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Saraswat L, Ayansina D, Cooper KG, Bhattacharya S. Risk of melanoma in women with endometriosis: A Scottish national cohort study. Eur J Obstet Gynecol Reprod Biol 2021; 257:144-148. [PMID: 33388182 DOI: 10.1016/j.ejogrb.2020.12.033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 12/11/2020] [Accepted: 12/18/2020] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To explore the risk of melanoma in women with endometriosis. STUDY DESIGN A retrospective cohort study using Scottish national population-based data was conducted. The study comprised 281,937 women with nearly 5 million person years (4,923,628) of follow up from 1981 to 2010. 17,834 women with a new surgical diagnosis of endometriosis were compared with 83,303 women with no evidence of endometriosis at laparoscopy, 162,966 women who underwent laparoscopic sterilisation and 17,834 age-matched women from the general population to determine the risk of melanoma. Cox proportional hazards regression was used to calculate crude and adjusted Hazards ratios with 95 % Confidence Intervals. RESULTS Women with endometriosis had a significantly higher risk of melanoma when compared to women with no evidence of endometriosis at laparoscopy (HR 1.59, 95 % CI 1.19-2.13), women who had undergone laparoscopic sterilisation (HR 1.82, 95 % CI 1.39-2.40) and age-matched women from the general population (HR 1.63, 95 % CI 1.08-2.45). CONCLUSION A diagnosis of endometriosis was associated with an increased risk of developing melanoma compared to those without endometriosis. These findings highlight the need for further research to explore shared pathways in the pathogenesis of the two conditions. It is important to acknowledge that the absolute increase in the risk of melanoma in women with endometriosis remains low, which should be considered when counselling women.
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Affiliation(s)
- L Saraswat
- Department of Obstetrics and Gynaecology, Aberdeen Royal Infirmary, Foresterhill, Aberdeen, AB25 2ZN, United Kingdom.
| | - D Ayansina
- Medical Statistics Team, University of Aberdeen, United Kingdom
| | - K G Cooper
- Department of Obstetrics and Gynaecology, Aberdeen Royal Infirmary, United Kingdom
| | - S Bhattacharya
- Obstetrics and Gynaecology, Head of Medical School, University of Aberdeen, United Kingdom
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Engelhardt T, Ayansina D, Bell GT, Oshan V, Rutherford JS, Morton NS. Incidence of severe critical events in paediatric anaesthesia in the United Kingdom: secondary analysis of the anaesthesia practice in children observational trial (APRICOT study). Anaesthesia 2018; 74:300-311. [PMID: 30536369 DOI: 10.1111/anae.14520] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/30/2018] [Indexed: 12/20/2022]
Abstract
The anaesthesia practice in children observational trial of 31,127 patients in 261 European hospitals revealed a high (5.2%) incidence of severe critical events in the peri-operative period and wide variability in practice. A sub-analysis of the UK data was undertaken to investigate differences compared with the non-UK cohort in the incidence and nature of peri-operative severe critical events and to attempt to identify areas for quality improvement. In the UK cohort of 7040 paediatric patients from 43 hospitals, the overall incidence of peri-operative severe critical events was lower than in the non-UK cohort (3.3%, 95%CI: 2.9-3.8 vs. 5.8%, 95%CI: 5.5-6.1, RR 0.57, p < 0.001). There was a lower rate of bronchospasm (RR 0.22, 95%CI: 0.14-0.33; p < 0.001), stridor (RR 0.42, 95%CI: 0.28-0.65; p < 0.001) and cardiovascular instability (RR 0.69, 95%CI: 0.55-0.86; p = 0.001) than in the non-UK cohort. The proportion of sicker patients where less experienced teams were managing care was lower in the UK than in the non-UK cohort (10.4% vs. 20.4% of the ASA physical status 3 and 9% vs. 12.9% of the ASA physical status 4 patients). Differences in work-load between centres did not affect the incidence and outcomes of severe critical events when stratified for age and ASA physical status. The lower incidence of cardiovascular and respiratory complications could be partly attributed to more experienced dedicated paediatric anaesthesia providers managing the higher risk patients in the UK. Areas for quality improvement include: standardisation of serious critical event definitions; increased reporting; development of evidence-based protocols for management of serious critical events; development and rational use of paediatric peri-operative risk assessment scores; implementation of current best practice in provision of competent paediatric anaesthesia services in Europe; development of specific training in the management of severe peri-operative critical events; and implementation of systems for ensuring maintenance of skills.
