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Communicable disease outbreaks can spread rapidly, causing enormous losses to individual health, national economies and social well-being. Therefore, communicable disease surveillance is essential for protecting public health. In Qatar, electronic reporting from primary health centres was proposed as a means of improving disease notification, replacing a paper-based method of reporting (via internal mail, facsimile, email or telephone), which has disadvantages and requires active cooperation and engagement of staff. This study is a predescriptive and postdescriptive analysis, which compared disease notifications received from electronic and paper-based systems during 3-month evaluation periods (quarter 2 in 2016 and quarter 2 in 2018 for paper-based and electronic reporting, respectively) in terms of comprehensiveness, timeliness and completeness. For the 23 notifiable diseases included in this study, approximately twice as many notifications were received through the electronic reporting system as from the paper-based reporting system, demonstrating it is more comprehensive. An overall increase in notifications is likely to have a positive public health impact in Qatar. 100% of electronic notifications were received in a timely manner, compared with 28% for paper-based notifications. Findings of the study show that electronic reporting presents a revolutionary opportunity to advance public health surveillance. It is recommended that electronic reporting be rolled out more widely to improve the completeness, stability and representativeness of the national public health surveillance system in Qatar as well as other countries.

This statement summarises and appraises the evidence on diagnosis, prevention and treatment of the most common lower extremity muscle injuries in sport. We systematically searched electronic databases, and included studies based on the highest available evidence. Subsequently, we evaluated the quality of evidence using the Grading of Recommendations Assessment, Development and Evaluation framework, grading the quality of evidence from high to very low. Most clinical tests showed very low to low diagnostic effectiveness. For hamstring injury prevention, programmes that included the Nordic hamstring exercise resulted in a hamstring injury risk reduction when compared with usual care (medium to large effect size; moderate to high quality of evidence). For prevention of groin injuries, both the FIFA 11+programme and the Copenhagen adductor strengthening programme resulted in a groin injury risk reduction compared with usual care (medium effect size; low to moderate quality of evidence). For the treatment of hamstring injuries, lengthening hamstring exercises showed the fastest return to play with a lower reinjury rate compared with conventional hamstring exercises (large effect size; very low to low quality of evidence). Platelet-rich plasma had no effect on time to return-to-play and reinjury risk (trivial effect size; moderate quality of evidence) after a hamstring injury compared with placebo or rehabilitation. At this point, most outcomes for diagnosis, prevention and treatment were graded as very low to moderate quality of evidence, indicating that further high-quality research is likely to have an important impact on the confidence in the effect estimates.

Research is urgently needed to help understand the mental health consequences of the covid-19 pandemic on healthcare workers and the public, researchers have argued in a position paper published in the Lancet Psychiatry .1 The paper, funded by the Academy of Medical Sciences, looks at the psychological, social, and neuroscientific effects of covid-19. It warns of major adverse consequences of the pandemic, including increased social isolation and loneliness, which are “strongly associated with anxiety, depression, self-harm, and suicide attempts across the lifespan.” The authors suggest a number of immediate and longer term actions to mitigate the mental health consequences of this pandemic and any similar future situations, including better monitoring systems and rapidly rolling out evidence based programmes and treatments that can be accessed remotely. These priorities were informed by two surveys of the public and a panel of 24 experts, including people with lived experience of a mental health issue. The surveys, conducted by Ipsos MORI (1099 people) and the mental health research charity MQ (2198 …

Hepatitis B during pregnancy presents unique management issues for both the mother and fetus. These include the lack of a current cohesive strategy for treatment and follow-up of mothers and their babies; the uncertain risk of postpartum HBV flares; the lack of randomised trial data on the safety and efficacy of antiviral treatment in pregnancy; the lack of head-to-head studies comparing different antivirals in pregnancy; and the lack of epidemiologic information regarding infection across different populations globally. This position paper provides a comprehensive review of the management of women with HBV infection prior to conception, throughout each stage of pregnancy and postpartum, as well as recommendations and clinical approaches for the follow-up of children born to infected mothers, based on available evidence in the literature and recommendations from international experts. Prevention of perinatal transmission is an important component of global efforts to reduce the burden of chronic HBV since vertical transmission is responsible for most of the chronic infection worldwide.

Primary care services in or alongside emergency\ud departments look and function differently and are\ud described using inconsistent terminology. Research to\ud determine effectiveness of these models is hampered by\ud outdated classification systems, limiting the opportunity\ud for data synthesis to draw conclusions and inform\ud decision-making and policy. We used findings from a\ud literature review, a national survey of Type 1 emergency\ud departments in England and Wales, staff interviews,\ud other routine data sources and discussions from\ud two stakeholder events to inform the taxonomy. We\ud categorised the forms inside or outside the emergency\ud department: inside primary care services may be\ud integrated with emergency department patient flow or\ud may run parallel to that activity; outside services may be\ud offered on site or off site. We then describe a conceptual\ud spectrum of integration: identifying constructs that\ud influence how the services function—from being closer\ud to an emergency medicine service or to usual primary\ud care. This taxonomy provides a basis for future evaluation\ud of service models that will comprise the evidence base\ud to inform policy-making in this domain. Commissioners\ud and service providers can consider these constructs in\ud characterising and designing services depending on local\ud circumstances and context.

