United Kingdom Population Research Articles

Fall-related mortality trends in Australia and the United Kingdom: Implications for research and practice

ObjectivesTo characterise changes in nationwide fall-related mortality rates in Australia and the United Kingdom (UK) between 2006 and 2016 by age group and sex. Study designTrend analysis of falls mortality data from World Health Organization (WHO) Mortality Database for the Australian and UK population. Main outcome measuresWe assessed age-specific, sex-specific and age-adjusted mortality rates. Mortality trends were assessed via the annual percentage change (APC) using joinpoint regression. ResultsThe annual average age-adjusted falls mortality rate was 38.63 per 1,000,000 population in Australia, and 34.12 per 1,000,000 population in the UK. From 2006 to 2016, age-adjusted mortality rate due to falls increased in Australia and the UK by an average annual rate of 3.77% (95% CI 2.91% to 4.64%; p<0.01) and 2.11% (95% CI 1.43% to 2.80%; p<0.01) respectively. Death rates from falls increased with age. People aged ≥95 years had the highest mortality rate from falls in Australia and the UK. Men had a higher annual average age-adjusted mortality rate from falls than women (1.6 times higher in Australia and 1.7 times higher in the UK). Women had a larger annual percentage increase in falls mortality rate compared to men over the study period. ConclusionsThere was a major increase in reported fall-related deaths in Australia and the UK between 2006 and 2016, especially in the very elderly. Men had a higher mortality rate from falls than women. Factors contributing to the apparent increases in fall-related mortality may include reduced cancer and cardiovascular mortality and better ascertainment of cause of death.

The green care code: How nature connectedness and simple activities help explain pro‐nature conservation behaviours

Abstract The biodiversity crisis demands greater engagement in pro‐nature conservation behaviours. Research has examined factors which account for general pro‐environmental behaviour; that is, behaviour geared to minimizing one's impact on the environment. Yet, a dearth of research exists examining factors that account for pro‐nature conservation behaviour specifically—behaviour that directly and actively supports conservation of biodiversity. This study is the first of its kind to use a validated scale of pro‐nature conservation behaviour. Using online data from a United Kingdom population survey of 1,298 adults (16+ years), we examined factors (composed of nine variable‐blocks of items) that accounted for pro‐nature conservation behaviour. These were: individual characteristics (demographics, nature connectedness), nature experiences (time spent in nature, engaging with nature through simple activities, indirect engagement with nature), knowledge and attitudes (knowledge/study of nature, valuing and concern for nature) and pro‐environmental behaviour. Together, these explained 70% of the variation in people's actions for nature. Importantly, in a linear regression examining the relative importance of these variables to the prediction of pro‐nature conservation behaviour, time in nature did not emerge as significant. Engaging in simple nature activities (which is related to nature connectedness) emerged as the largest significant contributor to pro‐nature conservation behaviour. Commonality analysis revealed that variables worked together, with nature connectedness and engagement in simple activities being involved in the largest portion of explained variance. Overall, findings from the current study reinforce the critical role that having a close relationship with nature through simple everyday engagement plays in pro‐nature conservation behaviour. Policy recommendations are made. A free Plain Language Summary can be found within the Supporting Information of this article.

Understanding the mental health burden of COVID-19 in the United Kingdom.

This article outlines the mental health burden of COVID-19 in the United Kingdom population, and presents preliminary evidence of less common psychiatric issues, such as paranoia and hallucinations, to which vulnerable groups in the U.K. population may be more vulnerable. It is argued that cognitive-behavioral therapy, with components of mindfulness, should be part of the therapeutic response. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Social networks and their influences on nutrient intake, nutritional status and physical function in community-dwelling ethnically diverse older adults: a mixed-methods longitudinal study

