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Sarah Cook,1 David Osborn,2,3 Arti Maini,1 Ravi Parekh,1 Shamini Gnani,1 Thomas Beaney,1 Ana Luisa Neves,1 Sonia Saxena,1 Jennifer K Quint1 1School of Public Health, Imperial College London, London, UK; 2Division of Psychiatry, University College London, London, UK; 3Camden and Islington NHS Foundation Trust, London, UKCorrespondence: Sarah Cook, White City Campus, Imperial College London, 9th Floor Michael Uren Building, London, W12 0BZ, UK, Email sarah.cook@imperial.ac.ukPurpose: Electronic health records (EHR) are valuable resources for health research; however, their use is challenging. A validated alcohol use disorder (AUD) codelist for UK primary care is needed to improve population-based research in this patient group. We aimed to develop an AUD codelist for use in the Clinical Practice Research Datalink (CPRD) Aurum database, a UK EHR primary-care database.Methods: The CPRD code browser was searched using keywords related to alcohol use using a previously developed search strategy. The resulting codes were categorised as AUD if they were: a) diagnostic of AUD, b) indicated alcohol withdrawal, or c) indicated chronic alcohol-related harm (physical or mental). Codes related to alcohol use but not used to define AUD were also classified into relevant categories (alcohol status, acute harm, and alcohol screening). All codes were categorised independently by at least two reviewers (one person reviewed all codes and five reviewers (all practising GPs) each reviewed a subset of codes (100– 200 codes each). Disagreements in categorisation were discussed by at least three coders and a consensus was reached. The reliability of categorisation was assessed using kappa statistics.Results: In total, 556 potential codes related to alcohol use were identified. The Kappa for reliability between coders was moderate for both AUD (0.72) and across all categories (0.62), with substantial variability between coders (AUD: 0.33– 0.97; all categories 0.36– 0.74). In the final codelist, 138 codes were included as indicating AUD: 38 codes identified which indicated diagnosis of AUD, 14 indicating withdrawal plus 85 codes indicating chronic alcohol-related harm (41 physical health and 44 mental health).Conclusion: Many codes are used in primary care to record alcohol use and associated harms, and there is substantial variability in how clinicians categorise them. While future work formally validating the codelist against gold standard clinical reviews and qualitative work with General Practitioners is needed for a deeper understanding of coding processes, we have documented here the process used for the development of an AUD codelist within primary care which can be used as a reference for future research.Keywords: alcohol use disorder, electronic health records, primary care, clinical practice research datalink

Introduction We have designed a prospective, randomised, single blinded non-inferiority trial to determine whether using a lower concentration local anaesthetic in caudal blocks (0.125% levobupivacaine) provides non-inferior analgesia compared to IG/IH blocks with fewer side effects. Material and methods We recruited 82 patients for our study at Medway Maritime Hospital. The intervention was caudal block with 0.125% levobupivacaine with clonidine as an additive compared with USS guided IG/IH nerve blocks. Our primary outcome measure was post-operative pain and our predefined non-inferiority margin was a 15% difference in pain. Secondary outcomes included rescue analgesia, motor block, time to discharge and micturition. Results 80 patients were included in analysis (caudal n=40, IG/IH n=40). We found a 5% absolute decrease in post-operative pain after low concentration caudal blocks compared to IG/IH blocks (95% CI -19.5 to 9.5, p <0.01) demonstrating non-inferiority. There was no evidence of noninferiority for motor block, with 12.5% more patients experiencing motor block in the caudal group immediately following recovery from general anaesthetic (95% CI - 2.4 to 28.4 p=0.379 for non-inferiority). Of these, 2 patients receiving caudal blocks (5%) had remaining motor block on the ward which recovered by discharge. Conclusions Our study shows non-inferiority between low concentration local anaesthetic in caudal blocks compared with USS guided IG/IH nerve blocks for analgesic benefit and requirement for post-operative analgesia. We suggest 0.125% levobupivacaine for anaesthetists who use caudal blocks in their practice. This technique demonstrates non-inferiority compared to USS guided IG/IH blocks. [ABSTRACT FROM AUTHOR]