Each year, the Heart editorial team selects the most meritorious research paper to receive the Heart Best Research Paper Award. Primary considerations are the relevance of the clinical question addressed by the research, the quality of the research study design and data presentation, and the interest generated by the paper among other researchers, clinical cardiologists and the general public. This year, we are pleased to announce the winner and two finalists for the 2020 Heart Best Paper Research Award, highlighting the first author of each paper and sincerely congratulating the entire research team on their outstanding research contribution (table 1). View this table: Table 1 Heart best research paper Award winner and Finalists 2020 Ralph K. Akyea MPH, MBChB (figure 1) is a second-year doctoral student and part-time research associate with the Primary Care Stratified Medicine Research Group, Division of Primary Care, University of Nottingham, UK. He received his medical degree from the University of Ghana Medical School and earned his master’s degree in public health from …

The aim of this study is to evaluate the current practice of statistical analysis of eye data in clinical science papers published in British Journal of Ophthalmology (BJO) and to determine whether the practice of statistical analysis has improved in the past two decades. All clinical science papers (n=125) published in BJO in January–June 2017 were reviewed for their statistical analysis approaches for analysing primary ocular measure. We compared our findings to the results from a previous paper that reviewed BJO papers in 1995. Of 112 papers eligible for analysis, half of the studies analysed the data at an individual level because of the nature of observation, 16 (14%) studies analysed data from one eye only, 36 (32%) studies analysed data from both eyes at ocular level, one study (1%) analysed the overall summary of ocular finding per individual and three (3%) studies used the paired comparison. Among studies with data available from both eyes, 50 (89%) of 56 papers in 2017 did not analyse data from both eyes or ignored the intereye correlation, as compared with in 60 (90%) of 67 papers in 1995 (P=0.96). Among studies that analysed data from both eyes at an ocular level, 33 (92%) of 36 studies completely ignored the intereye correlation in 2017, as compared with in 16 (89%) of 18 studies in 1995 (P=0.40). A majority of studies did not analyse the data properly when data from both eyes were available. The practice of statistical analysis did not improve in the past two decades. Collaborative efforts should be made in the vision research community to improve the practice of statistical analysis for ocular data.

Researchers whose rapid investigations into possible covid treatments that helped to save over a million lives worldwide have won a top prize in this year’s BMJ Awards. The Recovery collaborative group’s trial, which was the first to show that the inexpensive steroid dexamethasone improved survival among patients with covid-19 who had severe respiratory complications, was awarded The BMJ ’s research paper of the year.1 It found that dexamethasone reduced the risk of death by a third among patients on ventilators and by almost a fifth among those on oxygen. The award judges praised the “landmark” NHS study. They said, “The setup of …

It is 40 years since the seminal description of ‘Munchausen Syndrome by Proxy’ (MSbP) by UK Paediatrician Professor Sir Roy Meadow.1 There have been a number of developments since, which include terminology, definition, prevalence and management. The Royal College of Paediatrics and Child Health (RCPCH) adopted the term ‘Fabricated or Induced Illness by Carers’ (FII) in 2002,2 and updated their guidance in 2009.3 The most recent version of the RCPCH Child Protection Companion extended FII to embrace perplexing presentations with suggestions for management.4 The important evolution in the UK has been towards earlier diagnosis and intervention without the need for proof of deliberate deception. In the USA terms such as ‘Pediatric Condition Falsification’, ‘Medical Child Abuse’ and ‘Caregiver-Fabricated Illness in a Child’ have been introduced although MSbP is still widely used and deception is still implicit.5–7 In adult psychiatry, The Diagnostic and Statistic Manual of Mental Disorders produced by the American Psychiatric Association (DSM-5) replaces Factitious Disorder by Proxy with Factitious Disorder Imposed on Another (FDIoA).8 However, as DSM-5 stipulates that the carer behaviour is associated with identified deception, this excludes many carers involved in paediatric FII. In this paper, FII will be the term used to encompass all of these terms. Paediatricians in the UK have expressed significant concerns about FII, including when and how to recognise it, how to assess risk and how to manage these cases. Even in recent literature, most cases being reported still involve deliberate physical abuse by the carer. There are few descriptions of the earlier presentations and those involving erroneous reporting that form the majority of cases seen by paediatricians. While cases continue to be brought within the umbrella of FII and into the scope of national and local FII procedures for safeguarding children,9 there have …

IntroductionHormone replacement therapy (HRT) can help women experiencing menopausal symptoms, but usage has declined due to uncertainty around risks of cancer and some cardiovascular diseases (CVD). Moreover, improved cancer survival rates mean that more women who survive cancer go on to experience menopausal symptoms. Understanding these relationships is important so that women and their clinicians can make informed decisions around the risks and benefits of HRT. This study’s primary aim is to determine the association between HRT use after cancer diagnosis and the risk of cancer-specific mortality. The secondary aims are to investigate the risks of HRT on subsequent cancer, all-cause mortality and CVD.Methods and analysisWe will conduct a population-based longitudinal cohort study of 18–79 year-old women diagnosed with cancer between 1998 and 2020, using the QResearch database. The main exposure is HRT use, categorised based on compound, dose and route of administration, and modelled as a time-varying covariate. Analysis of HRT use precancer and postcancer diagnosis will be conducted separately. The primary outcome is cancer-specific mortality, which will be stratified by cancer site. Secondary outcomes include subsequent cancer diagnosis, CVD (including venous thrombo-embolism) and all-cause mortality. Adjustment will be made for key confounders such as age, body mass index, ethnicity, deprivation index, comorbidities, and cancer grade, stage and treatment. Statistical analysis will include descriptive statistics and Cox proportional hazards models to calculate HRs and 95% CIs.Ethics and disseminationEthical approval for this project was obtained from the QResearch Scientific Committee (Ref: OX24, project title ‘Use of hormone replacement therapy and survival from cancer’). This project has been, and will continue to be, supported by patient and public involvement panels. We intend to the submit the findings for peer-reviewed publication in an academic journal and disseminate them to the public through Cancer Research UK.