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Objective To evaluate the performance of the QStatin scores for predicting the 5-year risk of developing acute renal failure, cataract, liver dysfunction and myopathy in men and women in England and Wales receiving statins. Design Prospective cohort study to evaluate the performance of four statin risk prediction models. Setting 364 practices in the UK contributing to The Health Improvement Network database. Participants 2.2 million patients aged 35e84 years registered with a general practice surgery between 1 January 2002 and 30 June 2008, with 2037 incident cases of acute renal failure, 25 692 incident cataract cases, 14 756 cases of liver dysfunction and 1209 incident cases of myopathy. Main outcome measures First recorded occurrence of acute renal failure, cataract, moderate or severe liver dysfunction and moderate or severe myopathic events as recorded in general practice records. Results Results from this independent and external validation of QStatin scores indicate that models predicting the 5-year statin risk of developing acute renal failure, cataracts and myopathy perform well with areas under the receiver operating characteristic curve ranging from 0.73 to 0.87. Calibration plots for the three models also indicated close agreement between observed and predicted risks. Poor performance was observed for the model predicting the 5-year statin risk of developing liver dysfunction with areas under the receiver operating characteristic curve of 0.64 and 0.60 for women and men, respectively. Conclusions QStatin scores for predicting the 5-year statin risk of developing acute renal failure, cataract and myopathy appear to be useful models with good discriminative and calibration properties. The model for predicting the 5-year statin risk of developing liver dysfunction appears to have limited ability to identify high-risk individuals and the authors caution against its use. [ABSTRACT FROM AUTHOR]

The article focuses on a study which evaluated the performance of the QRISK score for predicting 10 year risk of cardiovascular disease in an independent cohort of patients in England and Wales from general practice and compared the performance with Framingham equations. The study found that QRISK provides an improved performance in predicting the 10 year risk of cardiovascular disease. A better QRISK was also noted in discrimination and calibration statistics. It was also observed that the incidence of cardiovascular disease in men was higher compared to women.

Examines the mathematical models in collecting data on infection with human immunodeficiency virus (HIV) in London, England. Transmission rate of HIV infection by vaginal intercourse; Identification of risk factors for spread of HIV infection; Importance of social and behavioral studies.

Importance: Stunting (short length for age) and wasting (low body mass index [BMI] for age) are widely used to assess child nutrition. In contrast, newborns tend to be assessed solely based on their weight., Objective: To use recent international standards for newborn size by gestational age to assess how stunted and wasted newborns differ in terms of risk factors and prognoses., Design, Setting, and Participants: A cross-sectional study with follow-up until hospital discharge was conducted at urban sites in Brazil, China, India, Italy, Kenya, Oman, England, and the United States that are participating in the INTERGROWTH-21st Project. The study was conducted from April 27, 2009, to March 2, 2014, and the final dataset for analyses was locked on March 19, 2014., Exposures: Sociodemographic and behavioral maternal risk factors, previous pregnancy history, and maternal and fetal conditions during pregnancy were investigated as risk factors for stunting and wasting. Anthropometry at birth was used to predict for neonatal prognosis., Main Outcomes and Measures: Newborn stunting and wasting were defined as birth length and BMI for gestational age below the third centiles of the INTERGROWTH-21st standards. Prognosis was assessed through mortality before hospital discharge, admission to neonatal intensive care units, and newborn complications., Results: From the 60 206 singleton live births during the study period, we selected all newborns between 33 weeks' and 42 weeks 6 days' gestation at birth (51 200 [85%]) with reliable ultrasound dating. Stunting affected 3.8% and wasting 3.4% of all newborns; both conditions were present in 0.7% of the sample. Of the 26 conditions studied, five were more strongly associated with stunting than with wasting (reported as odds ratios [OR]; 95% CI): short maternal height (6.7; 5.1-9.0), younger maternal age (0.7; 0.5-0.9), smoking (2.8; 2.3-3.3), illicit drug use (2.3; 1.5-3.6), and clinically suspected intrauterine growth restriction (5.2; 4.5-6.0). Wasting was more strongly related than stunting with 4 newborn outcomes (neonatal intensive care stay, 6.7 [5.5-8.1]; respiratory distress syndrome, 4.0 [3.3-4.9]; transient tachypnea, 2.1 [1.5-2.9]; and no oral feeding for >24 hours, 5.0 [3.9-6.5]). Maternal gestational diabetes mellitus was protective against wasting (0.6; 0.5-0.8) but not against stunting (0.9; 0.7-1.1)., Conclusions and Relevance: Although newborn stunting and wasting share some common determinants, they are distinct phenotypes with their own risk factors and neonatal prognoses. To be consistent with the literature on infant and child nutrition, newborns should be classified using the 2 phenotypes of stunting and wasting. The distinction will help to prioritize preventive interventions and focus the management of fetal undernutrition.

