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(1) Enhancing the awareness of (i) women of childbearing age suffering from epilepsy and prescribed new and/or older generation AEDs, and (ii) their healthcare professionals. Empowering both to make informed decisions through evidence-based practice that will reduce/prevent the risk of harm to unborn children potentially exposed to AEDs in early pregnancy.
(2) A change in the process by which GlaxoSmithKline (GSK) practices post-marketing epidemiological surveillance of the new generation AED `lamotrigine' in pregnancy.
(3) Benefit to the methodological practice of other researchers in Europe involved with AEDs and epidemiological surveillance
(4) Contribution to building European system for reproductive safety evaluation
Research conducted by LSHTM has played a key role in supporting the global elimination of congenital syphilis. Two studies providing evidence of the health burden of congenital syphilis in Africa and the effectiveness of benzathine penicillin treatment form a pillar upon which WHO established its new syphilis elimination initiative. Further research has resulted in the adoption of new point-of-care tests for screening pregnant women for syphilis in 30 countries. As a result, more women are diagnosed and fewer babies die of syphilis.
The Galatean Risk and Safety Tool (GRiST) is a clinical decision support system (CDSS) conceived and developed by computer scientists at Aston University from 2000 onwards, where it is being delivered as a cloud-computing service. It is used every day by mental-health practitioners in the NHS, charities, and private hospitals to assess and manage risks associated with mental-health problems. Between 1/1/2011 and 31/7/2013, clinicians provided 285,426 completed patient risk assessments using GRiST. It has changed organisational and clinical processes by its systematic collection of risk information, explicitly linking data to clinical risk judgements, and showing how those judgments are derived. Increasing international awareness has come through presentations to mental-health practitioners in Europe, America, and Australia.
University of Bristol research has led to a marked and persisting reduction in the number of cot deaths (sudden infant death syndrome or SIDS). The dramatic 67% fall from 1988 to 1992 in England and Wales resulted from the identification of risks associated with putting babies to sleep face-down (prone). Nationally, death rates have more than halved again (54% fall) between from 1992 and 2011, with an estimated additional 1025 lives saved between 2008 and 2011, after two studies conducted in 1993-6 and 2003-6 identified further contributory risk factors. Tens of thousands of SIDS deaths worldwide have been prevented thanks to the team's research, international collaboration and development of risk-reduction recommendations.
Malaria in pregnancy causes the deaths of 200,000 newborns and 10,000 mothers annually. The Liverpool School of Tropical Medicine is the coordinating centre of the global Malaria in Pregnancy Consortium. LSTM-led research from 2007 has contributed to the World Health Organisation's (WHO) estimates of the global burden of malaria in pregnancy, showing that 125M pregnancies are at risk, more than double previous estimates. The Consortium has also contributed to a better understanding of the low uptake of existing interventions by pregnant women, and identification of the best prevention strategies. Consequently, WHO updated its policy recommendations in 2007on intermittent-preventive-treatment for prevention of malaria in pregnancy, adopted in 37 sub-Saharan countries, and in 2012, already adopted in 9 countries.
Approximately 25,000 people in the UK die each year from venous thromboembolism (VTE); furthermore, VTE affects 1 in 100,000 women of childbearing age and causes one-third of all maternal deaths. Thrombophilia, pregnancy and the use of oral oestrogens can all place women at increased risk of VTE when compared with other individuals. University of Glasgow researchers quantified the probability of VTE among at-risk women and analysed the benefits and cost-effectiveness of thrombophilia screening. Their research is cited in the recommendations and evidence bases of leading national and international clinical guidelines. This work also galvanised an overhaul of VTE prevention policy within NHS Scotland by emphasising the need for regional health boards to implement and audit standardised in-house protocols and provide accessible patient information on VTE.
Permanent childhood hearing impairment (PCHI) is common and adversely affects language acquisition. Early identification enables effective early interventions including hearing aids and cochlear implants. Research at Southampton was central to the case accepted by policymakers in the UK, USA and across several continents to recommend universal newborn screening (UNS) for PCHI. From 2008-13 more than three million babies in the UK were screened and over 5,000 cases of PCHI were identified with benefit to family functioning, literacy, academic achievement, social-emotional well-being, employment, wider society and the UK economy.
Healthcare Associated Infections (HAI) can be an unintended consequence of healthcare delivery. They are caused by a range of organisms but are often preventable. GCU-led research has reduced avoidable infections in healthcare in the UK and Europe by stimulating policy debate and investment in new healthcare practice and influencing policy decisions, evidence guidelines, and educational practices. Important changes have been made to national and international approaches to meticillin-resistant Staphylococcus aureus (MRSA) screening with cost savings of £7.5 million to the NHS. 28 European countries now use the HAI point prevalence survey validation method determined by our research.
Around 2.5 million people in the UK have Type 2 diabetes, with many more in a pre-diabetic state, Both conditions are hard to detect and frequently remain undiagnosed and untreated for years. The cost burden to the NHS of eventual treatment is estimated at £10 billion; 80% of which is spent on complications that are, with good care, avoidable. Targeted diabetes prevention programmes could aid in prevalence reduction and associated costs. Leicester's Diabetes Research Centre has developed two risk scores, both suitable for use with an ethnically diverse UK population, to detect these conditions: a self-assessment questionnaire and a general practice database tool. Recommended by NICE, they have been used successfully in varied settings. Since July 2011, around 260,000 people have completed the self-assessment score online and more than 40,000 through other means.
Vitamin A deficiency (VAD) is a major public health problem in low- and middle-income countries with young children and pregnant women particularly at risk. Over the last 20+ years LSHTM researchers have carried out a series of definitive trials in collaboration with the Ghana Health Service to evaluate the impact of different vitamin A supplementation (VAS) strategies on maternal and/or child survival. Findings have had major impacts on national and global VAS programmes and influenced WHO guidelines on VAS in: infants and children 6-59 months of age; infants 1-5 months of age; postpartum women; and pregnant women.