BackgroundThe United Kingdom population is ageing and becoming increasingly diverse; thus, it is vital to develop and implement interventions supporting this population shift. Social networks (SN) significantly impact health outcomes in later life, however relatively little is known about SN of community-dwelling ethnically diverse older adults. This study aimed to: 1) profile SN and changes in SN in this population over 8 months; 2) examine associations between SN, dietary intake, nutritional status, and physical function.MethodsSN were assessed using the Wenger Practitioner Assessment of Network Type. Energy and nutrient intakes were measured using multiple-pass 24-h recalls. The Mini Nutritional Assessment-Short Form (MNA-SF) assessed nutritional status. Physical function was measured using the Short Physical Performance Battery (SPPB) and handgrip strength. Data were collected at baseline and 8-months. Correlation and regression analyses examined relationships between SN, physical function, nutrient intake and nutritional status. Semi-structured interviews were conducted at baseline (n = 92) and follow-up (n = 81) to identify potential influences of SN. Interviews were transcribed verbatim and analysed using directed content analysis.ResultsQuantitative data were obtained from 100 participants at baseline and 81 at follow-up. Mean (SD) age was 70.8 (8.1) years (59% male), comprising African/Caribbean (60%), South Asian (34%), and other ethnicities (6%). Five SN typologies were identified under two broad areas: integrated-SN consisting of locally integrated (44%) and wider community (8%); and non-integrated-SN consisting of family dependent (25%), local self-contained (17%), and private restricted (6%). At follow-up, 37% remained in non-integrated networks, 19% transitioned to non-integrated networks, 11% transitioned to, and 33% remained in, integrated networks. Participants within integrated networks at baseline had higher SPPB scores at follow-up. Compared to the private restricted, local self-contained SN significantly predicted zinc, riboflavin and vitamin B6 intakes. Participants remaining in, or transitioning to, non-integrated networks had low MNA-SF scores. Qualitative findings indicate that participants with reductions in SN perceived it as causing poorer physical function and eating behaviours.ConclusionIn the present study, integrated SN were associated with higher physical function and nutritional status at 8-month’s follow-up. These results can inform the design of interventions to improve social networks, physical function and healthy nutrition within this population.

Lifetime Interpersonal Victimization Profiles and Mental Health Problems in a Nationally Representative Panel of Trauma-Exposed Adults From the United Kingdom.

Traumatic event exposure has been associated with negative psychological outcomes. There is, however, a dearth of research on revictimization. The current study examined patterns of lifetime interpersonal victimization based on six types of childhood maltreatment, physical and sexual assault, and assault with a weapon during adulthood via latent class analysis (LCA), with gender as covariate. Using a three-step approach, we assessed differences across the latent classes in symptoms and diagnosis of depression, anxiety, and DSM-5 posttraumatic stress disorder (PTSD). A trauma-exposed adult sample representative of the United Kingdom population (N = 1,051) was recruited online through a research panel. The mean participant age 47.18 years (SD = 15.00, range: 18-90 years; 68.4% female). The LCA identified five classes: lifetime polyvictimization (8.3%; 69.5% female), sexual revictimization (13.7%; 96.5% female), physical revictimization (12.5%; 1.5% male), childhood trauma (25.9%; 85.6% female), and limited victimization (39.7%; 40.3% female). Compared to the other classes, the polyvictimization class, followed by the childhood trauma class, demonstrated the highest scores on anxiety, depression, and posttraumatic stress symptoms. The polyvictimization class had nearly a nine- to 33-fold increase in risk of depression, OR = 9.48, 95% CI [3.34, 26.87]; anxiety, OR = 12.10, 95% CI [5.36, 27.36]; and PTSD diagnoses, OR = 33.63, 95% CI [16.35, 69.43], compared to the limited victimization class. The findings facilitate the identification of individuals at risk for revictimization and indicate that evidence-based clinical interventions should be targeted toward those with exposure to revictimization and childhood trauma exposure to alleviate mental health challenges.

Symptoms, attitudes and treatment perceptions of vulvo-vaginal atrophy in UK postmenopausal women: Results from the REVIVE-EU study.