Objective: To independently evaluate the performance of the QRISK score for predicting 10 year risk of cardiovascular disease in an independent UK cohort of patients from general practice and compare the performance with Framingham equations., Design: Prospective open cohort study., Setting: 274 practices from England and Wales contributing to the THIN database., Participants: 1.07 million patients, registered between 1 January 1995 and 1 April 2006, aged 35-74 years (5.4 million person years) with 43 990 cardiovascular events., Main Outcome Measures: First diagnosis of cardiovascular disease (myocardial infarction, coronary heart disease, stroke, and transient ischaemic attack) recorded in general practice records., Results: This independent validation indicated that QRISK offers an improved performance in predicting the 10 year risk of cardiovascular disease in a large cohort of UK patients over the Anderson Framingham equation. Discrimination and calibration statistics were better with QRISK. QRISK explained 32% of the variation in men and 37% in women, compared with 27% and 31% respectively for Anderson Framingham. QRISK underpredicted risk by 13% for men and 10% for women, whereas Anderson Framingham overpredicted risk by 32% for men and 10% for women. In total, 85 010 (8%) of patients would be reclassified from high risk (>or=20%) with Anderson Framingham to low risk with QRISK, with an observed 10 year cardiovascular disease risk of 17.5% (95% confidence interval 16.9% to 18.1%) for men and 16.8% (15.7% to 18.0%) for women. The incidence rate of cardiovascular disease events among men was 30.5 per 1000 person years (95% confidence interval 29.9 to 31.2) in high risk patients identified with QRISK and 23.7 per 1000 person years (23.2 to 24.1) in high risk patients identified with Anderson Framingham. Similarly, the incidence rate of cardiovascular disease events among women was 26.7 per 1000 person years (25.8 to 27.7) in high risk patients identified with QRISK compared with 22.2 per 1000 person years (21.4 to 23.0) in high risk patients identified with Anderson Framingham., Conclusions: The QRISK cardiovascular disease risk equation offers an improvement over the long established Anderson Framingham equation in terms of identifying a high risk population for cardiovascular disease in the United Kingdom. QRISK underestimates 10 year cardiovascular disease risk, but the magnitude of underprediction is smaller than the overprediction with Anderson Framingham.

Background: Young women presenting with breast cancer are more likely to have a genetic predisposition to the disease than breast cancer patients in general. A genetic predisposition is known to increase the risk of new primary breast (and other) cancers. It is unclear from the literature whether genetic status should be taken into consideration when planning adjuvant treatment in a young woman presenting with a first primary breast cancer. The primary aim of the POSH study is to establish whether genetic status influences the prognosis of primary breast cancer independently of known prognostic factors., Methods/design: The study is a prospective cohort study recruiting 3,000 women aged 40 years or younger at breast cancer diagnosis; the recruiting period covers 1st June 2001 to 31st December 2007. Written informed consent is obtained at study entry. Family history and known epidemiological risk data are collected by questionnaire. Clinical information about diagnosis, treatment and clinical course is collected and blood is stored. Follow up data are collected annually after the first year. An additional recruitment category includes women aged 41 to 50 years who are found to be BRCA1 or BRCA2 gene carriers and were diagnosed with their first breast cancer during the study recruiting period., Discussion: Power estimates were based on 10% of the cohort carrying a BRCA1 gene mutation. Preliminary BRCA1 and BRCA2 mutation analysis in a pilot set of study participants confirms we should have 97% power to detect a difference of 10% in event rates between gene carriers and sporadic young onset cases. Most of the recruited patients (>80%) receive an anthracycline containing adjuvant chemotherapy regimen making planned analyses more straightforward.