 1988-1997 and 79% in 1998-2005. From the earliest to the latest period the survival rate for leukaemia increased from 24% to 81% (<0.0001), lymphoma from 46% to 87% (<0.0001), central nervous system tumours (CNS) from 43% to 73% (<0.0001), sympathetic nervous system tumours from 17% to 66% (<0.0001), bone tumours from 21% to 75% (<0.0001), soft tissue sarcoma from 30% to 58% (=0.0001) and for germ cell tumours from 59% to 97% (=0.0002). Cox analysis showed worse survival for acute lymphocytic leukaemia (ALL) and astrocytoma in the age group 10-14 years. For cancer in teenage and young adults (aged 15–24) five year survival rates for all cancers improved from 47% in 1968–1977 to 62% in 1978-1987, 75% in 1988–1997 and 83% in 1998–2005. From the earliest to the latest period the survival rate for leukaemia increased from 2% to 57% (<0.0001), lymphoma from 66% to 87% (<0.0001), CNS tumours from 52% to 81% (=0.002), bone tumours from 35% to 55% (=0.02), germ cell tumours from 41% to 95% (<0.0001) and carcinomas from 56% to 93% (<0.0001). Survival was worse for ALL in the age group 20–24 years but better for non-Hodgkin lymphoma. Conclusions There have been marked improvements in survival from childhood and young adult cancer in the North of England over the last four decades. Future work should analyse geographical and socio-demographic patterns for survival rates. [ABSTRACT FROM AUTHOR]

Objective To examine geographical patterning in the incidence of primary bone cancers diagnosed in 0–49 year olds in Great Britain (GB) during the period 1980–2005. The analyses focussed on the two most common types in this age range, osteosarcoma and Ewing sarcoma. We specifically aimed to analyse putative associations with area characteristics including deprivation and population density. Design The study accessed multiple data sources including population census, digital boundary, postcode directories and time series of Townsend deprivation scores. Incidence data from the 10 regional cancer registries in GB were accessed and analysed by census small-area level (census ward level for England and Wales; postcode sector level for Scotland). Setting GB. Participants Data from patients (0 to 49 years) diagnosed with a primary bone cancer between 1st January 1980 and 31st December 2005 and registered with one of the 10 regional cancer registries in GB. Main outcome measure Negative binomial regression was used to examine the relationship between incidence rates and population density, Townsend deprivation index (and its components). The models were fitted to small-area level data and aggregated to four age bands (0–14 years; 15–29 yrs; 30–49 years and 0–49 years) and by gender with the logarithm of the “at risk” population as an offset. Results The study analysed 2566 cases of osteosarcoma and 1650 cases of Ewing sarcoma. After adjustment for age and gender there was a statistically significant negative association for the incidence of osteosarcoma with area-level Townsend deprivation score (RR for one unit increase in level of deprivation 0.975; 95% CI 0.963 to to 0.986). For Ewing sarcoma, after adjustment for age and gender, there was a statistically significant negative association for incidence with population density (RR for an increase of one person per hectare 0.981; 95% CI 0.972 to to 0.989) and also with non-car ownership (RR for an increase of one percent in non-car ownership 0.996; 95% CI 0.993 to to 1.000). Conclusion Higher deprivation appears to have a protective effect on the incidence of osteosarcoma. Higher incidence of Ewing sarcoma was associated with living in less densely populated areas and greater levels of car ownership, both of which are characteristic of rural areas. This study contributes to the growing body of evidence linking risk of Ewing sarcoma to some aspect of agriculture and suggests further study of environmental exposures or land use may be informative. [ABSTRACT FROM AUTHOR]

The authors used a directed-forgetting task to investigate whether psychiatrically impaired adult survivors of childhood sexual abuse exhibit an avoidant encoding style and impaired memory for trauma cues. The authors tested women with abuse histories, either with or without posttraumatic stress disorder (PTSD), and women with neither abuse histories nor PTSD. The women saw intermixed trauma words (e.g., molested), positive words (e.g., confident), and categorized neutral words (e.g., mailbox) on a computer screen and were instructed either to remember or to forget each word. Relative to the other groups, the PTSD group did not exhibit recall deficits for trauma-related to-be-remembered words, nor did they recall fewer trauma-related to-be-forgotten words than other words. Instead, they exhibited recall deficits for positive and neutral words they were supposed to remember. These data are inconsistent with the hypothesis that impaired survivors exhibit avoidant encoding and impaired memory for traumatic information. [ABSTRACT FROM AUTHOR]