AbstractDeaths from air pollution in the UK are higher by a factor of 10 than from car crashes, 7 for drug-related deaths and 52 for murders, and yet awareness seems to be lacking in local government. We conducted an 18-year retrospective cohort study using routinely collected health care records from Ninewells Hospital, Dundee, and Perth Royal Infirmary, in Tayside, Scotland, UK, from 2000 to 2017. Hospitalisation events and deaths were linked to daily nitric oxides (NOX, NO, NO2), and particulate matter 10 (PM10) levels extracted from publicly available data over this same time period. Distributed lag models were used to estimate risk ratios for hospitalisation and mortality, adjusting for temperature, humidity, day of the week, month and public holiday. Nitric oxides and PM10 were associated with an increased risk of all hospital admissions and cardiovascular (CV) admissions on day of exposure to pollutant. This study shows a significant increase in all cause and CV hospital admissions, on high pollution days in Tayside, Scotland.
Deaths from air pollution in the UK are higher by a factor of 10 than from car crashes, 7 for drug-related deaths and 52 for murders, and yet awareness seems to be lacking in local government. We conducted an 18-year retrospective cohort study using routinely collected health care records from Ninewells Hospital, Dundee, and Perth Royal Infirmary, in Tayside, Scotland, UK, from 2000 to 2017. Hospitalisation events and deaths were linked to daily nitric oxides (NOX, NO, NO2), and particulate matter 10 (PM10) levels extracted from publicly available data over this same time period. Distributed lag models were used to estimate risk ratios for hospitalisation and mortality, adjusting for temperature, humidity, day of the week, month and public holiday. Nitric oxides and PM10 were associated with an increased risk of all hospital admissions and cardiovascular (CV) admissions on day of exposure to pollutant. This study shows a significant increase in all cause and CV hospital admissions, on high pollution days in Tayside, Scotland. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s11356-021-16544-0.
ABSTRACTBackgroundAlthough pharmacotherapy is to be avoided wherever possible during pregnancy, aggressive pharmacotherapy is required for the treatment of pregnancy associated hypertension, which remains a leading cause of morbidity and mortality in the UK. While the teratogenic effects of angiotensin-converting enzyme inhibitors are well documented, the possible long term effects, on the child, following in utero exposure to other antihypertensive agents remains unknown.
ApproachThe aim of this study was to systematically review all published literature relevant to possible adverse outcomes on the child associated with in utero exposure to antihypertensive medications. OVID (Medline, Embase), Scopus, EBSCO Collections (PsycINFO, CINAHL), The Cochrane Library and Web of Science databases were searched from January 1950 to January 2016 and a total of 688 papers were identified. Following review 43 primary studies and 4 Meta-analyses were eligible for inclusion. The Critical Appraisal Skills Programme (CASP) checklists were used to assess study quality. ResultsThree studies were of excellent quality the remainder were either mediocre or poor. Increased risk of low birth weight, low size for gestational age, preterm birth and congenital defects following in utero exposure to all antihypertensive agents were identified. The clinical importance of these reported risks is unclear, as many study findings were based on small case numbers. Four studies of mediocre quality reported on the relationship between in utero exposure and neurological adverse effects in offspring. Two studies reported an increased risk of attention deficit hyperactivity disorder following exposure to labetalol, and an increased risk of sleep disorders following exposure to methyldopa and clonidine. The remaining two studies identified no such associations. ConclusionsThis systematic review demonstrates a lack of published high quality studies. Available published studies indicate an increased risk of adverse child health outcomes, although it is unclear whether these outcomes are clinically significant. This review is the first step in a larger project, which is exploring child health outcomes in Scotland following in utero exposure to antihypertensive and psychotropic medications. Dispensed drug data will be used to identify mothers who have been prescribed antihypertensive or psychotropic medication during pregnancy. National databases (PIS, SMR02, SMR01, etc.) will be used to cross-link mother and child data to identify in utero exposure to the drugs of interest, and the resulting child outcomes. All aspects of child health outcomes will be assessed to identify possible adverse effects from in utero exposure to medications.
We acknowledge the support from the Farr Institute @ Scotland. The Farr Institute @ Scotland is supported by a 10-funder consortium: Arthritis Research UK, the British Heart Foundation, Cancer Research UK, the Economic and Social Research Council, the Engineering and Physical Sciences Research Council, the Medical Research Council, the National Institute of Health Research, the National Institute for Social Care and Health Research (Welsh Assembly Government), the Chief Scientist Office (Scottish Government Health Directorates), the Wellcome Trust, (MRC grant number MR/K007017/1). ; Peer reviewed ; Publisher PDF
Background with rationaleThis retrospective cohort study linked Scotland-wide education data to national health data to explore associations between childhood chronic conditions and subsequent educational and health outcomes.
Main AimConditions studied were diabetes, asthma, epilepsy, attention deficit hyperactivity disorder (ADHD) and depression. We also explored neurodevelopmental multimorbidity (comorbid autism, learning disability, ADHD or depression). Educational outcomes were school absenteeism and exclusion, special educational need, academic attainment and subsequent unemployment. Health outcomes were hospital admissions and all-cause mortality.
Methods/ApproachPupil census data and associated education records for all children attending primary and secondary schools in Scotland between 2009 and 2013 were linked to national prescribing data, acute and psychiatric hospital admissions, death records and retrospective maternity records enabling conditions to be studied whilst adjusting for sociodemographic and maternity factors and comorbid conditions. Conditions were ascertained from prescribing data and school records.
ResultsAll conditions were associated with increased school absenteeism, special educational need, and hospitalisation. All, excluding diabetes, were associated with poorer academic attainment and all, excluding ADHD were associated with increased mortality. ADHD and depression were associated with increased exclusion from school whilst epilepsy, ADHD and depression were associated with subsequent unemployment. Children experiencing neurodevelopmental multimorbidity had poorer outcomes across all educational domains. Depression was the biggest driver of absenteeism and ADHD was the biggest driver of exclusion.
ConclusionIn addition to poorer health outcomes, schoolchildren with these chronic conditions appear to experience significant educational disadvantage compared to their peers. Therefore interventions and further understanding of the intricate relationships between health and education among children with these conditions is required.