To describe the attitudes and perceptions of postmenopausal women from the United Kingdom regarding menopause, vulvo-vaginal atrophy and its therapeutic management. Post hoc analysis of the United Kingdom population from the REVIVE-EU Study. The survey contained questions about women's knowledge of menopause and vulvo-vaginal atrophy symptoms, impact on their life and sexual activities, communication with healthcare professionals and treatments. The most frequent symptom of menopause was hot flushes (75%). Vulvo-vaginal atrophy symptoms had a significant impact on participants' ability to enjoy sexual intercourse (66%), spontaneity (62%) and ability to be intimate (61%); however, only 68% of women had been to their healthcare professional for advice. Half of the sample expected that doctors would initiate a discussion of menopausal symptoms and sexual health, but was in fact rare (5%). Only 27% were under current treatment without a clear therapy pattern, of which 43% used vaginal over-the-counter treatments, 28% prescription (Rx), and 13% both. Efficacy was the main limitation for over-the-counter treatments, while for Rx products were side effects and safety. Women highlighted the restoring of the natural condition of the vagina as the main goal for a treatment (35%). Many United Kingdom women did not feel the need to see any healthcare professional for their gynaecological symptoms. Overall satisfaction with treatment was only 44%. Vulvo-vaginal atrophy remains underdiagnosed and undertreated in United Kingdom. There is a lack of coherent discussion about vulvo-vaginal atrophy symptoms with clinicians. Many United Kingdom healthcare professionals could improve proactive communication with patients about vulvo-vaginal atrophy.

SAT-097 Early Adiposity Rebound in Youth with Congenital Adrenal Hyperplasia Predicts Childhood Obesity and Adiposity in Adolescence

Purpose: Youth with classical Congenital Adrenal Hyperplasia (CAH) due to 21-hydroxylase deficiency have an increased prevalence of obesity, abdominal adiposity, and fat mass compared to unaffected youth. As well, CAH youth in the United Kingdom (UK) have been found to have an earlier adiposity rebound (AR; rise in BMI corresponding to increased adipocyte size and number) at 1.7 years old, three years earlier than the general UK population. In unaffected youth, an earlier AR is predictive of obesity in adolescence. Our objective was to further understand the relationships between AR, weight status, and disease factors inherent to CAH in pediatric patients at our United States (US) center. Methods: In 45 youth with classical CAH, weight-for-length (kg/cm; if <2 yr) percentiles or BMI (kg/m2; if ≥2 yr) Z-scores were calculated every 6 months between the ages of 1 and 7 years, and at the patient’s last clinic visit. The cubic polynomial method was used to determine age at AR, located at the nadir before the second rise in the model. BMI-Z at the last clinic visit (12.6±3.8 yr) was used to classify final weight status as lean (Z<2) or obese (Z≥2). AR, and weight-for-length percentile at 1 yr, were analyzed for prediction of BMI-Z at 7 yr. Additionally, in a subset of 21 CAH youth enrolled in prior studies, total body fat and trunk fat (DXA), as well as abdominal subcutaneous adipose tissue (SAT) and visceral adipose tissue (VAT; single-slice CT or 3-T MRI at the level of the umbilicus) were cross-sectionally measured. Other CAH factors assessed in all youth included: glucocorticoid dose at AR, 17OHP at newborn diagnosis, and average bone age SD from clinical x-rays. Mann-Whitney U tests and Pearson correlations were used to assess group differences and associations. Simple linear regressions were used to predict childhood obesity and adolescent adiposity. Data are presented as mean±SD. Results: Age at AR for CAH youth was 3.1±1.4 yr, which is earlier than the normative US population (5.5 yr). Stratifying youth by weight status at their last clinic visit, age at AR was earlier in obese (2.5±1 yr, n=23) versus lean (3.7±1.6 yr, n=22; p<0.01) youth. AR strongly predicted BMI-Z at 7 yr (R= -0.65, β= -0.27, p<0.001) whereas weight-for-length percentile did not (R=0.22, p=0.14). AR was negatively correlated with total body fat (R= -0.58, p<0.01), trunk fat (R= -0.60, p<0.01), and abdominal SAT (R= -0.60, p<0.01), but not with VAT (R= -0.24, p=0.3). There were no associations between AR and glucocorticoid dose or newborn 17OHP. However, AR was negatively correlated with bone age SD (R= -0.37, p=0.05). Conclusion: Youth with CAH at our center exhibited an earlier AR by two years compared to the normative US population. This earlier AR was predictive of obesity in childhood, as well as increased total body fat and central adiposity in adolescence. Further study of disease-specific factors such as genotype in CAH are merited.

