ObjectiveWe describe in detail the burden of infections in adults with diabetes mellitus (DM) within a large national population cohort. We also compare infection rates between Type 1 (T1DM) and Type 2 (T2DM) patients. Research Design and MethodsA retrospective cohort study compared 102,493 English primary care patients aged 40-89 years with a DM diagnosis by 2008 (n=5,863 T1DM, n=96,630 T2DM) to 203,518 age-sex-practice matched controls without DM. Infection rates during 2008-15, compiled from primary care and linked hospital and mortality records, were compared across 19 individual infection categories.These were further summarised as any requiring a prescription, hospitalisation, or as cause of death. Poisson regression was used to estimate incidence rate ratios (IRRs) between: (i) people with diabetes and controls; (ii) T1DM and T2DM adjusted for age, sex, smoking, BMI and deprivation. ResultsCompared to controls without diabetes, DM patients had higher rates for all infections, with the highest IRRs seen for bone and joint infections, sepsis and cellulitis. IRRs for infectionrelated hospitalisations were 3.71 (95%CI 3.27-4.21) for T1DM and 1.88 (95%CI 1.83-1.92) for T2DM. A direct comparison of types confirmed higher adjusted risks for T1DM vs. T2DM(death from infection IRR = 2.19, 95%CI 1.75-2.74). We estimate 6% of infection-related hospitalisations and 12% of infection-related deaths were attributable to DM. Conclusions 3People with diabetes, particularly T1DM, are at increased risk of serious infection representing an important population burden. Strategies that reduce the risk of developing severe infections and poor treatment outcomes are under-researched and should be explored. Words: 2494 Diabetes mellitus (DM) is one of the leading causes of morbidity and mortality across the globe and the burden of disease is projected to increase from 415 to 642 million adults between 2015 and 2040.(1) The association between diabetes (DM) and infection is well known clinically,(2;3), and has been linked to a number of causal pathways including impaired immune responses within the hyperglycaemic environment(4), as well as potentially other abnormalities associated with diabetes such as neuropathy and altered lipid metabolism. It has been described in other studies and populations,(5-17) however not all have consistently controlled for confounding factors such as smoking, which are more common in people with diabetes and associated with infection.(18) Initially, studies mainly considered predominately common infections,(6; 8; 12) with few able to include important but rare infections,(7) such as endocarditis, or considered the whole range of infection outcomes from health service use, (17) to hospitalisation(16) and mortality.(9) Also, few studies have included large numbers of older people, for whom infections may be frequent and more serious.(5) Larger recent studies, primarily from higher income countries using national datasets have overcome some of these limitations,(7-13) but do not always separate...

Poor glycemic control is powerfully associated with serious infections and should be a high priority.

Objectives. To describe mortality among adults with intellectual disability in England in comparison with the general population.Methods. We conducted a cohort study from 2009 to 2013 using data from 343 general practices. Adults with intellectual disability (n = 16 666; 656 deaths) were compared with age-, gender-, and practice-matched controls (n = 113 562; 1358 deaths).Results. Adults with intellectual disability had higher mortality rates than controls (hazard ratio [HR] = 3.6; 95% confidence interval [CI] = 3.3, 3.9). This risk remained high after adjustment for comorbidity, smoking, and deprivation (HR = 3.1; 95% CI = 2.7, 3.4); it was even higher among adults with intellectual disability and Down syndrome or epilepsy. A total of 37.0% of all deaths among adults with intellectual disability were classified as being amenable to health care intervention, compared with 22.5% in the general population (HR = 5.9; 95% CI = 5.1, 6.8).Conclusions. Mortality among adults with intellectual disability is markedly elevated in comparison with the general population, with more than a third of deaths potentially amenable to health care interventions. This mortality disparity suggests the need to improve access to, and quality of, health care among people with intellectual disability. (Am J Public Health.

BackgroundPedometers can increase walking and moderate-to-vigorous physical activity (MVPA) levels, but their effectiveness with or without support has not been rigorously evaluated. We assessed the effectiveness of a pedometer-based walking intervention in predominantly inactive adults, delivered by post or through primary care nurse-supported physical activity (PA) consultations.Methods and FindingsA parallel three-arm cluster randomised trial was randomised by household, with 12-mo follow-up, in seven London, United Kingdom, primary care practices. Eleven thousand fifteen randomly selected patients aged 45–75 y without PA contraindications were invited. Five hundred forty-eight self-reporting achieving PA guidelines were excluded. One thousand twenty-three people from 922 households were randomised between 2012–2013 to one of the following groups: usual care (n = 338); postal pedometer intervention (n = 339); and nurse-supported pedometer intervention (n = 346). Of these, 956 participants (93%) provided outcome data (usual care n = 323, postal n = 312, nurse-supported n = 321). Both intervention groups received pedometers, 12-wk walking programmes, and PA diaries. The nurse group was offered three PA consultations. Primary and main secondary outcomes were changes from baseline to 12 mo in average daily step-counts and time in MVPA (in ≥10-min bouts), respectively, measured objectively by accelerometry. Only statisticians were masked to group. Analysis was by intention-to-treat. Average baseline daily step-count was 7,479 (standard deviation [s.d.] 2,671), and average time in MVPA bouts was 94 (s.d. 102) min/wk. At 12 mo, mean steps/d, with s.d. in parentheses, were as follows: control 7,246 (2,671); postal 8,010 (2,922); and nurse support 8,131 (3,228). PA increased in both intervention groups compared with the control group; additional steps/d were 642 for postal (95% CI 329–955) and 677 for nurse support (95% CI 365–989); additional MVPA in bouts (min/wk) were 33 for postal (95% CI 17–49) and 35 for nurse support (95% CI 19–51). There were no significant differences between the two interventions at 12 mo. The 10% (1,023/10,467) recruitment rate was a study limitation.ConclusionsA primary care pedometer-based walking intervention in predominantly inactive 45- to 75-y-olds increased step-counts by about one-tenth and time in MVPA in bouts by about one-third. Nurse and postal delivery achieved similar 12-mo PA outcomes. A primary care pedometer intervention delivered by post or with minimal support could help address the public health physical inactivity challenge.Clinical Trial Registrationisrctn.com ISRCTN98538934.

