Fitzgerald F.,UCL Institute of Child Health |
Awonuga W.,Western Area Emergency Response Center |
Shah T.,Imperial College NHS Healthcare Trust |
Youkee D.,Connaught Hospital
Journal of Infection | Year: 2016
The West African Ebola virus disease (EVD) outbreak is the largest ever seen, with over 28,000 cases and 11,300 deaths since early 2014. The magnitude of the outbreak has tested fragile governmental health systems and non-governmental organizations (NGOs) to their limit. Here we discuss the outbreak in the Western Area of Sierra Leone, the shape of the local response and the impact the response had on caring for children suspected of having contracted EVD. Challenges encountered in providing clinical care to children whilst working in the "Red Zone" where risk of EVD is considered to be highest, wearing full personal protective equipment are detailed. Suggestions and recommendations both for further research and for operational improvement in the future are made, with particular reference as to how a response could be more child-focused. © 2016 The Authors.
Leighton P.,UCL Institute of Child Health |
Cortina-Borja M.,UCL Institute of Child Health |
Millar M.,Barts and The London NHS Trust |
Kempley S.,Institute of Cell and Molecular Science |
Gilbert R.,UCL Institute of Child Health
Clinical Microbiology and Infection | Year: 2012
Comparisons of bloodstream infection (BSI) rates between neonatal intensive-care units (NICUs) should take into account differences in babies' vulnerability and invasive procedures that can introduce infection. Our aim was to investigate which risk factors recorded in routine records should be adjusted for when NICUs are compared. This was a retrospective cohort study using routine records for two London NICUs. We analysed rates of BSI with Poisson regression models. The level of neonatal care used by the National Health Service was the strongest predictor of BSI incidence. The rate ratios for BSI, adjusted for birthweight, inborn/outborn status, and postnatal age, were 3.15 (95% CI 2.01-4.94) for intensive care and 6.58 (95% CI 4.18-10.36) for high-dependency care, relative to special care. Total parenteral nutrition was significantly associated with BSI incidence, but explained less of the variance among babies than level of care. A case-control study with the same dataset gave similar results. Further multicentre studies are required to confirm our predictive model. Until then, we recommend that comparisons of BSI rates between NICUs should include adjustments for level of care, birthweight, inborn/outborn status, and postnatal age, with the use of routinely recorded standardized measures in hospital administrative data. © 2011 The Authors. Clinical Microbiology and Infection © 2011 European Society of Clinical Microbiology and Infectious Diseases.
Cooper R.,University College London |
Hypponen E.,UCL Institute of Child Health |
Berry D.,UCL Institute of Child Health |
Power C.,UCL Institute of Child Health
American Journal of Clinical Nutrition | Year: 2010
Background: Parent-offspring associations in adiposity are well known, but the extent to which they are explained by modifiable environmental and lifestyle factors remains to be elucidated. Objectives: The objectives were to assess whether 1) parent-offspring associations in body mass index (BMI; in kg/m 2) persist from childhood to midadulthood, 2) parental BMI is associated with the offspring's adult lifestyle, and 3) parent-offspring BMI associations in midadulthood are explained by lifestyle factors. Design: Participants in the 1958 British Birth Cohort Study and their parents (n = 9346) were examined. Parental BMI was assessed in 1969; offspring (ie, cohort members) BMI was ascertained prospectively at 11 and 44-45 y. Lifestyle factors of the offspring, including diet, physical activity, alcohol consumption, and smoking, were assessed prospectively in adulthood. Results: Maternal and paternal BMI were positively associated with offspring BMI in both childhood and midadulthood, and the strength of the association did not diminish with offspring age. Maternal BMI was associated with several offspring lifestyle factors across adulthood; fewer associations were observed for paternal BMI. Parent-offspring BMI associations in adulthood were largely maintained after adjustment for multiple lifestyle and socioeconomic factors at different life stages: if parental BMI was 1 unit higher, offspring BMI at 44-45 y was higher by between 0.21 and 0.29 units in adjusted models. Conclusions: Strong parent-offspring BMI associations are maintained into midlife. These associations are largely unaffected by adjustment for a wide range of lifestyle factors. Offspring of obese parents are an important target for interventions aimed at reducing population levels of overweight and obesity. © 2010 American Society for Nutrition.
Bouma G.,UCL Institute of Child Health |
Ancliff P.J.,Hospital NHS Trust |
Thrasher A.J.,UCL Institute of Child Health |
Thrasher A.J.,Hospital NHS Trust |
And 2 more authors.