Ultra-processed food consumption and indicators of obesity in the United Kingdom population (2008-2016).

We examined the association between the consumption of ultra-processed foods and adiposity in a nationally representative sample of the UK adult population. We studied 6,143 participants (19 to 96 years, 51.6% female) sampled by the UK National Diet and Nutrition Survey (2008–16). Food items reported in four-day food diary were classified according to the NOVA system. Multiple linear and logistic regressions were used to evaluate associations between the dietary contribution of ultra-processed foods (sex-specific quartile and continuous) and Body Mass Index (BMI), Waist Circumference (WC) and obesity (BMI>30kg/m2) and abdominal obesity (men: WC≥102cm, women: WC≥88cm) status. Models were adjusted for sociodemographic and lifestyle characteristics. In multivariable analyses, the highest consumption of ultra-processed food was associated with 1.66 kg/m2 higher BMI (95%CI 0.96–2.36), 3.56 cm greater WC (95%CI 1.79–5.33) and 90% higher odds for being obese (OR = 1.90, 95%CI 1.39–2.61), compared with the lowest consumption. A 10% increase in the consumption of ultra-processed foods was associated with an increase of 0.38 kg/m2 in BMI (95%CI 0.20–0.55), 0.87 cm in WC (95%CI 0.40–1.33) and 18% higher odds of being obese (OR = 1.18, 95%CI 1.08–1.28). The consumption of ultra-processed food was associated with an increase in BMI, WC and prevalence of obesity in both sexes. A dose response relationship was observed in both sexes, with a 10% increase in the consumption of ultra-processed foods being associated with a 18% increase in the prevalence of obesity in men and a 17% increase in women. Higher consumption of ultra-processed food is associated with greater adiposity in the UK adult population. Policy makers should consider actions that promote consumption of unprocessed or minimally processed foods and reduce consumption of ultra-processed foods.

PCN76 COST-EFFECTIVENESS OF VENETOCLAX AND RITUXIMAB COMBINATION THERAPY VERSUS IBRUTINIB IN RELAPSED/REFRACTORY CHRONIC LYMPHOCYTIC LEUKEMIA (R/R CLL) IN COLOMBIA

In 2016 the incidence of CLL was 3,9 new cases and the mortality was 0,9 deaths per 100.000 American. Future projections indicate an increase in those. In Colombia data about CLL is scarce. To estimate the cost-effectiveness of Venetoclax+Rituximab (VEN+R) versus ibrutinib in the treatment of Relapsed/Refractory (R/R) Chronic Lymphocytic Leukaemia (CLL), from the Colombian Healthcare System perspective. We adapt the original cost-effectiveness model of VEN+R for United Kingdom population. Three-state partitioned survival model includes health states for progression free, progressed and dead in the time horizon of 30 years. Costs and health benefits are discounted by 5% per annum. Venetoclax is first delivered according to a dose ramping schedule and Rituximab is delivered after completion of the dose ramp up period. The key measure of health benefit is the Quality-Adjusted Life Year (QALY) and life year (LY). The cost included the treatment, management and monitoring of CLL at Colombian prices of 2018. The willingness to pay of 3 times gross domestic product (GDP) per capita. Costs and QALYs are presented for each comparator, incremental costs, incremental QALYs and ICERs are also presented. Deterministic and probabilistic sensitivity analysis were performed. The cost, LYGs, and QALYs of VEN+R were COP 496.339.802, 6,34 and 4,45, respectively. VEN+R was less costly (savings: 299.025.132) and more efficacious than ibrutinib in terms of LYGs and QALYs, showing incremental effectiveness of 2,25 and 1,42 respectively. These results show that VEN+R is a dominant treatment strategy over ibrutinib in relapsed/refractory Chronic Lymphocytic Leukemia in Colombia. Base case results are maintained among the simulated scenarios for the sensitivity analysis. The results of this study suggest that in Colombian context, 24-month fixed duration treatment with VEN+R would be a cost effectiveness alternative in R/R CLL patients due to its dominance (more efficacious and less expensive) over ibrutinib.

