Prescribing of long-term antibiotics to adolescents in primary care: a retrospective cohort study.

BACKGROUND: Antibiotic overuse is linked to increased risk of antimicrobial resistance. Long-term antibiotics are commonly used for treating acne and prophylaxis of urinary tract infection. Their contribution to the overall burden of antibiotic use is relatively unknown. AIM: To describe the volume of commonly prescribed long-term (≥28 days) antibiotic prescriptions in adolescents and young adults, trends over time, and comparisons with acute prescriptions. DESIGN AND SETTING: A retrospective cohort study using UK electronic primary care records. METHOD: Patients born between 1979 and 1996 and with data in the Care and Health Information Analytics database were included. The main outcome measures were antibiotic prescription rates per 1000 person-years and antibiotic prescription days per person-year between the ages of 11 and 21. RESULTS: In total, 320 722 participants received 710 803 antibiotic prescriptions between the ages of 11 and 21 years from 1998 to 2017. Of these 710 803 prescriptions, 191 443 (26.93%) were for long-term antibiotics (≥28 days and ≤6 months in duration). Long-term antibiotics accounted for more than two-thirds (72.48%) of total antibiotic exposure (days per person-year). Total long-term antibiotic prescribing peaked in 2013 at just under 6 days per person-year and declined to around 4 days in 2017. CONCLUSION: Among adolescents and young adults, exposure to long-term antibiotics (primarily lymecycline used for acne) was much greater than for acute antibiotics and is likely to make an important contribution to antimicrobial resistance. Urgent action is needed to reduce unnecessary exposure to long-term antibiotics in this group. Increasing the use of, and adherence to, effective non-antibiotic treatments for acne is key to achieving this.

Can routine blood tests be modelled to detect advanced liver disease in the community: model derivation and validation using UK primary and secondary care data.

OBJECTIVES: Most patients are unaware they have liver cirrhosis until they present with a decompensating event. We therefore aimed to develop and validate an algorithm to predict advanced liver disease (AdvLD) using data widely available in primary care. DESIGN, SETTING AND PARTICIPANTS: Logistic regression was performed on routinely collected blood result data from the University Hospital Southampton (UHS) information systems for 16 967 individuals who underwent an upper gastrointestinal endoscopy (2005-2016). Data were used to create a model aimed at detecting AdvLD: 'CIRRhosis Using Standard tests' (CIRRUS). Prediction of a first serious liver event (SLE) was then validated in two cohorts of 394 253 (UHS: primary and secondary care) and 183 045 individuals (Care and Health Information Exchange (CHIE): primary care). PRIMARY OUTCOME MEASURES: Model creation dataset: cirrhosis or portal hypertension. Validation datasets: SLE (gastro-oesophageal varices, liver-related ascites or cirrhosis). RESULTS: In the model creation dataset, 931 SLEs were recorded (5.5%). CIRRUS detected cirrhosis or portal hypertension with an area under the curve (AUC) of 0.90 (95% CI 0.88 to 0.92). Overall, 3044 (0.8%) and 1170 (0.6%) SLEs were recorded in the UHS and CHIE validation cohorts, respectively. In the UHS cohort, CIRRUS predicted a first SLE within 5 years with an AUC of 0.90 (0.89 to 0.91) continuous, 0.88 (0.87 to 0.89) categorised (crimson, red, amber, green grades); and AUC 0.84 (0.82 to 0.86) and 0.83 (0.81 to 0.85) for the CHIE cohort. In patients with a specified liver risk factor (alcohol, diabetes, viral hepatitis), a crimson/red cut-off predicted a first SLE with a sensitivity of 72%/59%, specificity 87%/93%, positive predictive value 26%/18% and negative predictive value 98%/99% for the UHS/CHIE validation cohorts, respectively. CONCLUSION: Identification of individuals at risk of AdvLD within primary care using routinely available data may provide an opportunity for earlier intervention and prevention of liver-related morbidity and mortality.

Evaluating the effectiveness of the NHS Health Check programme in South England: a quasi-randomised controlled trial.

