Antenatal findings and early postnatal outcomes in pregnancies with trisomy 21: a 10-year retrospective review at a tertiary centre

Objective To examine the antenatal imaging features, intrapartum findings and early postpartum course of pregnancies with trisomy 21 (T21). Design Ten-year retrospective review Setting A tertiary hospital in the United Kingdom Population Women with a pregnancy affected by T21, who did not have a termination. Methods Women with pregnancies diagnosed with T21 on: antenatal karyotyping; karyotyping of post-mortem tissue and postnatal karyotype samples, from February 2010-2020. Main Outcome Measures Antenatal imaging findings, fetal growth restriction (FGR), birthweight, mode of delivery, and early neonatal outcomes. Results Seventy-six women with a fetus affected by T21 were identified. There were 6 intrauterine deaths, and 70 livebirths. Thirty-eight (50%) had an antenatal diagnosis and twenty-five (33%) had a suspected diagnosis but declined further testing. The diagnosis was unanticipated in 13 (17%). Cardiac anomalies (n=27) were the most common antenatal anomaly. Doppler abnormalities were apparent in 48/73 (68%). Eighteen (25.7%) had ultrasound evidence of FGR. The majority delivered by Caesarean section, and 21.4% of babies weighed below the 3rd percentile at delivery. Fifty-eight (82%) were admitted to the neonatal unit. Forty-three (61%) required respiratory support and fifty-five (78%) either needed naso-gastric feeding or were nil by mouth. Mean PAPP-A values were significantly lower in cases with abnormal Dopplers, FGR, congenital anomalies and with a birthweight below the 10th percentile. Conclusions Fetuses with T21 have high rates of placental insufficiency. FGR and Doppler abnormalities are common. Postnatally, the majority will require respiratory and feeding support. Antenatal counselling and protocols should reflect these risks. Funding None

Vitamin D and socioeconomic deprivation mediate COVID-19 ethnic health disparities

Ethnic minorities in developed countries suffer a disproportionately high burden of COVID-19 morbidity and mortality, and COVID-19 ethnic disparities have been attributed to social determinants of health. Vitamin D has been proposed as a modifiable risk factor that could mitigate COVID-19 health disparities. We investigated the relationship between vitamin D and COVID-19 susceptibility and severity using the UK Biobank, a large progressive cohort study of the United Kingdom population. Structural equation modelling was used to evaluate the ability of vitamin D, socioeconomic deprivation, and other known risk factors to mediate COVID-19 ethnic health disparities. Asian ethnicity is associated with higher COVID-19 susceptibility, compared to the majority White population, and Asian and Black ethnicity are both associated with higher COVID-19 severity. Socioeconomic deprivation mediates all three ethnic disparities and shows the highest overall signal of mediation for any COVID-19 risk factor. Vitamin supplements, including vitamin D, mediate the Asian disparity in COVID-19 susceptibility, and serum 25-hydroxyvitamin D (calcifediol) levels mediate Asian and Black COVID-19 severity disparities. Several measures of overall health also mediate COVID-19 ethnic disparities, underscoring the importance of comorbidities. Our results support ethnic minorities’ use of vitamin D as both a prophylactic and a supplemental therapeutic for COVID-19.

Experiences and emotional strain of NHS frontline workers during the peak of the COVID19 pandemic

Background: The mental health of the population has been negatively affected due to the pandemic. Frontline healthcare workers with increased exposure to COVID diagnosis, treatment and care were especially likely to report psychological burden, fear, anxiety and depression. Aim: To elicit how working as a health professional during the pandemic is impacting on the psychological wellbeing of frontline staff. Method: United Kingdom population of healthcare workers were approached by advertising the survey via social media, NHS trusts and other organisations. Open-ended survey answers were qualitatively explored using content analysis. Results: Survey collected data from 395 NHS staff was developed into three themes; (1) Despair and uncertainty: feeling overwhelmed trying to protect everyone, (2) Behavioural and psychological impact: affecting wellbeing and functioning and (3) Coping and employer support: getting the right help. Conclusion: NHS staff felt enormous burden to adequately complete their professional, personal and civil responsibility to keep everyone safe leading to negative psychological and behavioural consequences and desire for NHS employers to offer better support. As the pandemic progresses, the results of this study may inform NHS employers on how optimum support can be offered to help them cope with negative psychological consequences of the pandemic.

