To examine trends in the prevalence and incidence of prescription opioid analgesic use in Australian women of reproductive age and to estimate the number of calendar months each year that women were dispensed opioids.

We conducted a retrospective cross-sectional study involving women aged 15 to 44 years using pharmaceutical dispensing claims for a 10% random sample of Australians. For the period 2013 to 2020, we calculated the annual prevalence and incidence of opioid analgesic dispensing per 100 (%) population by opioid type and age group. We also estimated the total number of calendar months that women were dispensed at least one opioid each year.

The prevalence of opioid use decreased from 12.8% in 2013 to 11.3% in 2020, representing a relative decrease of 11.6% (95% CI 10.7%, 12.6%). The incidence of opioid use decreased from 10.3% in 2014 to 8.3% in 2020, representing a relative decrease of 18.6% (95% CI 17.6%, 19.6%). Codeine in combination products, followed by oxycodone and tramadol, were the most prevalent opioids. Prevalence and incidence of opioid use were lowest in women aged 15 to 19 years and the highest in women 30 years and above. Among all women dispensed opioids, 72.7% were dispensed an opioid in only one month each year.

Prescription opioid use remains common, although decreasing, among women of reproductive age in Australia. However, it is reassuring that the majority of opioid use in this population is short-term.

Prescription opioid use remains common, although decreasing, among women of reproductive age in Australia. However, it is reassuring that the majority of opioid use in this population is short-term.

The dose-response relationship of vitamin D status and the risk of serious falls requiring hospitalization in older women is unclear. We examined the association between plasma 25-hydroxyvitamin D (25OHD) with falls-related hospitalizations over 14.5 years in a large cohort of older women.

In 1348 community-dwelling Australian women aged ≥70 years, plasma 25OHD concentrations were assessed at baseline (1998) using LC-MS/MS. Fall-related hospitalizations were obtained from linked data systems. Baseline grip strength and timed-up-and-go (TUG) were assessed as measures of muscle strength and physical function, respectively.

Mean plasma 25OHD was 66.9 ± 28.2 nmol/L. The number of women in the low (LOW; <50 nmol/L), medium (MED; 50 to <75 nmol/L), and higher 25OHD (HIGH; ≥75 nmol/L) categories were 384 (28.5%), 491 (36.4%), and 473 (35.1%), respectively. In the multivariable-adjusted analysis, compared to LOW, women in HIGH had significantly lower hazards for a falls-related hospitalization (HR 0.76 95d in women with higher 25OHD levels.Artificial intelligence-based tools designed to assist in the diagnosis of lymphoid neoplasms remain limited. The development of such tools can add value as a diagnostic aid in the evaluation of tissue samples involved by lymphoma. A common diagnostic question is the determination of chronic lymphocytic leukemia (CLL) progression to accelerated CLL (aCLL) or transformation to diffuse large B-cell lymphoma (Richter transformation; RT) in patients who develop aggressive disease. The morphologic assessment of CLL, aCLL, and RT can be diagnostically challenging. Using established diagnostic criteria of CLL progression/transformation, we designed four artificial intelligence-constructed biomarkers based on cytologic (nuclear size and nuclear intensity) and architectural (cellular density and cell to nearest-neighbor distance) features. We analyzed the predictive value of implementing these biomarkers individually and then in an iterative sequential manner to distinguish tissue samples with CLL, aCLL, and RT. Our model, based on these four morphologic biomarker attributes was able to achieve a robust analytic accuracy. This study suggests that biomarkers identified using artificial intelligence-based tools can be used to assist in the diagnostic evaluation of tissue samples from patients with CLL who develop aggressive disease features. This article is protected by copyright. All rights reserved.James Russell, BVA President, reflects on his presidential year ahead of handing over to Justine Shotton later this month.This focus article has been prepared by Scott Reid of the APHA’s virology department with Sharon Brookes, Rowena Hansen, David Welchman, Richard Irvine and Ian Brown of the APHA.Caterina Termine, Göran Akerström and Gonçalo Paixão of the Fédération Equestre Internationale’s Veterinary Department describe the management of an outbreak of neurological equine herpesvirus 1 that affected a number of international showjumping events in Europe earlier this year.

There is a lack of information regarding magnetic resonance imaging (MRI) features of polyostotic vertebral lesions in dogs. The aim of this retrospective study was to identify and differenciate low-field MRI features of aggressive versus benign multifocal vertebral diseases in dogs.

MRI examinations from 49 dogs with polyostotic vertebral lesions were reviewed. Images were evaluated for vertebral intensity changes, expansile lesions, new bone formation, cortical bone interruption, paravertebral musculature changes, lymphadenomegaly, spinal cord compression and spinal cord signal changes.

Twenty-nine dogs with non-aggressive bone lesions and 20 dogs with aggressive vertebral lesions were included. Non-aggressive lesions had variable T2-weighted fast spin-echo (T2W) signal intensity and the majority displayed low signal intensity on short tau inversion recovery (STIR). Aggressive lesions predominantly had high T2W and STIR signal intensity, with variable signal intensity on T1-weighted spin-echo and contrast enhancement. Aggressive lesions were associated with spinal pain (p < 0.01), new bone formation (p = 0.02), spinal cord compression (p < 0.01) and lymphadenomegaly (p < 0.01). Cortical interruption (p < 0.01) and paravertebral musculature changes (p < 0.01) were the strongest indicative imaging features for aggressive lesions.

