Estimating disease burden using national linked electronic health records: a study using an English population-based cohort.

Background: Electronic health records (EHRs) have the potential to be used to produce detailed disease burden estimates. In this study we created disease estimates using national EHR for three high burden conditions, compared estimates between linked and unlinked datasets and produced stratified estimates by age, sex, ethnicity, socio-economic deprivation and geographical region.

Methods: EHRs containing primary care (Clinical Practice Research Datalink), secondary care (Hospital Episode Statistics) and mortality records (Office for National Statistics) were used.

Methodological considerations in injury burden of disease studies across Europe: a systematic literature review.

Background: Calculating the disease burden due to injury is complex, as it requires many methodological choices. Until now, an overview of the methodological design choices that have been made in burden of disease (BoD) studies in injury populations is not available. The aim of this systematic literature review was to identify existing injury BoD studies undertaken across Europe and to comprehensively review the methodological design choices and assumption parameters that have been made to calculate years of life lost (YLL) and years lived with disability (YLD) in these studies.

Effect of maternal positioning during cardiopulmonary resuscitation: a systematic review and meta-analyses.

Background: Although rare, cardiac arrest during pregnancy is the leading cause of maternal death. Recently, its incidence has been increasing worldwide because more pregnant women have risk factors. The provision of early, high-quality cardiopulmonary resuscitation (CPR) plays a major role in the increased likelihood of survival; therefore, it is important for clinicians to know how to manage it.

Effectiveness of Trauma-Focused Psychological Therapies for Treating Post-traumatic Stress Disorder Symptoms in Women Following Childbirth: A Systematic Review and Meta-Analysis.

Approximately 3% of women in community samples develop posttraumatic stress disorder (PTSD) after childbirth. Higher prevalence rates are reported for high risk samples. Postpartum PTSD can adversely affect women's wellbeing, mother-infant relationships and child development.

Efficacy and safety of pertussis vaccination for pregnant women - a systematic review of randomised controlled trials and observational studies.

Background: Worldwide, pertussis remains a major health problem among children. During the recent outbreaks of pertussis, maternal antenatal immunisation was introduced in several industrial countries. This systematic review aimed to synthesize evidence for the efficacy and safety of the pertussis vaccination that was given to pregnant women to protect infants from pertussis infection.

A cluster-randomized trial to reduce caesarean delivery rates in Quebec: cost-effectiveness analysis.

Background: Widespread increases in caesarean section (CS) rates have sparked concerns about risks to mothers and infants and rising healthcare costs. A multicentre, two-arm, cluster-randomized trial in Quebec, Canada assessed whether an audit and feedback intervention targeting health professionals would reduce CS rates for pregnant women compared to usual care, and concluded that it reduced CS rates without adverse effects on maternal or neonatal health. The effect was statistically significant but clinically small.

Effectiveness of trauma-focused psychological therapies compared to usual postnatal care for treating post-traumatic stress symptoms in women following traumatic birth: a systematic review protocol.

Introduction: Maternal mental health has been largely neglected in the literature. Women, however, may be vulnerable to developing post-traumatic stress symptoms or post-traumatic stress disorder (PTSD), following traumatic birth. In turn, this may affect their capacity for child rearing and ability to form a secure bond with their baby and impact on the wider family.

Risk patterns in drug safety study using relative times by accelerated failure time models when proportional hazards assumption is questionable: an illustrative case study of cancer risk of patients on glucose-lowering therapies.

Observational drug safety studies may be susceptible to confounding or protopathic bias. This bias may cause a spurious relationship between drug exposure and adverse side effect when none exists and may lead to unwarranted safety alerts. The spurious relationship may manifest itself through substantially different risk levels between exposure groups at the start of follow-up when exposure is deemed too short to have any plausible biological effect of the drug.

Prediction of cardiovascular risk using Framingham, ASSIGN and QRISK2: how well do they predict individual rather than population risk?

Background: The objective of this study was to evaluate the performance of risk scores (Framingham, Assign and QRISK2) in predicting high cardiovascular disease (CVD) risk in individuals rather than populations.

Methods And Findings: This study included 1.8 million persons without CVD and prior statin prescribing using the Clinical Practice Research Datalink.