Early medical abortion by telemedicine in the United Kingdom: A cost-effectiveness analysis

Objective: To determine the potential cost savings resulting from the introduction of routine early medical abortion at home by telemedicine in the United Kingdom. Design: A cost-effectiveness analysis Setting: United Kingdom Population: Women in 2020 undergoing early medical abortion provided by three independent abortion providers and two NHS abortion clinics. Methods: Computation of the costs of each abortion procedure and of managing failed or incomplete abortion and haemorrhage requiring blood transfusion. Outcome measures: Cost savings (Pound Sterling) Results: Overall estimated cost savings are 15.80 per abortion undertaken by independent abortion providers representing a saving to the NHS of over 3 million per year. Limited data from NHS services resulted in an estimated average saving of 188.84 per abortion. Conclusions: Were telemedicine EMA to become routine, an increase in the number of women eligible for medical rather than surgical abortion, and a reduction in adverse events resulting from earlier abortion could result in significant cost-savings.

‘Gone for a soldier’: Irish Recruitment to the British Armed Forces, 1903–1914

There was a long tradition of Catholic, as well as Protestant, Irish service within the British armed forces. By 1913, 9% of British regular soldiers were Irish, a figure just slightly below the Irish share of the United Kingdom population. Militia, Yeomanry and Officer Training Corps units, which all attracted part-time amateur soldiers, were also well-recruited, though the wholesale disbandment of militia units in 1908 broke this link between some Irish counties and the British army. This recruitment occurred in spite of determined, if localised and unco-ordinated, attempts made by advanced Nationalists to prevent Irishmen enlisting in the British armed forces. Most recruits were from urban areas and were unskilled workers or unemployed at their time of enlistment. Recruitment rates were disproportionately high in Dublin and Cork, and notably low in industrial Belfast.

Symptoms, attitudes and treatment perceptions of vulvo-vaginal atrophy in UK postmenopausal women: Results from the REVIVE-EU study

Objectives To describe the attitudes and perceptions of postmenopausal women from the United Kingdom regarding menopause, vulvo-vaginal atrophy and its therapeutic management. Study design Post hoc analysis of the United Kingdom population from the REVIVE-EU Study. Main outcome measures The survey contained questions about women’s knowledge of menopause and vulvo-vaginal atrophy symptoms, impact on their life and sexual activities, communication with healthcare professionals and treatments. Results The most frequent symptom of menopause was hot flushes (75%). Vulvo-vaginal atrophy symptoms had a significant impact on participants’ ability to enjoy sexual intercourse (66%), spontaneity (62%) and ability to be intimate (61%); however, only 68% of women had been to their healthcare professional for advice. Half of the sample expected that doctors would initiate a discussion of menopausal symptoms and sexual health, but was in fact rare (5%). Only 27% were under current treatment without a clear therapy pattern, of which 43% used vaginal over-the-counter treatments, 28% prescription (Rx), and 13% both. Efficacy was the main limitation for over-the-counter treatments, while for Rx products were side effects and safety. Women highlighted the restoring of the natural condition of the vagina as the main goal for a treatment (35%). Many United Kingdom women did not feel the need to see any healthcare professional for their gynaecological symptoms. Overall satisfaction with treatment was only 44%. Conclusions Vulvo-vaginal atrophy remains underdiagnosed and undertreated in United Kingdom. There is a lack of coherent discussion about vulvo-vaginal atrophy symptoms with clinicians. Many United Kingdom healthcare professionals could improve proactive communication with patients about vulvo-vaginal atrophy.

“The expediency of local modelling to aid national responses to SARS-CoV-2.”

BackgroundWith the SARS-CoV-2 pandemic gripping most of the globe, healthcare and economic recovery strategies are being explored currently as a matter of urgency. The underpinning rationale of this paper is that we believe that health and care services are provided locally, therefore, local implications of national policy need to be reflected when informing national responses to the SARS-CoV-2 pandemic.MethodsWe adopted the assumptions underlying the United Kingdom government’s national epidemiological model which influences the national policy response to the SARS-CoV-2 pandemic. We used these in a local context and show projections in terms of presentations of symptomatic patients differ in a variety of settings. Setting:North of England, United Kingdom, population modelled at four local constituent levels which aggregated gives a total population of 3.2m.ResultsWe clearly demonstrate that there is significant difference in the way the national modelling outputs are replicated at local levels. Specifically, in terms of projected increased levels of demand for services on the local health and care systems.ConclusionsWe present significant evidence of differing timelines specifically in terms of subsequent projected peak demands. Additionally, it clearly indicates varying levels of such demand throughout the four modelled localities. These idiosyncrasies are ‘masked’ by both regional and national approaches to modelling. We urge readers to ensure that any national policy is appropriately adopted through the use of complementary bottom up approach, to suit local health and care systems. Finally, we share our methodology to ensure other professionals could replicate this study elsewhere.