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Affiliation(s)
- T Engelhardt
- Department of Anaesthesia, Royal Aberdeen Children's Hospital, Aberdeen, UK.,Institute of Education for Medical and Dental Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | - D Ayansina
- Medical Statistics Team, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - G T Bell
- Department of Anaesthesia, Royal Hospital for Children, Glasgow, Scotland, UK
| | - V Oshan
- Department of Anaesthesia, Royal Manchester Children's Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - J S Rutherford
- Designated Paediatric Anaesthetist, Dumfries and Galloway Royal Infirmary, Dumfries, Scotland, UK
| | - N S Morton
- Department of Paediatric Anaesthesia and Pain Management, University of Glasgow, Glasgow, Scotland, UK
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Saraswat L, Ayansina D, Cooper KG, Bhattacharya S, Horne AW, Bhattacharya S. Impact of endometriosis on risk of further gynaecological surgery and cancer: a national cohort study. BJOG 2017; 125:64-72. [DOI: 10.1111/1471-0528.14793] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2017] [Indexed: 11/28/2022]
Affiliation(s)
- L Saraswat
- Department of Obstetrics and Gynaecology; Aberdeen Royal Infirmary; Aberdeen UK
| | - D Ayansina
- Medical Statistics Team; University of Aberdeen; Aberdeen UK
| | - KG Cooper
- Department of Obstetrics and Gynaecology; Aberdeen Royal Infirmary; Aberdeen UK
| | - S Bhattacharya
- Dugald Baird Centre; University of Aberdeen; Aberdeen UK
| | - AW Horne
- MRC Centre for Reproductive Health; University of Edinburgh; Edinburgh UK
| | - S Bhattacharya
- Division of Applied Health Sciences; University of Aberdeen; Aberdeen UK
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MacKenzie RK, Dowell J, Ayansina D, Cleland JA. Do personality traits assessed on medical school admission predict exit performance? A UK-wide longitudinal cohort study. Adv Health Sci Educ Theory Pract 2017; 22:365-385. [PMID: 27704290 DOI: 10.1007/s10459-016-9715-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Accepted: 09/26/2016] [Indexed: 06/06/2023]
Abstract
Traditional methods of assessing personality traits in medical school selection have been heavily criticised. To address this at the point of selection, "non-cognitive" tests were included in the UK Clinical Aptitude Test, the most widely-used aptitude test in UK medical education (UKCAT: http://www.ukcat.ac.uk/ ). We examined the predictive validity of these non-cognitive traits with performance during and on exit from medical school. We sampled all students graduating in 2013 from the 30 UKCAT consortium medical schools. Analysis included: candidate demographics, UKCAT non-cognitive scores, medical school performance data-the Educational Performance Measure (EPM) and national exit situational judgement test (SJT) outcomes. We examined the relationships between these variables and SJT and EPM scores. Multilevel modelling was used to assess the relationships adjusting for confounders. The 3343 students who had taken the UKCAT non-cognitive tests and had both EPM and SJT data were entered into the analysis. There were four types of non-cognitive test: (1) libertariancommunitarian, (2) NACE-narcissism, aloofness, confidence and empathy, (3) MEARS-self-esteem, optimism, control, self-discipline, emotional-nondefensiveness (END) and faking, (4) an abridged version of 1 and 2 combined. Multilevel regression showed that, after correcting for demographic factors, END predicted SJT and EPM decile. Aloofness and empathy in NACE were predictive of SJT score. This is the first large-scale study examining the relationship between performance on non-cognitive selection tests and medical school exit assessments. The predictive validity of these tests was limited, and the relationships revealed do not fit neatly with theoretical expectations. This study does not support their use in selection.