OBJECTIVE: To evaluate uptake, risk factor detection and management from the National Health Service (NHS) Health Check (HC). DESIGN: This is a quasi-randomised controlled trial where participants were allocated to five cohorts based on birth year. Four cohorts were invited for an NHS HC between April 2011 and March 2015. SETTING: 151 general practices in Hampshire, England, UK. PARTICIPANTS: 366 005 participants born 1 April 1940-31 March 1976 eligible for an NHS HC. INTERVENTION: NHS HC invitation. MAIN OUTCOME MEASURES: HC attendance and absolute percentage changes and ORs of (1) detecting cardiovascular disease (CVD) 10-year risk >10% and >20%, smokers, and total cholesterol (TC) >5.5 mmol/L and >7.5 mmol/L; (2) diagnosing hypertension, type 2 diabetes mellitus, chronic kidney disease (CKD) and atrial fibrillation (AF); and (3) new interventions with statins, antihypertensives, antiglycaemics and nicotine replacement therapy (NRT). RESULTS: HC attendance rose from 12% to 30% between 2011/2012 and 2014/2015 (p<0.001). HC invitation increased detection of CVD risk >10% (2.0%-3.6, p<0.001) and >20% (0.1%-0.6%, p<0.001-0.392), TC >5.5 mmol/L (4.1%-7.0%, p<0.001) and >7.5 mmol/L (0.3%-0.4% p<0.001), hypertension (0.3%-0.6%, p<0.001-0.003), and interventions with statins (0.2%-0.9%, p<0.001-0.017) and antihypertensives (0.1%-0.6%, p<0.001-0.205). There were no consistent differences in detection of smokers, NRT, or diabetes, AF or CKD. Multivariate analyses showed associations between HC invitation and detecting CVD risk >10% (OR 8.01, 95% CI 7.34 to 8.73) and >20% (5.86, 4.83 to 7.10), TC >5.5 mmol/L (3.72, 3.57 to 3.89) and >7.5 mmol/L (2.89, 2.46 to 3.38), and diagnoses of hypertension (1.33, 1.20 to 1.47) and diabetes (1.34, 1.12 to 1.61). OR of CVD risk >10% plus statin and >20% plus statin, respectively, was 2.90 (2.36 to 3.57) and 2.60 (1.92 to 3.52), and for hypertension plus antihypertensive was 1.33 (1.18 to 1.50). There were no associations with AF, CKD, antiglycaemics or NRT. Detection of several risk factors varied inversely by deprivation. CONCLUSIONS: HC invitation increased detection of cardiovascular risk factors, but corresponding increases in evidence-based interventions were modest.

[Prospective study on associations between levels of total cholesterol, triglyceride and risk of ischemic and hemorrhagic strokes].

OBJECTIVE: To explore associations between levels of total cholesterol (TC), triglyceride (TG) and incidence of ischemic and hemorrhagic strokes in populations. METHODS: Baseline investigations on stroke-related risk factors and physical examinations were performed in 10 093 (> 35 years) stroke-free urban community residents from 5 cities in China during May to July in 1987, follow-up investigations on stroke events were made during 1998 to 2000. The hazard ratios and 95% confidence intervals (CI) of ischemic and hemorrhagic strokes in middle, high tertiles of baseline TC or TG levels were compared with low baseline tertile residents using the Cox regression model. RESULTS: There were 491 first strokes during the 8-years cohort follow-up. Compared with the low tertile, risk of ischemic stroke in the middle and high tertiles of TC level was increased by 61% (HR: 1.61, 95%CI: 1.14-2.27) and 58% (HR: 1.58, 95%CI: 1.12-2.22) after adjustments for DBP, age, sex and other variables in the Cox proportional hazards model. Compared with the low tertile, risk of ischemic stroke in the high tertile of TG level was increased by 43% (HR: 1.43, 95%CI: 1.02-2.00). However, risk of hemorrhagic stroke in the middle and high tertiles of TC level decreased by 12% (HR: 0.88, 95%CI: 0.64-1.22) and 33% (HR: 0.67, 95%CI: 0.48-0.95) compared with the low tertile. CONCLUSIONS: Elevated serum TC and TG are independent risk factors for risk of ischemic stroke. However, low TC was related with increased risk of hemorrhagic stroke.