A 10-Year Review of the Complications Caused by Ingested and Aspirated Dentures.

Dentures are worn by 20% of the United Kingdom population for both physical and psychological symptoms associated with tooth loss. However, significant morbidity and mortality can result if dentures are swallowed or aspirated. This 10-year review investigated the development of complications following denture aspiration or ingestion, and identified key learning points. The Medline database was searched for cases of denture ingestion or aspiration from October 1, 2009, to October 31, 2019. Search terms included "dental prosthesis, denture, dental plate, bridge and false teeth" and "swallow, ingest, eat, aspirate and inhale." Potential factors influencing the development of complications were assessed (hollow viscus perforation, fistula formation, abscess, bowel obstruction, necrosis, hemorrhage, and airway obstruction). Statistical analysis was performed using χ2 and Pearson correlation tests in R Studio. No ethical approval was required. Eighty-five patients were identified from 77 case reports. Fourteen articles were excluded due to insufficient information. Complications were documented in 37.6% (n = 32) of patients with 2 cases resulting in death. Duration of symptoms over 1 day (P = .005) and delayed removal beyond 4 days post-ingestion (P = .017) was significantly associated with increased rates of complications. There was no significant association between complication rate and patient age, denture type, level of impaction, or radiolucency. Denture aspiration or ingestion can have serious consequences. Factors impacting complication rate revolve around early recognition and treatment. Clinician awareness of the potential risks of dentures is paramount to early diagnosis. We recommend early intervention to reduce the morbidity associated with this unassuming device.

Temporal Relationship Between Depressive Symptoms and Cognition in Mid and Late Life: A Longitudinal Cohort Study

ObjectivesTo examine the bidirectional temporal relationship between depressive symptoms and cognition in relation to risk, reaction, and prodrome. DesignCross-lag analysis of longitudinal data collected online at baseline and 12-month follow-up. Setting and ParticipantsA United Kingdom population cohort of 11,855 participants aged 50 years and over. MeasuresPatient Health Questionnaire-9 (depressive symptoms), cognitive measures: Paired Associate Learning, Verbal Reasoning, Spatial Working Memory, and Digit Span. ResultsDepressive symptoms predicted a decline in paired associates learning [β = −.020, P = .013, (95% confidence interval [CI], ‒.036, −.004)] and verbal reasoning [β = −.014, P = .016, (95% CI ‒.025, −.003)] but not vice versa. Depressive symptoms predicted [β = −.043, P < .001, (95% CI ‒.060, −.026); β = −.029, P < .001, (95% CI ‒.043, −.015)] and were predicted by [β = −.030, P = < .001, (95% CI ‒.047, −.014); β = −.025, P = .003, (95% CI ‒.041, −.009)], a decline in spatial working memory and verbal digit span, respectively. Conclusions and ImplicationsDepressive symptoms may be either a risk factor or prodrome for cognitive decline. In addition, a decline in attention predicts depressive symptoms. Clinical implications and implications for further research are discussed.