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Affiliation(s)
- R K MacKenzie
- Senior Clinical Lecturer in Medical Education, Institute of Education for Medical and Dental Sciences, University of Aberdeen, Room 2:036, Polwarth Building, Foresterhill, Aberdeen, AB25 2ZD, UK.
| | - J Dowell
- Dundee Medical School, University of Dundee, Dundee, UK
| | - D Ayansina
- Medical Statistics Team, College of Life Sciences and Medicine, University of Aberdeen, Aberdeen, UK
| | - J A Cleland
- Senior Clinical Lecturer in Medical Education, Institute of Education for Medical and Dental Sciences, University of Aberdeen, Room 2:036, Polwarth Building, Foresterhill, Aberdeen, AB25 2ZD, UK
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Abstract
OBJECTIVES Most UK medical programmes use aptitude tests during student selection, but large-scale studies of predictive validity are rare. This study assesses the UK Clinical Aptitude Test (UKCAT: http://www.ukcat.ac.uk), and 4 of its subscales, along with individual and contextual socioeconomic background factors, as predictors of performance during, and on exit from, medical school. METHODS This was an observational study of 6294 medical students from 30 UK medical programmes who took the UKCAT from 2006 to 2008, for whom selection data from the UK Foundation Programme (UKFPO), the next stage of UK medical education training, were available in 2013. We included candidate demographics, UKCAT (cognitive domains; total scores), UKFPO Educational Performance Measure (EPM) and national exit situational judgement test (SJT). Multilevel modelling was used to assess relationships between variables, adjusting for confounders. RESULTS The UKCAT-as a total score and in terms of the subtest scores-has significant predictive validity for performance on the UKFPO EPM and SJT. UKFPO performance was also affected positively by female gender, maturity, white ethnicity and coming from a higher social class area at the time of application to medical school An inverse pattern was seen for a contextual measure of school, with those attending fee-paying schools performing significantly more weakly on the EPM decile, the EPM total and the total UKFPO score, but not the SJT, than those attending other types of school. CONCLUSIONS This large-scale study, the first to link 2 national databases-UKCAT and UKFPO, has shown that UKCAT is a predictor of medical school outcome. The data provide modest supportive evidence for the UKCAT's role in student selection. The conflicting relationships of socioeconomic contextual measures (area and school) with outcome adds to wider debates about the limitations of these measures, and indicates the need for further research.
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Affiliation(s)
- R K MacKenzie
- Institute of Education for Medical and Dental Sciences, School of Medicine and Dentistry, University of Aberdeen, Aberdeen, UK
| | - J A Cleland
- Institute of Education for Medical and Dental Sciences, School of Medicine and Dentistry, University of Aberdeen, Aberdeen, UK
| | - D Ayansina
- Department of Medical Statistics, College of Life Sciences and Medicine, University of Aberdeen, Aberdeen, UK
| | - S Nicholson
- Centre for Medical Education, Institute of Health Sciences Education, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
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Ayansina D, Black C, Hall SJ, Marks A, Millar C, Prescott GJ, Wilde K, Bhattacharya S. Long term effects of gestational hypertension and pre-eclampsia on kidney function: Record linkage study. Pregnancy Hypertens 2016; 6:344-349. [PMID: 27939480 PMCID: PMC5161246 DOI: 10.1016/j.preghy.2016.08.231] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Accepted: 08/05/2016] [Indexed: 11/29/2022]
Abstract
We examine risk of chronic kidney disease (CKD) after pregnancy hypertension. We found increased risk of chronic kidney disease after gestational hypertension. Risk of chronic kidney disease was further increased after preeclampsia. Women with pregnancy hypertension develop CKD earlier than normotensive women.
Objective To assess the long term effects of hypertensive disorders of pregnancy on renal function. Design Cohort study where exposure was gestational hypertension or preeclampsia in the first pregnancy. Normotensive women formed the comparison group. Setting Aberdeen, Scotland. Participants All women with date of birth on or before 30th June 1969 and at least their first singleton delivery recorded in the Aberdeen Maternity and Neonatal Databank. Methods Participants were linked to the Renal Biochemistry Register, Scottish Morbidity Records, Scottish Renal Registry and National Register for deaths. Main outcome measures Occurrence of chronic kidney disease (CKD) as identified from renal function tests in later life, hospital admissions or death from kidney disease or recorded as receiving renal replacement therapy. Results CKD was diagnosed in 7.5% and 5.2% of women who previously had GH and PE respectively compared to 3.9% in normotensive women. The unadjusted odds ratio (95% confidence interval) of having CKD in PE was 2.04 (1.53, 2.71) and that for GH was 1.37 (1.15, 1.65), while the adjusted odds ratio (95% confidence interval) of CKD was 1.93 (1.44, 2.57) and 1.36 (1.13, 1.63) in women with PE and GH respectively. Kaplan–Meier curves of survival time to development of chronic kidney disease revealed that women with preeclampsia were susceptible to kidney function impairment earliest, followed by those with gestational hypertension. Conclusions There was an increased subsequent risk of CKD associated with hypertensive disorders of pregnancy. Women with GH and PE were also found to have CKD earlier than normotensive women.