Multilevel models for cost-effectiveness analyses that use cluster randomised trial data: An approach to model choice.

Multilevel models provide a flexible modelling framework for cost-effectiveness analyses that use cluster randomised trial data. However, there is a lack of guidance on how to choose the most appropriate multilevel models. This paper illustrates an approach for deciding what level of model complexity is warranted; in particular how best to accommodate complex variance-covariance structures, right-skewed costs and missing data.

The efficiency of cardiovascular risk assessment: do the right patients get statin treatment?

Objective: To evaluate targeting of statin prescribing for primary prevention to those with high cardiovascular disease (CVD) risk.

Design: Two cohort studies including the general population and initiators of statins aged 35-74 years.

Setting: UK primary care records in the Clinical Practice Research Datalink.

Methods for covariate adjustment in cost-effectiveness analysis that use cluster randomised trials.

Statistical methods have been developed for cost-effectiveness analyses of cluster randomised trials (CRTs) where baseline covariates are balanced. However, CRTs may show systematic differences in individual and cluster-level covariates between the treatment groups. This paper presents three methods to adjust for imbalances in observed covariates: seemingly unrelated regression with a robust standard error, a 'two-stage' bootstrap approach combined with seemingly unrelated regression and multilevel models.

Developing appropriate methods for cost-effectiveness analysis of cluster randomized trials.

Aim: Cost-effectiveness analyses (CEAs) may use data from cluster randomized trials (CRTs), where the unit of randomization is the cluster, not the individual. However, most studies use analytical methods that ignore clustering. This article compares alternative statistical methods for accommodating clustering in CEAs of CRTs.

A prospective, population-based study of the role of visual impairment in motor vehicle crashes among older drivers: the SEE study.

Purpose: To determine the role of vision and visual attention factors in automobile crash involvement.

Methods: Drivers aged 65 to 84 years were identified during the baseline interview (1993-1995) of the Salisbury Eye Evaluation (SEE) Study. Crash involvement through December 1997 was determined from Maryland State motor vehicle records.

Inequalities in influenza vaccine uptake among people aged over 74 years in Britain.

Background: In the UK, payments to providers (General Practitioners) for vaccinating all people aged over 64 years old against influenza commenced in 2000. Little information exists on the relationship between uptake and need. We assessed factors influencing uptake and equity in uptake in over 74 year olds.

Population-based multidimensional assessment of older people in UK general practice: a cluster-randomised factorial trial.

Background: The benefit of multidimensional assessment and management of older people remains controversial. Most trials have been too small to produce adequate evidence to inform policy. We aimed to measure the effects of different approaches to assessment and management of older people.

Characteristics of long bone DXA reference data in Hong Kong Chinese.

With the increasing number of geriatric long bone fractures, the establishment of long bone reference BMD data is desirable for the accurate diagnosis of osteoporosis, study of fracture mechanics, implant design, and indications for augmentation of fracture fixation with biomaterials. We report the normal reference bone mineral density (BMD) and bone mineral content (BMC) at three femoral sites (proximal, diaphyseal, and distal) in 106 male and 93 female Hong Kong Chinese aged 12 to 80, measured with dual-energy X-ray absorptiometry (DXA). The length and width of the femur were also measured.

Performance of a single screening question for depression in a representative sample of 13 670 people aged 75 and over in the UK: results from the MRC trial of assessment and management of older people in the community.

Background: A concise, accurate screening question for depression would be an important contribution to the Single Assessment Process for Older People.

Objective: To examine the performance of a previously validated screening question for depression, in a large community sample.

Methods: Both the single screening question, and the Geriatric Depression Scale (GDS-15) were completed by 13 670 people aged 75 and over in the community.

Factors associated with depression in a representative sample of 14 217 people aged 75 and over in the United Kingdom: results from the MRC trial of assessment and management of older people in the community.

Background: Several social, demographic and physical factors have been shown to be associated with depression in later life, but results have been inconsistent. We aimed to assess factors associated with depression in old age, using data from the MRC trial of assessment and management of older people in the community.

Method: Analysis of cross-sectional data.