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We report key learning from the public health management of the first two confirmed cases of COVID-19 identified in the UK. The first case imported, and the second associated with probable person-to-person transmission within the UK. Contact tracing was complex and fast-moving. Potential exposures for both cases were reviewed, and 52 contacts were identified. No further confirmed COVID-19 cases have been linked epidemiologically to these two cases. As steps are made to enhance contact tracing across the UK, the lessons learned from earlier contact tracing during the country's containment phase are particularly important and timely.
Medical experts may be instructed by designated bodies such as the coroner or the court, to provide expert witness statements concerning patients treated under their care. Such reports are factual and are prepared on the basis of the medical records and personal recollection of events. Other authorities such as the Driving Vehicle and Licensing Agency can also seek information on patients with traumatic brain injury. In the civil court, experts may advise on matters relating to personal injury and medical negligence. Reports are usually based upon review of records, and often medical examination of the claimant. The expert may be instructed to provide reports on condition, prognosis and/or causation. This chapter discusses liaison with the various authorities that require medico-legal input relevant to head injury and whiplash.
The major determinant of outcome from TBI is the severity of the primary injury; however, not all brain damage happens at that time point. Invariably, primary injury activates cellular and molecular cascades which mediate potentially reversible, secondary injury in the ensuing hours and days. These events can lead to progressive brain swelling and increased intracranial pressure (ICP) thus compromising cerebral perfusion pressure (CPP) and cerebral blood flow (CBF) resulting in tissue ischaemia, hypoxia and cellular energy failure. Further cell damage exacerbates the brain swelling, forming part of a vicious circle that can lead to life-threatening brain herniation. A large body of evidence links post-traumatic intracranial hypertension at levels above 20 to 25 mmHg with excess mortality and worse functional outcomes.
Intracranial pressure (ICP) is well recognised as a critical parameter to both measure and influence in the management of the head injured patient. Since Lundberg’s seminal studies, ICP has arguably become the major focus of monitoring in head injury, as well as a number of other neurosurgical scenarios.1 Mean ICP and the features that make up the ICP waveform provide insight into the state of elastance and compliance of the injured brain, impending trends and events related to changes in intracranial pathophysiology, and also end-prognosis in traumatic brain injury (TBI).
Rates of common mental health problems (depression/anxiety) rise sharply in adolescence and peak in young adulthood, often coinciding with the transition to parenthood. Little is known regarding the persistence of common mental health problems from adolescence to the perinatal period in both mothers and fathers.
A total of 393 mothers (686 pregnancies) and 257 fathers (357 pregnancies) from the intergenerational Australian Temperament Project Generation 3 Study completed self-report assessments of depression and anxiety in adolescence (ages 13–14, 15–16, 17–18 years) and young adulthood (ages 19–20, 23–24, 27–28 years). The Edinburgh Postnatal Depression Scale was used to assess depressive symptoms at 32 weeks pregnancy and 12 months postpartum in mothers, and at 12 months postpartum in fathers.
Most pregnancies (81%) in which mothers reported perinatal depression were preceded by a history of mental health problems in adolescence or young adulthood. Similarly, most pregnancies (83%) in which fathers reported postnatal depression were preceded by a preconception history of mental health problems. After adjustment for potential confounders, the odds of self-reporting perinatal depression in both women and men were consistently higher in those with a history of persistent mental health problems across adolescence and young adulthood than those without (ORwomen 5.7, 95% CI 2.9–10.9; ORmen 5.5, 95% CI 1.03–29.70).
Perinatal depression, for the majority of parents, is a continuation of mental health problems with onsets well before pregnancy. Strategies to promote good perinatal mental health should start before parenthood and include both men and women.
Advocating a pragmatic and multidisciplinary approach to the management of patients with brain injuries, Traumatic Brain Injury provides a detailed description of care along the whole-patient pathway. Delivering an evidence-based update on the optimal care of both adult and paediatric patients who have sustained injuries ranging from mild to severe, information from on-going multi-centre studies in neurotrauma is included. The basic scientific principles of neuropathology, head injury research and scoring systems are presented before detailed sections on emergency department care, patient transfer, intensive care and longer-term care. Rehabilitation is reviewed in detail with chapters discussing the aims and roles of physiotherapy, occupational therapy and neuropsychology amongst others. Discussing medico-legal issues in detail, the effect of injury on the individual and their family are also examined. Emphasising a holistic approach to caring for patients with brain injuries, this is an essential guide for all involved.
The WHO encourages countries to conduct national dietary surveys (NDS) to inform preventative policies targeting malnutrition and noncommunicable diseases. Previous reviews have found inadequate nutrient intakes and survey provision across Europe. This research is the first to provide an updated review of NDS provision within the whole WHO European Region, across the lifecourse, with reference to disadvantaged groups, obesity and nutrients of concern. Over a third of WHO European countries, mainly Central and Eastern European countries (CEEC), had no identifiable NDS. Where countries reported nutrient intakes, poor WHO recommended nutrient intake attainment was Europe-wide across the lifecourse, particularly in CEEC. Lower educated individuals had poorer diet quality. However, heterogeneity in age group sampled, dietary assessment method, nutrient composition database and under-reporting hindered inter-country comparisons. Average population trans fatty acid intakes below WHO recommended limits may hide inequalities in disadvantaged groups; legislative bans may help alleviate this. There were few associations between NDS-derived consumed food portion size (FPS) and BMI. However, consumed FPS was greater than on-pack serving-size in the majority of foods studied. This review illustrates how NDS can generate information on diet, nutrient intakes and the food environment. However, to enable valid inter-country comparisons, countries should be encouraged to conduct and report harmonised NDS, particularly in the age groups sampled, dietary assessment methodology, nutrient range, underpinning food composition database and treatment of under-reporters. This will aid effective, coordinated policy development that can have a real impact on dietary improvement, on a population and subgroup level, throughout Europe.
