77, 95% CI 1.16 to 2.71, p=0.007), age of 46-64 years (OR 2.20, 95% CI 1.15 to 4.21, p=0.009) or ≥65 years (OR 3.02, 95% CI 1.40 to 6.50, p=0.002), presence of leucopenia (OR 6.85, 95% CI 4.27 to 10.99, p<0.001) and high mean corpuscular haemoglobin (MCH) levels (OR 2.00, 95% CI 1.29 to 3.12, p=0.005).

Older age, male sex, presence of leucopenia and high MCH levels were identified as risk factors associated with the development of thrombocytopenia in this population.

Older age, male sex, presence of leucopenia and high MCH levels were identified as risk factors associated with the development of thrombocytopenia in this population.

The Caribbean Consortium for Research in Environmental and Occupational Health prospective environmental epidemiologic cohort study addresses the impact of chemical and non-chemical environmental exposures on mother/child dyads in Suriname. The study determines associations between levels of environmental elements and toxicants in pregnant women, and birth outcomes and neurodevelopment in their children.

Pregnant women (N=1143) were enrolled from December 2016 to July 2019 from three regions of Suriname Paramaribo (N=738), Nickerie (N=204) and the tropical rainforest interior (N=201). Infants (N=992) were enrolled at birth. Follow-up will take place until children are 48 months old.

Biospecimens and questionnaire data on physiological and psychosocial health in pregnant women have been analysed. 39.1% had hair mercury (Hg) levels exceeding values considered safe by international standards. Median hair Hg concentrations in women from Paramaribo (N=522) were 0.64 µg/g hair (IQRs 0.36-1.09; range 0.00-7.12 long-term effects of prenatal exposures to toxicant mixtures are ongoing.

Fish consumption advisories are in development, especially relevant to interior women for whom fish consumption is likely to be the primary source of Hg exposure. Effects of potentially beneficial neuroprotective factors in fish that may counter neurotoxic effects of Hg are being examined. A pesticide literacy assessment in pregnant women is in progress. Neurodevelopmental assessments and telomere length measurements of the children to evaluate long-term effects of prenatal exposures to toxicant mixtures are ongoing.

Many central nervous system (CNS) medications are considered potentially inappropriate for prescribing in older people; however, these medications are common in polypharmacy (≥5 medicines) regimens. This paper aims to determine the prevalence of CNS drug classes commonly taken by older people. Furthermore, this paper aims to determine whether polypharmacy and other factors, previously found to be associated with overall polypharmacy, are associated with the most common CNS drug classes.

Cross-sectional study.

English Longitudinal Study of Ageing (wave 6).

7730 participants (≥50 years).

Adjusted Odds Ratios (OR) and 95% confidence intervals (CI) for CNS drug classes.

31% of the sample were currently taking ≥5 medications (polypharmacy), of whom 58% (n=1362/2356) were taking CNS medicines as part of their regimen. The most common CNS drug classes in polypharmacy regimens were non-opioid analgesics, opioid analgesics, tricyclic and related antidepressants (TCAs) and selective serotonin reuptake inhibthe prescribing of CNS medicines. These findings provide a baseline for future research into this area.

Opioid and non-opioid analgesics were the most prevalent classes of CNS medicines in this study. Polypharmacy is strongly associated with the aforementioned classes of analgesics. Polypharmacy is also associated with TCAs and SSRIs, although to a lesser extent than for analgesics. For all CNS medicine classes, polypharmacy may need to be considered in relation to reducing the risk of potential adverse events. After adjustment, lower wealth is associated particularly with analgesics, highlighting that socioeconomic factors may play a role in the prescribing of CNS medicines. These findings provide a baseline for future research into this area.

Psoriasis (PS) is a chronic inflammatory skin disease accompanied by reduced quality of life. Mindfulness is the ability to focus on the present moment without evaluation. Findings on the effects of 8-week mindfulness trainings in patients with PS reveal positive effects on the severity of the disease and quality of life. However, it remained unclear what distinguishes patients with PS interested in psychological interventions from those without interest and whether also a shorter, namely 2-week mindfulness-based intervention is beneficial in this patient group. This will be investigated with this study.

Data will be collected at a rehabilitation clinic in Germany. The study is divided into two parts study 1a is an observational study. Its aim is to investigate whether sociodemographic, skin-related and psychological factors are significant predictors of interest in a brief psychological intervention in 127 patients with PS. Study 1b is a randomised controlled trial, in which 60 patients (retrieved from study 1a) will be randomised to an intervention or control group (treatment as usual). The main outcome variables are mindfulness and self-compassion. In addition, mediation analyses will be used in an explorative manner to test whether there is a relationship between mindfulness/self-compassion and the severity of PS and whether it is mediated by itch catastrophising and fear of negative evaluation (first model) or perceived stress (second model).