Hypertension (HT) is a public health problem in sub-Saharan Africa. In addition, other cardiovascular risk factors are on the rise in this part of the world. To determine the proportion of HT and the relationship between blood pressure (BP) variation and overweight, obesity and excessive alcohol intake in the republic of the Congo. Screening was conducted during the period from 15 may to 15 June 2019. Have been included, consenting persons, over 18 years of age, with no disabling signs or pathologies. The screening concerned urban and rural areas. The protocol May Measurement Month (MMM) of International Society of Hypertension (ISH) was applied. In total, 3157 persons were included. The mean age was 44.7 ± 14.9, male sex 1486 (47.1%). The mean BMI 25.4 ± 5.1. They were in overweight 881 (27.9%), and obesity 447 (14.2%). Excessive alcohol intake was reported in 208 cases (6.6%). The proportion of hypertension was 33.5% (n = 1057), and HT was aware in 42.6%, on medication 37.3%, of them proportion under treatment was 62.4%, and hypertensives with controlled blood BP was 23.3%. After imputation, the proportions of HT were: 30.1% (n = 1475) according age and sex standardised. Systolic and diastolic BP increased in compared to baseline in case of obesity (P < 0.001) and excessive alcohol intake (P < 0.001). Only diastolic BP increased in compared to baseline in case of overweight (P = 0.001). Overweight, obesity and excessive alcohol intake are associated factors of increased blood pressure. Advocacy for the education of the population to prevent the occurrence of these risk factors is recommended. [ABSTRACT FROM AUTHOR]

To determine the proportion of arterial hypertension in the Republic of Congo. This cross-sectional study was conducted in May 2018. Screening was carried out in urban (Brazzaville, Pointe-Noire, and Nkayi) and rural (Kouilou and Bouenza) areas in the Republic of the Congo. The screening was carried out on a voluntary basis, as part of the MMM initiative of the International Society of Hypertension (London, UK). A total of 6169 people were screened, including 3751 men (61%) and black Africans 5793 (94%). The mean age was 30.9 ± 14.7 years, the population was often aged from 18 to 29 years (n = 4184, 67.8%). The population was on antihypertensive treatment 493 (8%). Associated factors were: diabetes (n = 135, 2.2%), history of stroke (n = 139, 2.3%), alcohol consumption 1608 (26.1%), current smoker (n = 127, 2.1%). The average BMI was 22.6 ± 4.3, overweight was noted in 952 cases (15.4%) and obesity in 449 cases (7.3%). The proportion of hypertension was 22.2% (n = 1371). Hypertension was known (40.2%), treated (36%), treated and controlled (44.5%), controlled (16%). After adjusting for sex and age, the frequency of hypertension was 39%, and of 26.8% excluding those treated, and 48.3% including those treated. The proportion of people treated for hypertension is low, and the people treated are poorly controlled. Actions for a wider screening of the population are necessary to improve care strategies. [ABSTRACT FROM AUTHOR]

The prevalence of cardiovascular risk factors is increasing in sub-Saharan Africa. To determine the prevalence of hypertension (HT) and other cardiovascular risk factors. this cross-sectional study was conducted in May 2017 at Brazzaville. This screening included subjects over 18 years old. Screening was carried out in 5 districts of Brazzaville. This activity (May Measurement Month) was initiated and supported by International Society of Hypertension (ISH). A total of 3842 subjects were screened, including 2320 women (60.4%). The mean age was 47.6 ± 15.8 years. The medical history were: excessive alcohol intake (13.7%), cigarette smoking (5.4%) and diabetes (5%). Of these, 954 were known HT and did not receive treatment (29.8%). Of these hypertensive patients, 409 (66%) were treated and uncontrolled. Mean BMI was 26 ± 5.6, and abdominal obesity was noted in 823 (21.4%) cases. The mean systolic blood pressure (BP) was 134.5 mm Hg, 131.8 mm Hg and 130.6 mm Hg respectively for the measurement 1, measurement 2 and measurement 3. The mean diastolic BP was 83.1 mm Hg for the measurement 1, 81.5 mm Hg for the measurement 2 and 80.7 mm Hg for the measurement 3. HT was noted in 1576 subjects (41%). After adjusting for sex and age, the change in systolic BP was dependent on antihypertensive drugs (P < 0.0001), previous stroke (P = 0.001), alcohol consumption (P = 0.001), abdominal obesity (P < 0.0001), overweight (P < 0.0001) and obesity (P < 0.0001). The change in diastolic BP depended on: antihypertensive drugs (P < 0.0001), previous stroke (P = 0.01), alcohol consumption (P < 0.0001), abdominal obesity (P < 0.0001), overweight (P = 0.001) and obesity (P < 0.0001). The prevalence of HT is high at Brazzaville. Known hypertensive patients are little treated, and they are poorly controlled. Therefore, nationwide screening is needed to increase awareness and prevent complications. [ABSTRACT FROM AUTHOR]