Search

BACKGROUND: A sulphur dioxide (SO(2)) episode occurred in the United Kingdom in 1998. The worst affected area was the city of Nottingham. METHODS: Emergency hospital admissions in Nottingham in the episode week were compared with those in the previous week. RESULTS: A statistically significant increase in admissions for all respiratory diseases occurred in the episode week (odds ratio (OR) = 1.40, 95 per cent confidence interval (CI) = 1.00-1.94). Ten of the 25 excess admissions were for asthma, although the excess for asthma alone was not statistically significant (OR = 1.90, 95 per cent CI = 0.87-4.15). CONCLUSIONS: The excess admissions for respiratory diseases could have been caused by exposure to SO(2), to other pollutants present in increased concentrations during the pollution episode, or by seasonal variations in the frequency of asthma symptoms, or prevailing weather conditions. This study shows how simple analyses of routinely collected health data can be used to assess public health impacts of pollution episodes. [ABSTRACT FROM AUTHOR]

Background: Recommendations within guidelines are developed by synthesising the best available evidence; when limited evidence is identified recommendations are generally based on informal consensus. However, there are potential biases in group decision making, and formal consensus methods may help reduce these., Methods: We conducted a case study using formal consensus, to develop one set of recommendations within the Neonatal Parenteral Nutrition guideline being produced for the National Institute for Health and Care Excellence. Statements were generated through identification of published guidelines on several topics relating to neonatal parenteral nutrition. Ten high quality guidelines were included, and 28 statements were generated; these statements were rated by the committee via two rounds of voting. The statements which resulted in agreement were then used to develop the recommendations., Results: The approach was systematic and provided transparency. Additionally, a number of lessons were learnt; including the value of selecting the appropriate topic, giving adequate time to the process, and ensuring methodologies are understood by the committee for their value and relevance., Conclusion: Formal consensus is a valuable option for use within guideline development when specific criteria are met. The approach provides transparent methodology, ensuring clarity on how recommendations are developed.

Objectives: Grading of Recommendations Assessment, Development and Evaluation (GRADE) is a system for rating the confidence in estimates of effect and grading guideline recommendations. It promotes evaluation of the quality of the evidence for each outcome and an assessment of balance between desirable and undesirable outcomes leading to a judgment about the strength of the recommendation. In 2007, the National Institute for Health and Clinical Excellence began introducing GRADE across its clinical guideline program to enable separation of judgments about the evidence quality from judgments about the strength of the recommendation., Study Design and Setting: We describe the process of implementing GRADE across guidelines., Results: Use of GRADE has been positively received by both technical staff and guideline development group members., Conclusion: A shift in thinking about confidence in the evidence was required leading to a more structured and transparent approach to decision making. Practical problems were also encountered; these have largely been resolved, but some areas require further work, including the application of imprecision and presenting results from analyses considering more than two alternative interventions. The use of GRADE for nonrandomized and diagnostic accuracy studies needs to be refined., (Crown Copyright © 2013. Published by Elsevier Inc. All rights reserved.)

Aims/hypothesis: The cost-effectiveness of eight strategies for screening for gestational diabetes (including no screening) was estimated with respect to the level of individual patient risk., Methods: Cost-utility analysis using a decision analytic model populated with efficacy evidence pooled from recent randomised controlled trials, from the funding perspective of the National Health Service in England and Wales. Seven screening strategies using various combinations of screening and diagnostic tests were tested in addition to no screening. The primary outcome measure was the incremental cost per quality-adjusted life-year (QALY) over a lifetime., Results: The strategy that has the greatest likelihood of being cost-effective is dependent on the risk of gestational diabetes mellitus for each individual woman. When gestational diabetes mellitus risk is <1% then the no screening/treatment strategy is cost-effective; where risk is between 1.0% and 4.2% fasting plasma glucose followed by OGTT is most likely to be cost-effective; and where risk is >4.2%, universal OGTT is most likely to be cost-effective. However, acceptability of the test alters the most cost-effective strategy., Conclusions/interpretation: Screening for gestational diabetes can be cost-effective. The best strategy is dependent on the underlying risk of each individual and the acceptability of the tests used. The current study suggests that if a woman's individual risk of gestational diabetes could be accurately predicted, then healthcare resource allocation could be improved by providing an individualised screening strategy.

The World Health Organization (WHO) recently produced draft guidelines for safe recreational water environments. The microbiological standards proposed in the guidelines are expected to overestimate the degree of water quality required to provide given levels of public health protection. The WHO standards were obtained by means of a risk assessment which featured a dose-response model derived from a series of randomised controlled trials. The trials have many strengths but biases and problems with statistical analysis are likely to have led to over-estimation of the risks from bathing in the dose-response model. In addition, the WHO risk assessment failed to consider the effects of uncertainty and variability in risk estimates and sensitivity to model assumptions. Improved standards could be obtained by extending the risk assessment to examine these effects and by incorporating a suitably revised dose-response model.

This study investigated the combined effect in rat lungs of simultaneous exposure to chrysotile asbestos and N-nitrosoheptamethyleneimine (NHMI), with the objective of determining the potential for chrysotile to promote or otherwise enhance the pathological responses to this potent rodent lung carcinogen. Groups of 15 or 20 male and female animals were treated with 0, 3, or 10 mg kg(-1) NHMI subcutaneously, once a week for 10 wk, plus either clean air (control) or 50 mg m(-3) chrysotile by nose-only inhalation for 4 wk. A broad range of pulmonary metaplastic, hyperplastic, and neoplastic lesions was observed. Effects were more marked in male than in female animals. NHMI treatment increased the incidence of hyperplastic lesions, with apparent augmentation by chrysotile exposure (not statistically significant). Similarly, a "promoting" effect of chrysotile in the induction of lung tumors was observed, with all but 2 of the 11 primary tumors detected being in animals treated with both NHMI and asbestos. However, this apparent interaction was again not confirmable statistically, probably because of the low number of observed tumors (stemming from premature termination of the experiment). The study results are in line with those of similar previous studies, which found a higher incidence of hyperplastic and neoplastic changes in animals treated with both nitrosamine and asbestos than in those given nitrosamine alone. It is proposed that the method described (with minor modification) could be used to investigate either (1) the ability of other inhaled particles to augment NHMI carcinogenicity, or (2) the propensity of other chemical carcinogens to interact with asbestos in the production of pulmonary neoplasms.