The study protocol has been approved by the University of Giessen. Study results will be disseminated by publication of the results at (inter) national conferences and in scientific journals.

DRKS00017426 and DRKS00017429.

DRKS00017426 and DRKS00017429.

To investigate the association of volume of total hip arthroplasty (THA) between consultants and within the same consultant in the previous year and the hazard of revision using multilevel survival models.

Prospective cohort study using data from a national joint replacement register.

Elective THA across all private and public centres in England and Wales between April 2003 and February 2017.

Patients aged 50 years or more undergoing THA for osteoarthritis.

The volume of THA conducted in the preceding 365 days to the index procedure.

Revision surgery (excision, addition or replacement) of a primary THA.

Of the 579 858 patients undergoing primary THA (mean baseline age 69.8 years (SD 10.2)), 61.1% were women. Multilevel survival found differing results for between and within-consultant effects. There was a strong volume-revision association between consultants, with a near-linear 43.3% (95% CI 29.1% to 57.4%) reduction of the risk of revision comparing consultants with volumes between 1 and 200 p of revision after THA. The lack of association within-consultants suggests that individual changes to consultant volume alone will have little effect on outcomes following THA.These novel findings provide strong evidence supporting the practice of specialisation of hip arthroplasty. It does not support the practice of low-volume consultants increasing their personal volume as it is unlikely their results would improve if this is the only change. Limiting the exposure of patients to consultants with low volumes of THA and greater utilisation of centres with higher volume surgeons with better outcomes may be beneficial to patients.

This study aimed to investigate the knowledge, behaviour and attitudes towards Chagas disease (CD) among Latin American migrants in Japan and to evaluate the effectiveness of an educational activity (EA) in increasing knowledge of CD.

A cross-sectional, mixed-methods study employing a preknowledge and postknowledge test and focus group discussion, conducted from March 2018 to June 2018.

Seventy-two participants were included, all born in Bolivia and residents in four Japanese cities. Fifty-nine of them participated in the EA.

The EA comprised showing three videos about CD and a group discussion covering different dimensions of CD and was evaluated with questionnaires to analyse the knowledge of the participants before and after.

Seventy-two participants were enrolled, predominantly from highly endemic CD areas of Bolivia. Though most participants were familiar with vector-borne transmission, epidemiology and symptomatology of CD, the baseline knowledge of CD was low. Less than 10% of them had been t policies and interventions aimed to decrease the global burden.

EA with an integrative approach is useful to increase the knowledge of CD within the Bolivian migrant population living in Japan. The activity brings the possibility to explore not only the level of knowledge but also to reveal experiences and to understand the needs of the people at risk. Considering them as actors towards healthcare solutions could lead to better outcomes for the success of future policies and interventions aimed to decrease the global burden.Dystonia is a hyperkinetic movement disorder characterised by sustained or intermittent muscle contractions causing abnormal movements, postures or both. Dystonia is a challenging condition to diagnose and treat. Dystonia is often under-recognised in children, particularly in cerebral palsy, and frequently coexists with spasticity. This guide aims to simplify the approach to diagnosis, investigation and treatment of childhood-onset dystonia. The principle of treatment is similar regardless of the underlying aetiology identification of potential triggers and consideration of both pharmacological and surgical options.Central giant cell granuloma (CGCG) is an expansile osteolytic lesion of the jawbone. Conventional treatment of CGCG is surgical and vary from simple curettage to more aggressive resection of the jaw. However, surgical management is associated with drawbacks including requirement of hospitalisation and general anaesthesia, damage to vital anatomic structures and continuity defect of the mandible requiring reconstruction surgery. Use of intralesional injections of corticosteroid for the management of CGCG have been inconsistently used as an alternative non-surgical method of management of CGCG with varying success. While the use of such conservative modality over ablative surgery can significantly reduce postoperative morbidity, follow-up of such cases for a long period is important to study the possible recurrence. This paper reports successful treatment of a recurrent CGCG of posterior mandible by intralesional administration of triamcinolone acetonide in a 27-year old female patient, with long-term follow-up of 10 years.The effect of COVID-19 by SARS-CoV-2 on the paediatric population remains an evolving mystery. Early reports from China stated that children seem to be unharmed by its dangerous effects, yet more recently there has been evidence of a systemic inflammatory response in a small number of children who are affected. We discuss a 5-week-old male infant who presented atypically with severe COVID-19 infection. To our knowledge, he is the youngest reported case in the UK to require mechanical ventilation and intensive care treatment as a direct result of COVID-19 following horizontal transmission. This case has generated several learning points with regard to atypical presentations of COVID-19 and identifying a potential cohort of 'at risk’ infants. We also highlight a number of new challenges that have arisen for paediatricians and anaesthetists providing airway management for infants with SARS-CoV-2.