Spinal pain, spinal cord compression, new bone formation, lymphadenomegaly and especially cortical interruption and paravertebral musculature signal intensity changes were the best discriminators for differentiating malignant from benign vertebral lesions.

Spinal pain, spinal cord compression, new bone formation, lymphadenomegaly and especially cortical interruption and paravertebral musculature signal intensity changes were the best discriminators for differentiating malignant from benign vertebral lesions.The Veterinary Policy Research Foundation employs a veterinary intern to assist Lord Trees in advancing veterinary thinking in parliament. Here, the current intern Catrina Prince shares an update.When recent graduates Ilianna Bakali and Auxi Garcia wanted to embark on further study, they looked at ways of funding additional qualifications.Despite deserving his much-needed holiday, Fabian Rivers, recent graduate rep on BVA Council, felt somewhat guilty about leaving a new grad to take on extra responsibility.Nominations for the 2021 BVA Young Vet of the Year Award, supported by Zoetis, are now closed and our expert judges will soon be deciding on the winner.Earlier this month, we were delighted to announce that climate scientist and broadcaster Dr Tamsin Edwards will deliver this year’s Wooldridge Memorial Lecture at BVA Congress at the London Vet Show. Here are five facts about our fascinating keynote speaker.A kind, patient, inspirational man with a broad sense of humour.A vet with a strong character and a keen mind, who was never happier than when on a beach with his family.A vet who was well known in the field of artificial insemination of pigs.We’re currently looking for a new member of the Electoral College, the body that assesses nominations and formally selects members for election to officer status.Eve Ritchie, AWF communications officer, invites you to this year’s AWF Discussion Forum.Georgina Mills reports on new research investigating whether antimicrobial resistance in Swedish brown bears replicates the history of antibiotic use in the country.BVA policy officer Megan Knowles-Bacon offers some advice on how to get started with our good veterinary workplaces workbook.Ultrasound-guided procedures require excellent hand-eye coordination and practice. Trainees should gain this important skill with a phantom prior to performing procedures on patients. Currently available phantoms each have their own unique limitations. We propose an easily made, inexpensive, tissue-like phantom using a previously unreported material. The sonographic appearance of the phantom, with and without a 14-gauge needle, is compared with breast tissue, gelatin phantoms, and commercial phantoms. Target lesions can be produced using readily available materials. The proposed phantom is cheaper than commercial phantoms; performs better than gelatin phantoms, and is ultimately a superior practice tool for residents.In aortic stenosis (AS), a left ventricular (LV) ejection fraction (EF) less then 50% or symptoms are class I indications for aortic valve intervention. However, an EF less then 50% may be too conservative since subendocardial fibrosis may already have developed. An earlier marker of LV systolic dysfunction is therefore needed and first phase EF (EF1) is a promising new candidate. It is the EF measured over early systole to the point of maximum transaortic blood flow. It may be low in the presence of preserved total LV EF since the heart may compensate by recruiting myosin motors in later systole. The EF1 is inversely related to the grade of AS and directly related to markers of subendocardial fibrosis like late gadolinium enhancement on cardiac magnetic resonance scanning. A reduced EF1 ( less then 25%) predicts adverse clinical events better that total EF and global longitudinal strain. We suggest that it is worth exploring as an indication for surgery in patients with asymptomatic severe AS.

Glucocorticoids are steroid hormones that play a vital role in late pregnancy in maturing fetal organs, including the heart. In fetal cardiomyocytes in culture, glucocorticoids promote mitochondrial fatty acids oxidation, suggesting they facilitate the perinatal switch from carbohydrates to fatty acids as the predominant energy substrate. Administration of a synthetic glucocorticoid in late pregnancy in mice down-regulates the glucocorticoid receptor and interferes with the normal increase in genes involved in fatty acid metabolism in the heart. In a sheep model of preterm birth, antenatal corticosteroids (synthetic glucocorticoid) down-regulates glucocorticoid receptor and the gene encoding PGC-1α, a master regulator of energy metabolism. These experiments suggest that administration of antenatal corticosteroids in anticipation of preterm delivery may interfere with fetal heart maturation by down-regulating the ability to respond to glucocorticoids.

The late gestational rise in glucocorticoids contributese of antenatal corticosteroids in a translational sheep model of preterm birth, both GR and PGC-1α were down-regulated in heart. These data suggest endogenous glucocorticoids support the perinatal switch to fatty acid oxidation in cardiomyocytes through changes in gene expression rather than gross changes in mitochondrial volume or mitochondrial turnover. Moreover, our data suggest that treatment with exogenous glucocorticoids may interfere with normal fetal heart maturation, possibly by down-regulating GR. This has implications for clinical use of antenatal corticosteroids when preterm birth is considered a possibility. This article is protected by copyright. All rights reserved.