CARDIOVASCULAR EVENTS ARE VERY FREQUENT IN LUNG CANCER AND MULTIPLE MYELOMA WHEN COMPARED TO BREAST CANCER SURVIVORS

While cancer survivors have been shown to be at a significantly increased risk for cardiovascular (CV) events, prior data have often been limited to breast cancer and childhood cancer survivors with the exception of a single recent study from a United Kingdom population. We sought to determine the

Oral antibiotic use and chronic disease: long-term health impact beyond antimicrobial resistance and Clostridioides difficile

ABSTRACT We recently reported an increased colon cancer risk associated with oral antibiotic use in a large United Kingdom population. This association between antibiotic exposure and cancer risk adds to a growing body of evidence that antibiotic use has unintended off-target long-term health consequences. This addendum highlights major studies linking antibiotic use and chronic disease in pediatric and adult populations. Microbiota dysbiosis is the key proposed mechanism underlying antibiotic:disease associations, resulting in alterations in gene expression, epigenetic modification, colonization by pathogenic bacteria, instigation of biofilms, and immune regulation and inflammation. These adverse outcomes of antibiotic exposure underscore the need for diagnostic and antibiotic stewardship, as well as the urgency for further development of non-antibiotic therapies for bacterial infections.

Deepfakes and Disinformation: Exploring the Impact of Synthetic Political Video on Deception, Uncertainty, and Trust in News

Artificial Intelligence (AI) now enables the mass creation of what have become known as “deepfakes”: synthetic videos that closely resemble real videos. Integrating theories about the power of visual communication and the role played by uncertainty in undermining trust in public discourse, we explain the likely contribution of deepfakes to online disinformation. Administering novel experimental treatments to a large representative sample of the United Kingdom population allowed us to compare people’s evaluations of deepfakes. We find that people are more likely to feel uncertain than to be misled by deepfakes, but this resulting uncertainty, in turn, reduces trust in news on social media. We conclude that deepfakes may contribute toward generalized indeterminacy and cynicism, further intensifying recent challenges to online civic culture in democratic societies.

“How can you be allergic to peas?” – A qualitative study to explore food handler’s knowledge, attitudes and understanding of food allergens

Abstract It is clear that there is an increasing proportion of the United Kingdom (UK) population who are suffering with food allergies and this combined with an increase in the frequency of eating away from home (where there is less control over the content of food) poses a significant risk. In December 2014, the European Union (EU) introduced legislation which aimed to ensure that customers with food allergens could make informed choices and safely consume food, without the risk of a potentially life-threatening reaction. The research used semi-structured interviews with staff from a BCB, located in the North West of the UK, as the aim of the research was to explore food handlers’ knowledge, attitudes and understanding of food allergens. The findings of the semi-structured interviews identified five themes: E-learning training programmes: the staff felt that these were ineffective and did not take into account individual learning styles. Responsibility: there is a lack of clarity as to who is responsible, with staff believing the key responsibility lies with the customer. Communication: similarly, communication, both within the kitchen and within the company was not clear and likely to give rise to confusion. Need to make a profit: the staff felt that the drive for profit meant that customer safety was being compromised, especially when staff numbers were reduced. Staff awareness: the staff felt confident in their own ability to prepare a safe meal but indicated that staff may be dismissive towards claims of allergen sufferers. In conclusion, these themes illustrate that a significant risk exists for allergen suffers, who rely upon the knowledge, attitudes and understanding of BCB staff to ensure their meals are safely prepared.

Examining the Discriminant Validity of Complex Posttraumatic Stress Disorder and Borderline Personality Disorder Symptoms: Results From a United Kingdom Population Sample.

Complex posttraumatic stress disorder (CPTSD) was added to the diagnostic nomenclature in the 11th revision of the International Classification of Diseases (ICD-11). Although considerable evidence exists supporting the construct validity of CPTSD, the distinguishability of CPTSD symptoms from those of borderline personality disorder (BPD) has been questioned. The present study examined the discriminant validity of CPTSD and BPD symptoms among a trauma-exposed population sample from the United Kingdom (N = 546). Participants completed self-report measures of CPTSD and BPD symptoms, and their latent structure was assessed using exploratory structural equation modeling (ESEM). A three-factor model with latent variables reflecting PTSD, disturbances in self-organization (DSO), and BPD symptoms provided the best fit of the data, χ2 (399, N = 546) = 1,650, p < .001; CFI = .944; TLI = .930; RMSEA = .077, 90% CI [.073, .081]. We identified multiple symptoms distinctive to individual constructs (e.g., disturbed relationships and suicidality) as well as symptoms shared across the constructs (e.g., affective dysregulation). The PTSD, β = .24; DSO, β = .23; and BPD, β = .27, latent variables were positively and significantly associated with childhood interpersonal trauma. The current findings support the discriminant validity of CPTSD and BPD symptoms and highlight various phenomenological signatures of each construct as well as demonstrate how these constructs share important similarities in symptom composition and exogenous correlates.