Maternal mental health during pregnancy and postpartum predicts later emotional and behavioural problems in children. Even though most perinatal mental health problems begin before pregnancy, the consequences of preconception maternal mental health for children's early emotional development have not been prospectively studied.
We used data from two prospective Australian intergenerational cohorts, with 756 women assessed repeatedly for mental health problems before pregnancy between age 13 and 29 years, and during pregnancy and at 1 year postpartum for 1231 subsequent pregnancies. Offspring infant emotional reactivity, an early indicator of differential sensitivity denoting increased risk of emotional problems under adversity, was assessed at 1 year postpartum.
Thirty-seven percent of infants born to mothers with persistent preconception mental health problems were categorised as high in emotional reactivity, compared to 23% born to mothers without preconception history (adjusted OR 2.1, 95% CI 1.4–3.1). Ante- and postnatal maternal depressive symptoms were similarly associated with infant emotional reactivity, but these perinatal associations reduced somewhat after adjustment for prior exposure. Causal mediation analysis further showed that 88% of the preconception risk was a direct effect, not mediated by perinatal exposure.
Maternal preconception mental health problems predict infant emotional reactivity, independently of maternal perinatal mental health; while associations between perinatal depressive symptoms and infant reactivity are partially explained by prior exposure. Findings suggest that processes shaping early vulnerability for later mental disorders arise well before conception. There is an emerging case for expanding developmental theories and trialling preventive interventions in the years before pregnancy.
This paper aims to synthesise the literature on machine learning (ML) and big data applications for mental health, highlighting current research and applications in practice.
We employed a scoping review methodology to rapidly map the field of ML in mental health. Eight health and information technology research databases were searched for papers covering this domain. Articles were assessed by two reviewers, and data were extracted on the article's mental health application, ML technique, data type, and study results. Articles were then synthesised via narrative review.
Three hundred papers focusing on the application of ML to mental health were identified. Four main application domains emerged in the literature, including: (i) detection and diagnosis; (ii) prognosis, treatment and support; (iii) public health, and; (iv) research and clinical administration. The most common mental health conditions addressed included depression, schizophrenia, and Alzheimer's disease. ML techniques used included support vector machines, decision trees, neural networks, latent Dirichlet allocation, and clustering.
Overall, the application of ML to mental health has demonstrated a range of benefits across the areas of diagnosis, treatment and support, research, and clinical administration. With the majority of studies identified focusing on the detection and diagnosis of mental health conditions, it is evident that there is significant room for the application of ML to other areas of psychology and mental health. The challenges of using ML techniques are discussed, as well as opportunities to improve and advance the field.
To bring together stakeholders in the United Kingdom to establish national priorities for research in single-ventricle heart conditions.
This study comprised two surveys and a workshop. The initial public online survey asked respondents up to three questions they would like answered for research. Responses were classified as unanswered, already answered, or unable to be answered by scientific research. In the follow-up survey, unanswered questions were divided into categories and respondents were asked to rank categories and questions by priority. A stakeholder workshop attended by patients, parents, healthcare professionals, researchers, and charities was held to determine the final list of research priorities.
A total of 128 respondents posed 344 research questions, of which 271 were classified as unanswered, and after removing duplicates, 204 questions remained, which were divided into 20 categories. In the second survey, 56 (49.1%) respondents successfully ranked categories and questions. A total of 39 participants attended the workshop, drawing up a list of 30 research priorities across nine priority categories. The nine priority categories are: Associated co-morbidities; Brain & neurodevelopment; Exercise; Fontan failure; Heart function; Living with a single ventricle heart condition; Management of the well-functioning Fontan circulation; Surgery & perioperative care; and Transplantation, mechanical support & novel therapies.
Through a multi-stage process, we engaged a wide range of interested parties to establish a list of research priorities in single-ventricle heart conditions. This provides a platform for clinicians, researchers, and funders in the United Kingdom and elsewhere to address the most important questions and improve outcomes in these rare but high-impact CHDs.
The WHO encourages national diet survey (NDS) implementation to obtain relevant data to inform policies addressing all forms of malnutrition, which remains a pressing issue throughout Europe. This paper provides an up-to-date review on energy, macro- and selected micronutrient intakes in children across WHO Europe using the latest available NDS intakes. It assesses these against WHO recommended nutrient intakes (RNI) to highlight vulnerable groups and areas of concern. Dietary survey information was gathered by Internet searches, contacting survey authors and nutrition experts. Survey characteristics, energy and nutrient intakes were extracted and weighted means calculated and presented by region. Child energy and nutrient intakes were extracted from twenty-one NDS across a third (n 18) of the fifty-three WHO Europe countries. Of these, 38 % (n 6) reported intakes by socio-economic group, but by various indicators. Energy and macronutrients, where boys and older children had higher intakes, were more widely reported than micronutrients. Most countries met under half of the WHO RNI for nutrients reported in their NDS. Micronutrient attainment was higher than macronutrients, but worst in girls and older children. Only a third, mainly Western, WHO European member states provided published data on child nutrient intakes. Gaps in provision mean that dietary inadequacies may go unidentified, preventing evidence-based policy formation. WHO RNI attainment was poor, particularly in girls and older children. Inconsistent age groups, dietary methodologies, nutrient composition databases and under-reporting hinder inter-country comparisons. Future efforts should encourage countries to conduct NDS in a standardised format by age and sociodemographic variables.