British Journal of Haematology | Year: 2010
Neutrophils are amongst the first immune cells to arrive at sites of infection and play an important role as the host's first line of defence against invading pathogens. Defects of neutrophil number or function are usually recognized clinically by recurrent infections that often are life-threatening. Over the last few years, a number of genetic mutations have been discovered to be the basis for congenital neutropenia, adding to our understanding of the molecular basis of these diseases. While many genetic mutations that cause severe congenital neutropenia result in a differentiation block at the promyelocyte stage, defects of neutrophil function are more heterogeneous on clinical, genetic and mechanistic levels. In this review we discuss recent advances in our understanding of the genetic and molecular basis of human neutrophil disorders. © 2010 Blackwell Publishing Ltd.
Kirkham F.,UCL Institute of Child Health |
Kirkham F.,Southampton General Hospital
European Journal of Paediatric Neurology | Year: 2011
Primary out-of-hospital cardiac arrest in childhood is rare but survival is a little better for children than for adults, although the prognosis for infants is very poor. Hypoxic-ischaemic encephalopathy after in-hospital cardiac arrest in children undergoing complicated treatment for previously untreatable conditions is now a common problem and is probably increasing. An additional ischaemic insult worsens the prognosis for other encephalopathies, such as that occurring after accidental or non-accidental head injury. For near-drowning, the prognosis is often good, provided that cardiopulmonary resuscitation (CPR) is commenced immediately, and the child gasps within 40 minutes of rescue and regains consciousness soon afterwards. The prognosis is much worse for the nearly drowned child admitted to casualty or the emergency room deeply unconscious with fixed dilated pupils, requiring continuing CPR and with an arterial pH <7, especially if there is little recovery by the time of admission to the intensive care unit. The use of adrenaline, sodium bicarbonate and calcium appears to worsen prognosis. Neurophysiology, specifically serial electroencephalography and evoked potentials, is the most useful tool prognostically, although neuroimaging and biomarkers may play a role. In a series of 89 patients studied after cardiac arrest in three London centres between 1982 and 1985, 39% recovered consciousness within one month. Twenty seven percent died a cardiac death whilst in coma, and the outcome in the remainder was either brain death or vegetative state. EEG and initial pH were the best predictors of outcome in this study. Seizures affected one third and were associated with deterioration and worse outcome. The advent of extracorporeal membrane oxygenation (ECMO) and the positive results of hypothermia trials in neonates and adults have rekindled interest in timely management of this important group of patients. © 2011 European Paediatric Neurology Society. Published by Elsevier Ltd. All rights reserved.
Power C.,UCL Institute of Child Health |
Atherton K.,UCL Institute of Child Health |
Thomas C.,UCL Institute of Child Health
Atherosclerosis | Year: 2010
Objective: To establish whether maternal smoking in pregnancy is associated with risk factors for cardiovascular disease (CVD) in mid-adulthood and whether associations are explained by postnatal influences. Methods: Participants were 8815 men and women in the 1958 British birth cohort, with data on CVD risk factors measured at 45 y. Maternal smoking was recorded at birth. Results: Offspring of smokers had a higher adult BMI, waist circumference, blood pressure, HbA1c and triglycerides on average than offspring of non-smokers; females had lower HDL cholesterol levels. Total cholesterol was unrelated to maternal smoking. Associations were abolished after adjustment for postnatal influences across life, except for BMI and waist circumference: offspring of smokers had a BMI greater by 0.83kg/m 2 on average than offspring of non-smokers and a 1.8cm larger waist circumference. Mean BMI and waist circumference increased with number of cigarettes that the mother smoked, but were not elevated in offspring whose mother had quit smoking before or early in pregnancy. Conclusions: Adults exposed to tobacco in utero had a more adverse CVD risk profile in mid-adulthood which appeared to reflect a lifetime accumulation of postnatal influences; whereas their higher BMI and central adiposity may be due in part to intrauterine mechanisms. © 2010 Elsevier Ireland Ltd.
Lau K.D.,Center for Mathematics and Physics |
Diaz-Zuccarini V.,UCL |
Scambler P.,UCL Institute of Child Health |
Journal of Biomechanics | Year: 2011
The effect of functional mitral regurgitation has been investigated in an anatomically sized, fluid-structure interaction mitral valve model, where simulated correction has been performed by applying: (1) edge-to-edge repair with annuloplasty and (2) edge-to-edge repair only. Initially defined in an open unstressed/corrected configuration, fluid-structure interaction simulations of diastole have been performed in a rigid ventricular volume. Comparison of the maximum principal stresses (during diastole) in the normal and repaired models has shown that the magnitude of stress in the repaired scenarios is ~200% greater. The combined edge-to-edge and annuloplasty procedure was found to spread the induced stresses across the free margin of the leaflets, whereas without annuloplasty a localised stress concentration in the region of the suture was observed. Fluid flow downstream of the corrected configurations was able to achieve the same magnitude as in the normal case, although the flow rate was impaired. The maximum flow rate was found to be reduced by 44-50% with the peak flow rate shifted from the end of the diastole in the normal case to the start in the repaired cases. © 2011 Elsevier Ltd.