A Cost-effectiveness Analysis of Multigene Testing for All Patients With Breast Cancer

Moving to multigene testing for all women with breast cancer (BC) could identify many more mutation carriers who can benefit from precision prevention. However, the cost-effectiveness of this approach remains unaddressed. To estimate incremental lifetime effects, costs, and cost-effectiveness of multigene testing of all patients with BC compared with the current practice of genetic testing (BRCA) based on family history (FH) or clinical criteria. This cost-effectiveness microsimulation modeling study compared lifetime costs and effects of high-risk BRCA1/BRCA2/PALB2 (multigene) testing of all unselected patients with BC (strategy A) with BRCA1/BRCA2 testing based on FH or clinical criteria (strategy B) in United Kingdom (UK) and US populations. Data were obtained from 11 836 patients in population-based BC cohorts (regardless of FH) recruited to 4 large research studies. Data were collected and analyzed from January 1, 2018, through June 8, 2019. The time horizon is lifetime. Payer and societal perspectives are presented. Probabilistic and 1-way sensitivity analyses evaluate model uncertainty. In strategy A, all women with BC underwent BRCA1/BRCA2/PALB2 testing. In strategy B, only women with BC fulfilling FH or clinical criteria underwent BRCA testing. Affected BRCA/PALB2 carriers could undertake contralateral preventive mastectomy; BRCA carriers could choose risk-reducing salpingo-oophorectomy (RRSO). Relatives of mutation carriers underwent cascade testing. Unaffected relative carriers could undergo magnetic resonance imaging or mammography screening, chemoprevention, or risk-reducing mastectomy for BC risk and RRSO for ovarian cancer (OC) risk. Incremental cost-effectiveness ratio (ICER) was calculated as incremental cost per quality-adjusted life-year (QALY) gained and compared with standard £30 000/QALY and $100 000/QALY UK and US thresholds, respectively. Incidence of OC, BC, excess deaths due to heart disease, and the overall population effects were estimated. BRCA1/BRCA2/PALB2 multigene testing for all patients detected with BC annually would cost £10 464/QALY (payer perspective) or £7216/QALY (societal perspective) in the United Kingdom or $65 661/QALY (payer perspective) or $61 618/QALY (societal perspective) in the United States compared with current BRCA testing based on clinical criteria or FH. This is well below UK and US cost-effectiveness thresholds. In probabilistic sensitivity analysis, unselected multigene testing remained cost-effective for 98% to 99% of UK and 64% to 68% of US health system simulations. One year's unselected multigene testing could prevent 2101 cases of BC and OC and 633 deaths in the United Kingdom and 9733 cases of BC and OC and 2406 deaths in the United States. Correspondingly, 8 excess deaths due to heart disease occurred in the United Kingdom and 35 in the United States annually. This study found unselected, high-risk multigene testing for all patients with BC to be extremely cost-effective compared with testing based on FH or clinical criteria for UK and US health systems. These findings support changing current policy to expand genetic testing to all women with BC.

Mode and Frame Matter: Assessing the Impact of Survey Mode and Sample Frame in Choice Experiments.