Effect of hyperbaric oxygen on cytochrome C, Bcl-2 and Bax expression after experimental traumatic brain injury in rats.

OBJECTIVE: To explore the effects of hyperbaric oxygen (HBO) treatment on the neuronal apoptosis at an earlier stage and the expressions of Cytochrome C (Cyt C), Bcl-2 (B-cell lymphoma-2 family) and Bax (Bcl-2 associated X protein) in rat brain tissues after traumatic brain injury (TBI). METHODS: Forty adult rats were divided into two groups, i.e., Group A (the rats with untreated TBI) and Group B (rats with HBO treatment after TBI). Sections of brain tissues of these two groups were then detected at 3, 6, 12, 24, 72 hours after TBI by immunohistochemistry and electronmicroscope, respectively. RESULTS: HBO treatment could up-regulate the expression of Bcl-2 within 72 hours, reduce the release of Cyt C from mitochondria, attenuate the formation of dimeric Bax and alleviate the mitochondrial edema within 24 hours after TBI. CONCLUSIONS: HBO treatment can alleviate neuronal apoptosis after TBI by reducing the release of Cyt C and the dimers of Bax and up-regulating the expression of Bcl-2.

Subtype hypertension and risk of stroke in middle-aged and older Chinese: a 10-year follow-up study.

BACKGROUND AND PURPOSE: Hypertension is the most important indicator of stroke. We aim to compare the long-term effects of the subtypes of hypertension on the risk of stroke in a Chinese cohort. METHODS: A total of 26,587 subjects > or =35 years of age and free of stroke were recruited in 5 cities in 1987. The subtypes of hypertension were defined as isolated systolic hypertension (ISH), isolated diastolic hypertension (IDH), systolic and diastolic hypertension (SDH), as well as managed hypertension (MHT), according to the criteria of systolic blood pressure > or =140 or diastolic blood pressure >90 mm Hg or under antihypertensive treatment. The relative risks of stroke with the subtypes of hypertension, compared with normotensives, were estimated using the Cox model after adjustments for age, sex, and other confounders. RESULTS: The prevalence of hypertension was: ISH 7.1%, SDH 18.4%, IDH 6.7%, and MHT 3.9%. During a total of 233 437 person years of follow-up, 1107 subjects developed stroke (614 ischemic and 451 hemorrhagic events and 42 unclassified). SDH patients were at the highest risk of stroke among all the hypertensives. The hazard ratio and 95% CI was 2.96 (2.49 to 3.52) for all stroke, 4.05 (3.10 to 5.30) for hemorrhagic, and 2.33 (1.84 to 2.95) for ischemic stroke. Although the incidence of stroke was higher in the older population, the effect of hypertension, especially SDH, on hemorrhagic stroke is stronger in the middle-aged population. CONCLUSIONS: ISH and IDH are similarly prevalent in the population; both are independent predictors of stroke. Patients with SDH are at the highest risk of stroke and should be treated more aggressively.

Effect of thyrotropin-releasing hormone on cerebral free radical reactions following acute brain injury in rabbits.

OBJECTIVE: To investigate the early effect of thyrotropin-releasing hormone (TRH) on cerebral free radical reactions after acute brain injury in rabbits. METHODS: 30 healthy white rabbits were randomly divided into three groups: Group A (n=10), Group B (n=12) and Group C (n=8). The rabbits in Group A and Group B were injured by direct hit. At 0.5-4 hours after injury, the rabbits in Group A were injected with TRH (8 mg/kg body weight) through a vein and the rabbits in Group B were injected with normal saline of equal volume. The rabbits in Group C served as the normal control. Then all the rabbits were killed and brain tissues were obtained. The content of lipoperoxide (LPO), the activity of superoxide dismutase (SOD) and the water content of the brain tissues were measured. RESULTS: The contents of LPO and water in brain tissues in Group A were lower and the activity of SOD was higher than those of Group B (P<0.05). After injury, intracranial pressure (ICP) rose rapidly and continuously with time passing by. When TRH was given to the animals in Group A, the rising speed of ICP slowed down significantly. CONCLUSIONS: TRH can decrease the cerebral free radical reactions and cerebral edema after acute brain injury in rats.