Various emotional states and stress increase oscillatory resistance largely independently of concurrent increases in autonomic or ventilatory activity. The particular sensitivity of asthmatics to passive coping demand requires additional research.

WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT• In vitro studies suggest that b-adrenoceptor blocker therapy inhibits cancer cell proliferation and migration leading to their consideration as novel therapeutic agents for cancer.• While trials in humans have suggested b-adrenoceptor blockers have no effect on cancer incidence, their effect on cancer survival has not been studied.• Recent limited evidence in breast cancer patients suggests that b-adrenoceptor blockers may improve cancer-specific survival. WHAT THIS STUDY ADDS• This study is the first to examine cancer survival in patients receiving b-adrenoceptor blockers across a range of common cancers in a large population-based sample.• For common tumour sites, including lung, breast and colon, there was no evidence that b-adrenoceptor blocker treatment modified overall survival but poorer survival was seen in patients with prostate and pancreatic cancer.• Our findings do not support development of clinical trials on b-adrenoceptor blocker therapy for cancer without further evidence of a beneficial effect in humans. AIMSTo examine the effect of b-adrenoceptor blocker treatment on cancer survival. METHODSIn a UK primary care database, we compared patients with a new cancer diagnosis receiving b-adrenoceptor blockers regularly (n = 1406) with patients receiving other antihypertensive medication (n = 2056). RESULTSCompared with cancer patients receiving other antihypertensive medication, patients receiving b-adrenoceptor blocker therapy experienced slightly poorer survival (HR = 1.18, 95% CI 1.04, 1.33 for all b-adrenoceptor blockers; HR = 1.21, 95% CI 0.94, 1.55 for non-selective b-adrenoceptor blockers). This poorer overall survival was explained by patients with pancreatic and prostate cancer with no evidence of an effect on survival for patients with lung, breast or colorectal cancer. Analysis in a cancer-free matched parallel cohort did not suggest selection bias masked a beneficial effect. CONCLUSIONOur study does not support the hypothesis that b-adrenoceptor blockers improve survival for common cancers.

focusing on older people with increasing disability, pain, physical ill-health and compromised social support should help in both the prevention and recognition of onset of later-life depression. In older people with depression, those with the highest symptom scores and low belief in powerful others at baseline were more likely to develop chronic symptoms and could be targeted for more intensive treatment and support.

Objective: To study trends in the use of lipid lowering drugs in the UK, and to assess which patient factors influence prescribing. Methods: Routinely collected computerised medical data were analysed from 142 general practices across England and Wales that provide data for the Doctors' Independent Network database. Subjects included were people aged 35 years or more with treated ischaemic heart disease, averaging annually over 30 000. The temporal trend from 1994 to 2001 in prescription of lipid lowering drugs and daily statin dose and the odds ratios (ORs) for receiving a statin prescription in 1998 were examined. Results: Lipid lowering drug prescribing increased greatly over time, entirely because of statins, so that in 2001 56.3% of men and 41.1% of women with ischaemic heart disease received lipid lowering drugs. However, 33% of these patients were on a < 20 mg simvastatin daily equivalent. In 1998 the OR for receiving a statin fell from 1 at age 55-64 to 0.64 at 65-74 and 0.16 at 75-84 years. The age effect was similar in those without major comorbidity. Revascularised patients were much more likely to receive a statin than those with angina (OR 3.92, 95% confidence interval (CI) 3.57 to 4.31). Men were more likely to receive a statin than women (OR 1.62, 95% CI 1.54 to 1.71) but this difference disappeared after adjustment for age and severity of disease (OR 1.06). Geographical region had little effect but there was a very weak socioeconomic gradient. Conclusions: Although prescribing has increased, many patients who may benefit from lipid lowering drugs either do not receive it or are undertreated, possibly because of lack of awareness of the relative potency of the different statins. Patients with angina and the elderly are less likely to receive treatment that may prevent a coronary event.