Background. Choice experiments (CE) are applied in health economics to elicit public preferences and willingness to pay (WTP). CEs are frequently administered as Internet-based surveys. Internet surveys have recognized advantages, but concerns exist about the representativeness of Internet samples, data quality, and the impact on elicited values. Aim. We conducted the first study in health comparing an Internet-based CE survey with the more traditional general population mail survey. We also compared the Internet-based and mail CE surveys with computer-assisted personal interviews (CAPIs), which are commonly used to elicit health state valuations. Methods. Two separate samples were drawn from 2 United Kingdom (UK) volunteer Internet panels (IPs), CAPIs were undertaken with respondents sampled from UK Census Output Areas, and mail surveys were sent to UK households drawn from the postcode address file (PAF). Each mode received more than 1000 respondents. We compared modes and frames using objective measures (response rate, sample representativeness of the UK population, elicited values, theoretical validity, and cost per response) and subjective/self-reported measures (time taken to complete the study, perceived study consequentiality, and stated attribute nonattendance). This study intentionally confounded the survey modes and sample frame by choosing sample frames that are typically used by researchers for each mode. Results. Estimated WTP differs across mode-frame pairs. On most measures, CAPIs dominated. They are more expensive, however. On all measures, except response rates, Internet surveys dominated the mail survey. They were also cheaper. Conclusion. Researchers using IPs should pay attention to response rates and be aware that the quality of IPs differs. Given the importance of perceived consequentiality and attribute attendance in CEs, future research should address their impact across modes and frames.

Population frequencies of pathogenic alleles of BRCA1 and BRCA2: analysis of 173 Danish breast cancer pedigrees using the BOADICEA model.

The Breast and Ovarian Analysis of Disease Incidence and Carrier Estimation Algorithm (BOADICEA) calculates the probability that a woman carries a pathogenic variant in BRCA1 or BRCA2 based on her pedigree and the population frequencies of pathogenic alleles of BRCA1 (0.0006394) and BRCA2 (0.00102) in the United Kingdom (UK). BOADICEA allows the clinician to define the population frequencies of pathogenic alleles of BRCA1 and BRCA2 for other populations but only includes preset values for the Ashkenazy Jewish and Icelandic populations. Among 173 early-onset breast cancer pedigrees in Denmark, BOADICEA discriminated well between carriers and non-carriers of pathogenic variants (area under the receiver operating characteristics curve: 0.81; 95% CI 0.74-0.86) but underestimated the frequency of carriers of pathogenic variants in BRCA1 or BRCA2 as measured by the observed-to-expected ratio (O/E 1.83; 95% CI 1.18-2.84). This reflects findings from older studies of BOADICEA in UK, German, Italian, and Chinese populations, all accounting for the different calibration for different carrier probabilities. To improve the performance of BOADICEA for non-UK populations, we developed a method to derive population frequencies of pathogenic alleles of BRCA1 and BRCA2. Compared to the UK population frequencies, we estimated the Danish population frequencies of pathogenic alleles to be higher for BRCA1 (0.0015; 95% CI 0.00064-0.0034) and lower for BRCA2 (0.00052; 95% CI 0.00018-0.0017) after adjusting for the different calibration of BOADICEA for different carrier probabilities. Incorporating additional population frequencies into BOADICEA could improve its performance for non-UK populations.

Gambling Problems and Military- and Health-Related Behaviour in UK Armed Forces Veterans

Internationally, problem gambling is elevated in Armed Forces veterans compared to the general population. Here, we re-examined the prevalence of problem gambling in veterans and non-veterans residing in England using an established large dataset and investigated whether gambling was associated with length of service, common mental health disorders, substance abuse, or financial management history. Using the 2007 Adult Psychiatric Morbidity Survey, 257 post-national service veterans and 514 age- and sex-matched controls were compared. Veterans had significantly higher rates of problem gambling than non-veterans. Male veterans were more likely than non-veterans to have experienced a traumatic event. The relationship between veteran status and problem gambling was not explained by differences in mental health conditions, substance abuse, or financial management. No differences were found for length of service. Further research is required with larger samples targeting problem gambling and Armed Forces experience in the United Kingdom population using contemporary diagnostic criteria.