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ObjectivesChildren born during the Covid-19 pandemic had reduced exposure to early-life respiratory infections compared to pre-pandemic cohorts. This study investigated whether varying level of infection exposure was associated with differing patterns of salbutamol prescription.MethodsA retrospective cohort study using the Northwest London Discover dataset (94% NWL population coverage) including prescription data from General Practice systems. Four birth cohorts were tracked for three years to investigate the impact of Covid-19 on salbutamol prescriptions. Logistic regression assessed cohorts and patient’s characteristics on salbutamol prescriptions.ResultsThere was a significant drop in salbutamol prescriptions during the Covid-19 lockdown followed by a return to pre-pandemic levels as restrictions were lifted (table 1). After adjusting for deprivation, gender and ethnicity, Cohort 2 had 28% lower odds (OR 0.72, 95% CI 0.68–0.77, p<0.001) and Cohort 3 had 18% lower odds (OR 0.82, 95% CI 0.78–0.88, p<0.001) of receiving a salbutamol prescription compared to Cohort 1. Children in Cohort 4, born during the 1st pandemic year, showed salbutamol prescription patterns similar to those in Cohort 1, suggesting a return to pre-pandemic levels.Abstract 6710 Table 1Number and proportion of children receiving salbutamol prescriptions by age for each cohortOverall, males had 43% higher odds of salbutamol prescription compared to females (OR 1.43,95% CI 1.37–1.50, p<0.001). Asian children had 7% lower odds (OR 0.93, 95% CI 0.88–0.98, p<0.05) and Black children had 9% higher odds (OR 1.09, 95% CI 1.00–1.18, p<0.05) compared to White children. Children from most deprived quintile had 16% higher odds (OR 1.16, 95% CI 1.07–1.24, p<0.001) compared to the middle quintile.ConclusionThe Covid-19 pandemic had a major impact on children’s exposure to respiratory infections, significantly affecting salbutamol prescriptions. Ongoing monitoring of these ‘Covid’ cohorts offers a unique opportunity to study the long-term impact of respiratory infections at different stages of childhood.

There is ongoing scientific interest regarding comorbidities associated with the metabolic syndrome (MeTS). MeTS comprises a combination of parameters that predispose individuals to the development of type 2 diabetes and cardiovascular disease (CVD). Three or more of the following criteria are necessary: fasting glucose > 110 mg/dl (5.6 mmol/l), hypertriglyceridemia > 150 mg/dl (1.7 mmol/l), HDL levels < 40 mg/dl (men)/< 50 mg/dl (women), blood pressure > 130/85 mmHg, waist circumference (values for Mediterranean populations > 94 cm (men)/> 89 cm (women). In this review we attempted to summarize relevant data by searching dermatological literature regarding associations between various skin conditions and MeTS. A multitude of studies was retrieved and a further goal of the present article is to present plausible mechanistic connections. The severity of skin conditions like psoriasis has been linked with MeTS. Parameters of MeTS like insulin resistance are present in patients with early onset androgenic alopecia, hidradenitis suppurativa acne and rosacea. Since MeTS can lead to CVD and type 2 diabetes early detection of patients would be very important. Also therapeutic intervention on MeTS could lead to improvement on the severity of skin conditions. This reciprocal relationship between skin diseases and MeTS in our opinion holds great interest for further investigation.