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Affiliation(s)
- D Ayansina
- Division of Applied Health Sciences, University of Aberdeen, United Kingdom.
| | - C Black
- Chronic Diseases Group, Division of Applied Health Sciences, University of Aberdeen, United Kingdom.
| | - S J Hall
- Chronic Diseases Group, Division of Applied Health Sciences, University of Aberdeen, United Kingdom
| | - A Marks
- Chronic Diseases Group, Division of Applied Health Sciences, University of Aberdeen, United Kingdom
| | | | - G J Prescott
- Division of Applied Health Sciences, University of Aberdeen, United Kingdom
| | - K Wilde
- Division of Applied Health Sciences, University of Aberdeen, United Kingdom.
| | - S Bhattacharya
- Obstetric Epidemiology, Division of Applied Health Sciences, University of Aberdeen, United Kingdom.
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Bhattacharya S, Ayansina D, Black C, Hall S, Afolabi E, Millar C. PP038. Are women with gestational hypertension or preeclampsia at an increased long term risk of kidney function impairment? Pregnancy Hypertens 2012; 2:262. [PMID: 26105362 DOI: 10.1016/j.preghy.2012.04.149] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Preeclampsia is known to cause impairment of kidney function in pregnancy, which manifests as proteinuria. Previous studies have found an association between preeclampsia and kidney disease but were restricted in their numbers or had a short follow up time. OBJECTIVES To assess the long term effects of hypertensive disorders of pregnancy on kidney function in later life. METHODS From the Aberdeen maternity and neonatal databank (AMND), we identified the first singleton pregnancy of all women with date of birth on or before 30th June 1969. These women were linked by means of their identifying information to the local renal biochemistry database (GRBD). GRBD captures all kidney function tests from primary and secondary care in the health region. A cohort study design was used to assess the odds ratios with 95% confidence intervals for chronic kidney disease stage 1-5 (predefined based on internationally accepted KDOQI definition) occurring at least 1year following delivery. Those with gestational hypertension and preeclampsia were compared to normotensive women using multivariate logistic regression to adjust for potential confounders. RESULTS A total of 14675 women who had been linked to the RBD and had complete information regarding age, socio-economic class, smoking category, and body mass index (BMI) were included in a multivariate model. The unadjusted odds ratio (95% confidence interval) of having chronic kidney disease (according to previously stated definition) in preeclamptic women was 2.04 (1.53,2.71) and that in women with gestational hypertension was 1.37 (1.15,1.65), while the adjusted odds ratio (95% confidence interval) of having chronic kidney disease was 1.93 (1.44,2.57) and 1.36 (1.13,1.63) in preeclamptic women and women with gestational hypertension respectively compared to women who were normotensive in their first pregnancy. CONCLUSION Women who had gestational hypertension or preeclampsia in their first pregnancy had a higher risk of impairment of renal function compared to women who were normotensive.
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Affiliation(s)
- S Bhattacharya
- Applied Health Sciences, University of Aberdeen, United Kingdom
| | - D Ayansina
- Applied Health Sciences, University of Aberdeen, United Kingdom
| | - C Black
- Applied Health Sciences, University of Aberdeen, United Kingdom
| | - S Hall
- Applied Health Sciences, University of Aberdeen, United Kingdom
| | - E Afolabi
- Applied Health Sciences, University of Aberdeen, United Kingdom
| | - C Millar
- Renal Medicine, NHS Grampian, Aberdeen, United Kingdom
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