Public Health Wales (PHW; Welsh: Iechyd Cyhoeddus Cymru) is an NHS Trust which was established on 1 October 2009 as part of a major restructuring of the health service in Wales. It aims to protect and improve health and wellbeing and reduce health inequalities in Wales.
BACKGROUND:Catheter-associated urinary tract infections (CAUTI) are among the most prevalent healthcare-associated infections and an important site for development and spread of antimicrobial resistance. Although CAUTI are frequently polymicrobial, the majority of research focuses on individual pathogens in monoculture, largely due to a lack of representative and tractable models. AIMS:The aim of this study was to develop a tractable and reproducible model of polymicrobial CAUTI. METHODS:Here we describe the use of an in vitro model of the catheterized urinary tract to generate polymicrobial communities encompassing common uropathogens (Klebsiella pneumoniae, Pseudomonas aeruginosa, Escherichia coli, Enterococcus faecalis, Staphylococcus aureus, and Proteus mirabilis), in an environment representative of the catheterized urinary tract. RESULTS AND CONCLUSIONS:We show that our system establishes stable and reproducible polymicrobial communities and facilitates analysis across both planktonic and biofilm lifestyles. We confirm that polymicrobial biofilms in this system display distinct population dynamics compared to planktonic populations and modulate the impact of ciprofloxacin treatment by protecting the most susceptible community members. In addition, we demonstrate the capacity of P. mirabilis to encrust and block catheters when part of a polymicrobial community and confirm that thioridazine treatment remains effective at inhibiting catheter blockage under these conditions.
AIM:Many women take medications during pregnancy. However, the risk to the fetus from most medications is uncertain. Congenital anomalies are one of the leading causes of infant death and contribute to long-term disability. Signal detection methods can be used to systematically identify possible medication-anomaly associations that require further investigation. METHODS:Data on first trimester medication exposures in pregnancies with a congenital anomaly reported to 14 EUROmediCAT registries with a birth year of 2005-2018 were analysed. Case-malformed disproportionality analysis identified medication-anomaly signals using a disproportionality signal detection method. Identified signals were then compared to previous EUROmediCAT signal detection studies and ranked based on a proxy for the severity of impact at a population level using the number of estimated excess congenital anomaly cases within the exposed population and the average additional time in hospital over the first year of life. Generalized linear mixed models were used to assess confounding by birth year and registry within the top 20 ranked signals. RESULTS:1611 medication-outcome pairs with at least three observations were analysed, and 153 signals for 63 different medications were identified. Of the top 20 ranked signals, 10 (involving nine medications) were prioritized for further independent investigation. CONCLUSION:The signals identified here are hypothesis forming only. Independent studies that adequately account for confounding are subsequently needed to evaluate if the identified signals are causal. Further investigation of signals with low population impact, but high potential individual risk is also recommended.
Background Problems relating to the commissioning and delivery of National Health Service (NHS) General Dental Services (GDS) have been well-documented. Objectives This study aimed to gain consensus on issues deemed of importance to the future delivery of dental care in NHS GDS. Methodology Consensus was gained using a modified-Delphi technique. This method asks respondents the degree to which they agree or disagree with the statements on a nine-point Likert scale. Consensus is achieved when more than 70% of respondents either agreed or conversely disagreed with the statement. Results General dental practitioners (n = 70) agreed on 24 of 33 statements. There was consensus on statements relating to a more preventively orientated service and it was possible to identify agreement on what might constitute a core dental service such as the concept of a ‘shortened dental arch' and the exclusion of molar endodontics from NHS GDS. However, the idea that NHS dental care should be provided only to children and a defined subset of the population, with for example, those earning over a predefined threshold, ineligible for NHS dental care failed to achieve consensus. There were no significant differences between dentists' views relating either to age or NHS contractor status (performer/provider) when it came to agreement/disagreement on the issues scrutinised. Conclusions This work provides pointers as to the current views of dentists in Wales and could inform future development of NHS GDS.
Substance misuse (SM) within a household is associated with child deprivation and inferior health. This study was the first to utilise linked healthcare, criminal justice, and children’s social care records in Wales, to produce a reusable electronic cohort (e-cohort) of households that experience substance misuse (SMHH) and compare with the rest of the population. Using the SAIL Databank, a population-scale retrospective electronic cohort of co-resident children and adults during 2011–2019 was created. Households were identified using the Residential Anonymised Linkage Field (RALF), which links individuals to their encrypted Unique Property Reference Number. Individuals registered at the same address at the same time for a minimum of 90 days were grouped into a household, to allow for delays in address changes with their General Practice (GP) and retrospective re-coding due to a change of GP. SM-related healthcare and criminal justice events were then flagged. A large reusable nationwide e-cohort of over 1.8 million people (776,366 children and 1,032,088 adults) was created, where 83,558 children (11%) lived in SMHH, and 48,398 adults who lived with a child (5%) had a SM event. This study gives a comprehensive population-level overview of children living in SMHH and compares with the rest of the population. A novelty of the study is the links between children and all adults registered in a household, to better describe their home environment. Reproducible methods and scripts can be used by researchers to recreate the e-cohort of households to expedite further research.