BackgroundInfluenza is a common seasonal acute respiratory viral illness. Children, especially those with co-morbidities, are at risk of complications and ICU admission. No specific guidelines have been formulated about starting neuraminidase inhibitors (NAI) in critically ill children with influenza, but the Health Protection Agency and American Academy of Pediatrics have both stated that antiviral therapy should be initiated as soon as possible in this cohort.ObjectivesWe aimed to evaluate the evidence supporting the early initiation of NAI in critically ill children with influenza, by conducting a literature search to establish whether NAI improved survival and shortened intensive care admissions in children critically ill with influenza.MethodsWe searched the literature for articles on the use of NAI treatment in critically unwell children or children in PICU diagnosed with influenza. We excluded articles with adult patients only, or with a mixture of adults and children where the results were not stratified by age. We also excluded articles with children in outpatient settings, or hospitalised on low-dependency units.ResultsOut of 369 articles (Cochrane Library: 2, PUBMED: 328, NHS Evidence: 39), twelve studies published between 2010 and 2017 were included, seven of which were cohort studies (Level 3 evidence) and five case series (Level 4 evidence), with a total of over 7,000 critically ill children with influenza worldwide.Six cohort studies compared mortality in children receiving NAI and children who did not: five of these demonstrated a trend towards decreased mortality with the use of NAI, and one showed no difference between treated and untreated groups. Only one study reached statistical significance, with p = 0.01 for association of NAI treatment with survival. We noted that the two studies which reported on NAI-related adverse events reported none.There is some evidence in our data that early NAI within 48 hours of symptom onset and/or admission has additional benefits compared to late NAI, although the largest cohort study did not demonstrate this effect.The studies included here had limitations. Patient cohorts were heterogeneous, with some having had RT-PCR confirmed influenza and others just a clinical diagnosis. Few studies reported on concurrent treatment with antibiotics or steroids. Several studies stressed that patients receiving NAI were more likely to have co-morbidities and very severe influenza requiring mechanical ventilation at baseline, compared to patients who were not started on NAI.ConclusionsThe current evidence on the use of NAI in critically ill children with influenza is weak (Level 3), but trends toward improved survival. The trend of improved survival is particularly salient if NAI treatment is initiated within 48 hours of symptom onset. This may mean starting oseltamivir on clinical suspicion of influenza, without waiting for a laboratory confirmation of the diagnosis, to avoid delay.

ObjectivesTo describe the characteristics of high-cost high-need children and young people (CYP) (0–24 years) in England.MethodsRetrospective observational study using data from the Clinical Practice Research Database linked to Hospital Episode Statistics in 2014/2015 and 2015/2016. Healthcare utilisation of primary and secondary care services were calculated, and costs were estimated using Healthcare Resource Group for secondary care and Personal Social Services Research Unit for primary care. High-cost high-need CYP were defined as the top 5% of users by cost.Results3891 of 73 392 CYP made up the top 5% that were classified as high-cost high-need, and this group accounted for 54% of total annual costs. In this population, 7.3% were males <5 years and 11.0% were females 20–24 years. Inpatient care (acute) accounted for 63% of known spending in high-cost high-need patients. Total mean monthly cost per patient was 22.7 times greater in the high-cost high-need group compared with all other patients (£4417 vs £195). 29% of CYP in the high-cost high-need group in 2014/2015 were also classified as high-cost high-need in the following year.ConclusionsThese findings indicate the importance of further understanding and anticipating trends in CYP health spending to optimise care, reduce costs and inform new models of care. This includes integrated services, a further look into societal factors in reducing health inequalities and a particular focus of mental health services, the demand of which increases with age.

Several benefits of peer tutoring in medical school teaching have been described. However, there is a lack of research on the perceptions of peer tutoring, particularly from tutees who partake in a long-term clinical skills scheme integrated into the medical school curriculum. This study evaluates the opinions of preclinical tutees at the end of a 2-year peer-tutored clinical skills program and peer tutors themselves. A cross-sectional study was conducted in a UK-based medical school that primarily utilizes peer tutoring for clinical skills teaching. A questionnaire was designed to assess the views of preclinical tutees and peer tutors. Likert scales were used to grade responses and comment boxes to collect qualitative data. Sixty-five questionnaires were collected (52 tutees, 13 peer tutors). Seventy-nine percent of students felt satisfied with their teaching, and 70% felt adequately prepared for clinical placements. Furthermore, 79% believed that peer tutoring is the most effective method for clinical skills teaching. When compared to faculty teaching, tutees preferred being taught by peer tutors (63%), felt more confident (73%), and were more willing to engage (77%). All peer tutors felt that teaching made them more confident in their Objective Structured Clinical Examination performance, and 91% agreed that being a tutor made them consider pursuing teaching in the future. Thematic analysis of qualitative data identified 3 themes regarding peer tutoring: a more comfortable environment (69%), a more personalized teaching approach (34%), and variation in content taught (14%). Preclinical tutees prefer being taught clinical skills by peer tutors compared to faculty, with the peer tutors also benefitting. Studies such as this, looking at long-term schemes, further validate peer tutoring and may encourage more medical schools to adopt this method as an effective way of clinical skills teaching.