In utero exposure to antidepressant medication and neonatal and child outcomes: a systematic review.

OBJECTIVE: The aim of this study is to systematically review published studies, reporting outcomes to offspring following in utero exposure to antidepressant medications, which used an untreated depressed comparison group. METHODS: OVID, Scopus, EBSCO Collections, the Cochrane Library and Web of Science databases were searched for relevant publications published between January 1950 and May 2018 and a total of 188 potentially eligible studies were identified. RESULTS: Following review, 16 primary studies were eligible for inclusion. Antidepressant exposure was associated with an increased risk of lower gestational age, preterm birth, but not low birthweight or being small for gestational age compared to untreated depression. There is some evidence that congenital defects are associated with antidepressant use, particularly between cardiac defects and paroxetine use. There is conflicting evidence regarding neurodevelopment in offspring, with some reports of increased incidence of autistic spectrum disorders and depression, but also reports of no problems when measuring emotional symptoms, peer problems, conduct problems and hyperactivity-inattention scores. CONCLUSION: When compared with an untreated depressed group, antidepressant exposure was associated with adverse outcomes at birth, while there is insufficient data to determine whether the association between antidepressants and congenital defects or developmental disorders is a true association. However, although we compared treated vs. untreated depression there still may be residual confounding as an untreated depressed group is likely to have less severe depression.

Differences in all-cause hospitalisation by ethnic group: a data linkage cohort study of 4.62 million people in Scotland, 2001-2013.

OBJECTIVES: Immigration into Europe has raised contrasting concerns about increased pressure on health services and equitable provision of health care to immigrants or ethnic minorities. Our objective was to find out if there were important differences in hospital use between the main ethnic groups in Scotland. STUDY DESIGN: A census-based data linkage cohort study. METHODS: We anonymously linked Scotland's Census 2001 records for 4.62 million people, including their ethnic group, to National Health Service general hospitalisation records for 2001-2013. We used Poisson regression to calculate hospitalisation rate ratios (RRs) in 14 ethnic groups, presented as percentages of the White Scottish reference group (RR = 100), for males and females separately. We adjusted for age and socio-economic status and compared those born in the United Kingdom or the Republic of Ireland (UK/RoI) with elsewhere. We calculated mean lengths of hospital stay. RESULTS: 9.79 million hospital admissions were analysed. Compared with the White Scottish, unadjusted RRs for both males and females in most groups were about 50-90, e.g. Chinese males 49 (95% confidence interval [CI] = 45-53) and Indian females 76 (95% CI 71-81). The exceptions were White Irish, males 120 (95% CI 117-124) and females 115 (95% CI 112-119) and Caribbean females, 103 (95% CI 85-126). Adjusting for age increased the RRs for most groups towards or above the reference. Socio-economic status had little effect. In many groups, those born outside the UK/RoI had lower admission rates. Unadjusted mean lengths of stay were substantially lower in most ethnic minorities. CONCLUSIONS: Use of hospital beds in Scotland by most ethnic minorities was lower than by the White Scottish majority, largely explained by their younger average age. Other countries should use similar methods to assess their own experience.

Major ethnic group differences in breast cancer screening uptake in Scotland are not extinguished by adjustment for indices of geographical residence, area deprivation, long-term illness and education.

BACKGROUND: Breast cancer screening data generally show lower uptake in minority ethnic groups. We investigated whether such variations occur in Scotland. METHODS: Using non-disclosive computerised linkage we combined Scottish breast screening and Census 2001 data. Non-attendance at first breast-screening invitation (2002-2008) was compared between 11 ethnic groups using age-adjusted risk ratios (RR) with 95% confidence intervals (CI), multiplied by 100, using Poisson regression. RESULTS: Compared with the White Scottish (RR=100), non-attendance was similar for Other White British (99.5, 95% CI 96.1-103.2) and Chinese (112.8, 95% CI 96.3-132.2) and higher for Pakistani (181.7, 95% CI 164.9-200.2), African (162.2, 95% CI 130.8-201.1), Other South Asian (151.7, 95% CI 118.9-193.7) and Indian (141.7, 95% CI 121.1-165.7) groups. Adjustment for rural vs urban residence, long-term illness, area deprivation and education, associated with risk of non-attendance, increased the RR for non-attendance except for Pakistani women where it was modestly attenuated (RR=164.9, 149.4-182.1). CONCLUSION: Our data show important inequality in breast cancer screening uptake, not attenuated by potential confounding factors. Ethnic inequalities in breast screening attendance are of concern especially given evidence that the traditionally lower breast cancer rates in South Asian groups are converging towards the risks in the White UK population. Notwithstanding the forthcoming review of breast cancer screening, these data call for urgent action.

High prevalence of skin symptoms among bakery workers.

BACKGROUND: Occupational skin disease is common and bakery workers are at increased risk of hand dermatitis. AIMS: To explore the frequency of, and to identify risk factors for, skin symptoms in a small bakery. METHODS: A cross-sectional survey of workers in a small bakery in Scotland, using a self-completed questionnaire regarding skin symptoms over the last 12 months. Additionally, data on self-reported atopy status, glove use and daily hand washing frequencies were obtained. Workers were classed as being at low, medium or high risk of occupational skin disease based on their job titles. RESULTS: The overall response rate was 85% (52 women, 41 men) with a mean age of 41 (range 17-72). Eleven per cent of bakers, confectioners and packers and 31% of cleaners, cooks and food production workers reported at least one skin symptom. Thirty-three per cent of symptomatic low-risk workers, 50% of symptomatic medium-risk workers and 75% of symptomatic high-risk workers stated their symptoms usually improved away from work. While washing hands more frequently than 20 times a day had an increased risk of skin symptoms, this was not significant [OR 3.5 (95% CI 0.9-13.2)]. CONCLUSIONS: There was a high prevalence of skin symptoms among these bakery workers which was more than double that previously reported in UK bakeries. Frequent washing of hands as a risk factor for skin symptoms may warrant further investigation in bakery workers.