IntroductionExposure to armed conflict has manifold implications for both military and civilian populations. Prenatal stress has detrimental effects on both obstetric outcomes, fetal development and the development of an individual later in life. As well as causing stress to the mother, armed conflicts can decimate local infrastructures making it increasingly difficult to access antenatal and general healthcare. The present review is particularly salient in light of the many ongoing current conflicts. It examines the impacts of exposure to armed conflicts on the pregnancy outcomes.MethodsA thorough literature search was carried out on three databases using MeSH and truncation terms. 13 studies were included in the final analysis relating to mothers exposed to armed conflicts since 1990.ResultsThe studies include data from 1 172 151 patients: mothers from Libya, Bosnia, Herzegovina, Israel, Palestine, Kosovo, Yugoslavia, Nepal, Somalia, Iraq, Kuwait and Afghanistan. There is evidence of an increased risk of mothers giving birth to babies of low birth weight as reported in nine included studies. All have a degree of bias, with four at lower and five at higher risk of bias, either not adjusting for confounders or not employing robust measures of exposure to conflict. Further evidence suggested an increase in the incidence of miscarriage, stillbirth, prematurity, congenital abnormalities, miscarriage and premature rupture of membranes among mothers exposed to armed conflict.ConclusionDespite the varying degrees of bias which must be considered for the available evidence, the data with the lowest risk of bias suggest a relationship between exposure to armed conflict and low birth weight. In light of the current level of displacement experienced by such populations, the identification of pregnancies at risk could improve the efficacy of antenatal care. Clinicians should consider additional ultrasound scanning where appropriate to monitor for restricted growth in such pregnancies.
IntroductionGlobally, a record number of people are affected by humanitarian crises caused by conflict and natural disasters. Many such populations live in settings where epidemiological transition is underway. Following the United Nations high level meeting on non-communicable diseases, the global commitment to Universal Health Coverage and needs expressed by humanitarian agencies, there is increasing effort to develop guidelines for the management of hypertension in humanitarian settings. The objective was to investigate the prevalence and incidence of hypertension in populations directly affected by humanitarian crises; the cascade of care in these populations and patient knowledge of and attitude to hypertension.MethodsA literature search was carried out in five databases. Grey literature was searched. The population of interest was adult, non-pregnant, civilians living in any country who were directly exposed to a crisis since 1999. Eligibility assessment, data extraction and quality appraisal were carried out in duplicate.ResultsSixty-one studies were included in the narrative synthesis. They reported on a range of crises including the wars in Syria and Iraq, the Great East Japan Earthquake, Hurricane Katrina and Palestinian refugees. There were few studies from Africa or Asia (excluding Japan). The studies predominantly assessed prevalence of hypertension. This varied with geography and age of the population. Access to care, patient understanding and patient views on hypertension were poorly examined. Most of the studies had a high risk of bias due to methods used in the diagnosis of hypertension and in the selection of study populations.ConclusionHypertension is seen in a range of humanitarian settings and the burden can be considerable. Further studies are needed to accurately estimate prevalence of hypertension in crisis-affected populations throughout the world. An appreciation of patient knowledge and understanding of hypertension as well as the cascade of care would be invaluable in informing service provision.
Background/Aims Prior to each treatment of zoledronate (ZA) or denosumab, it is routine clinical practice to test for vitamin D. If vitamin D levels are low, patients must be started on replacement therapy prior to treatment. Other studies suggest that osteoporosis patients not taking vitamin D supplementation are likely to have subtherapeutic vitamin D levels. Awaiting vitamin D levels can delay timely treatment and organising these tests is labour intensive. In this service evaluation, we examined whether patients could have been treated empirically with vitamin D without testing. Methods We included all 542 patients from the New Cross Hospital osteoporosis treatment clinic lists between November 2021 to June 2022. The only patients excluded were those not taking ZA or denosumab. Data collected included demographics, medication history, and vitamin D levels. Vitamin D levels were measured as follows: <15 nmol/L: severe deficiency, 15-30 nmol/L: deficiency, >30-50 nmol/L: insufficiency, >50-250 nmol/L: adequate, >250 nmol/L: potential toxicity. Results 484 patients were included of which 88.6% were female. The mean age was 76.8. 90.0% were either on vitamin D and calcium supplementation, or on vitamin D supplementation alone. Of these patients on supplementation, vitamin D levels were adequate in 79.8%, insufficient in 7.8%, deficient in 0.4%, severely deficient in 0.2% and not available for the remaining patients. Of those not on supplementation, vitamin D levels were adequate in 45.9%, insufficient in 16.2%, deficient in 10.8% and severely deficient in 4%, and not available for the remaining patients. None of the patients had toxic levels of vitamin D. On contacting the 3 patients prescribed vitamin D supplementation but with deficient or severely deficient vitamin D levels, 2 were not taking the supplements and 1 was taking alfacalcidol (which is not measured in the standard trust vitamin D test). Therefore, of those patients taking vitamin D supplementation as prescribed, their vitamin D levels were all above 30 nmol/L. Conclusion This service evaluation therefore supports an approach of not testing vitamin D levels in patients who are due to receive either ZA or denosumab and are taking vitamin D supplementation. A small number of patients taking vitamin D supplementation still had insufficient levels of vitamin D; therefore, it could be recommended to treat all patients on vitamin D supplementation with a short course of high does vitamin D prior to ZA or denosumab treatment. In addition, any patients not taking vitamin D supplementation could also be treated with a course of high dose vitamin D prior to treatment without testing vitamin D levels. This will ensure safe levels of vitamin D and timely treatment of osteoporosis. This will save time and money and reduce waste. Disclosure J. Keasley: None. C. Stevens: None. A. Kumar: None. H. Sapkota: None.
Symptoms of depression, socioeconomic position and physical disability were adjusted for. Results No associations were found between marital status or number of household occupants and DASH scores. Being fully retired compared to still being in main occupation was associated with a 0.73 (95% CI: 0.16 to 1.30) increase in DASH points when adjusting for sex, socioeconomic position, symptoms of depressions and physical disability. When stratifying for sex, an increase in DASH points of 0.84 (95% CI: 0.041 to 1.63) was seen in females but not males fully retired. Conclusion Results so far from this study suggest that being retired at 60-64 years, compared to still being in main employment, may be associated with improved diet quality, especially in females.Next analyses will consider other social health exposures, including functional aspects of social relationships, and other indices of dietary intake.
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