Lau K.D.,Center for Mathematics and Physics in the Life science and Experimental Biology |
Diaz V.,UCL |
Scambler P.,UCL Institute of Child Health |
Medical Engineering and Physics | Year: 2010
Modelling and simulation of heart valves is a challenging biomechanical problem due to anatomical variability, pulsatile physiological pressure loads and 3D anisotropic material behaviour. Current valvular models based on the finite element method can be divided into: those that do model the interaction between the blood and the valve (fluid-structure interaction or 'wet' models) and those that do not (structural models or 'dry' models).Here an anatomically sized model of the mitral valve has been used to compare the difference between structural and fluid-structure interaction techniques in two separately simulated scenarios: valve closure and a cardiac cycle. Using fluid-structure interaction, the valve has been modelled separately in a straight tubular volume and in a U-shaped ventricular volume, in order to analyse the difference in the coupled fluid and structural dynamics between the two geometries.The results of the structural and fluid-structure interaction models have shown that the stress distribution in the closure simulation is similar in all the models, but the magnitude and closed configuration differ. In the cardiac cycle simulation significant differences in the valvular dynamics were found between the structural and fluid-structure interaction models due to difference in applied pressure loads. Comparison of the fluid domains of the fluid-structure interaction models have shown that the ventricular geometry generates slower fluid velocity with increased vorticity compared to the tubular geometry.In conclusion, structural heart valve models are suitable for simulation of static configurations (opened or closed valves), but in order to simulate full dynamic behaviour fluid-structure interaction models are required. © 2010 IPEM.
Denholm R.,UCL Institute of Child Health |
Power C.,UCL Institute of Child Health |
Li L.,UCL Institute of Child Health |
Thomas C.,St George's, University of London
Child Abuse Review | Year: 2013
In this article, we assess the prevalence of child maltreatments, their co-occurrence and associations with household dysfunction in a large population cohort. Information from the 1958 British birth cohort on childhood abuse, neglect and household dysfunction recorded at 45years and during childhood was used. Prevalence was calculated in three samples: individuals with each measure (n=9310-15 583); 45-year-old participants (n=9310); and all surviving to 45years (n=17 313) includes imputed data. A cumulative neglect score was derived. Latent Class Analysis (LCA) was applied to establish the co-occurrence of maltreatments. In the three samples, 14.2 to 17.1 per cent of participants reported any form of abuse: psychological (10.0-12.5%), physical (6.1-9.0%), sexual (1.6-2.9%) and witnessing abuse (6.0-8.5%). A high neglect score (≥ 3; prevalence 25.9-32.1%) was positively associated with any form of abuse (30% increase/unit). LCA identified 8.2 per cent of participants at risk of both abuse and neglect, and 24.9 per cent at high risk of neglect 'only'. Measures of household dysfunction were associated with all types of child maltreatment, particularly with abuse and neglect. Approximately one-third of this population sample showed a high risk of child maltreatment; over one in ten reported any form of abuse. Those from dysfunctional family backgrounds were particularly vulnerable to both child abuse and neglect. © 2013 John Wiley & Sons, Ltd.
McAloney K.,University of York |
Graham H.,University of York |
Law C.,UCL Institute of Child Health |
Platt L.,University of London
Preventive Medicine | Year: 2013
Background: Smoking, diet, exercise, and alcohol are leading causes of chronic disease and premature death, many engage in two or more of these behaviours concurrently. The paper identified statistical approaches used to investigate multiple behavioural risk factors. Method: A scoping review of papers published in English from 2000 to 2011 was conducted; papers are related to concurrent participation in at least two of the behaviours. Statistical approaches were recorded and categorised. Results: Across 50 papers, two distinct approaches were identified. Co-occurrence analyses focused on concurrent but independent behaviours, represented by prevalence of behavioural combinations and/or by the summing behaviours into risk indexes. Clustering analyses investigated underlying associations between the concurrent behaviours, with clustering identified by divergences in observed and expected prevalence of combinations or through identification of latent or unobservable clusters. Co-occurrence was more frequently reported, but the use of clustering techniques and, in particular, cluster analytic and latent variable techniques increased across the study period. Discussion: The two approaches investigate concurrent participation in multiple health behaviours but differ in conceptualisation and analysis. Despite differences, inconsistency in the terminology describing the study of multiple health behaviours was apparent, with potential to influence understandings of concurrent health behaviours in policy and practice. © 2013 Elsevier Inc.