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1.  Women’s compliance with nutrition and lifestyle recommendations before pregnancy: general population cohort study 
Objective To examine the extent to which women planning a pregnancy comply with recommendations for nutrition and lifestyle.
Design Prospective cohort study.
Setting Southampton, United Kingdom.
Participants 12 445 non-pregnant women aged 20-34 recruited to the Southampton Women’s Survey through general practices, 238 of whom became pregnant within three months of being interviewed.
Main outcome measures Folic acid supplement intake, alcohol consumption, smoking, diet, and physical activity before pregnancy.
Results The 238 women who became pregnant within three months of the interview were only marginally more likely to comply with recommendations for those planning a pregnancy than those who did not become pregnant in this period. Among those who became pregnant, 2.9% (95% confidence interval 1.2% to 6.0%) were taking 400 μg or more of folic acid supplements a day and drinking four or fewer units of alcohol a week, compared with 0.66% (0.52% to 0.82%) of those who did not become pregnant. 74% of those who became pregnant were non-smokers compared with 69% of those who did not become pregnant (P=0.08). Women in both groups were equally likely to consume five or more portions of fruit and vegetables a day (53% in each group, P=1.0), but only 57% of those who became pregnant had taken any strenuous exercise in the past three months compared with 64% in those who did not become pregnant (P=0.03).
Conclusion Only a small proportion of women planning a pregnancy follow the recommendations for nutrition and lifestyle. Greater publicity for the recommendations is needed, but as many pregnancies are unplanned, improved nutrition and lifestyles of women of childbearing age is also required.
doi:10.1136/bmj.b481
PMCID: PMC2643441  PMID: 19213768
2.  Physiotherapy for neck and back pain 
BMJ : British Medical Journal  2005;330(7482):53-54.
PMCID: PMC543853  PMID: 15637350
3.  Topical NSAIDs in osteoarthritis 
BMJ : British Medical Journal  2004;329(7461):304-305.
PMCID: PMC506841  PMID: 15297323
7.  Fluoridation of water supplies  
BMJ : British Medical Journal  1999;319(7205):269-270.
PMCID: PMC1126914  PMID: 10426716
8.  Corticosteroids in rheumatoid arthritis 
BMJ : British Medical Journal  1998;316(7134):789-790.
PMCID: PMC1112762  PMID: 9549442
10.  Association between bisphosphonate use and implant survival after primary total arthroplasty of the knee or hip: population based retrospective cohort study  
Objectives To test whether bisphosphonate use is related to improved implant survival after total arthroplasty of the knee or hip.
Design Population based retrospective cohort study.
Setting Primary care data from the United Kingdom.
Participants All patients undergoing primary total arthroplasty of the knee (n=18 726) or hip (n=23 269) in 1986-2006 within the United Kingdom’s General Practice Research Database. We excluded patients with a history of hip fracture before surgery or rheumatoid arthritis, and individuals younger than 40 years at surgery.
Intervention Bisphosphonate users were classified as patients with at least six prescriptions of bisphosphonates or at least six months of prescribed bisphosphonate treatment with more than 80% adherence before revision surgery.
Outcome measures Revision arthroplasties occurring after surgery, identified by READ and OXMIS codes. Parametric survival models were used to determine effects on implant survival with propensity score adjustment to account for confounding by indication.
Results Of 41 995 patients undergoing primary hip or knee arthroplasty, we identified 1912 bisphosphonate users, who had a lower rate of revision at five years than non-users (0.93% (95% confidence interval 0.52% to 1.68%) v 1.96% (1.80% to 2.14%)). Implant survival was significantly longer in bisphosphonate users than in non-users in propensity adjusted models (hazard ratio 0.54 (0.29 to 0.99); P=0.047) and had an almost twofold increase in time to revision after hip or knee arthroplasty (time ratio 1.96 (1.01 to 3.82)). Assuming 2% failure over five years, we estimated that the number to treat to avoid one revision was 107 for oral bisphosphonates.
Conclusions In patients undergoing lower limb arthroplasty, bisphosphonate use was associated with an almost twofold increase in implant survival time. These findings require replication and testing in experimental studies for confirmation.
doi:10.1136/bmj.d7222
PMCID: PMC3232250  PMID: 22147909
11.  Risk of fracture after bariatric surgery in the United Kingdom: population based, retrospective cohort study  
Objectives To estimate fracture risk in patients receiving bariatric surgery versus matched controls.
Design Population based, retrospective cohort study.
Setting Use of records from the United Kingdom General Practice Research Database, now known as the Clinical Practice Research Datalink (from January 1987 to December 2010).
Participants Patients with a body mass index of at least 30, with a record of bariatric surgery (n=2079), and matched controls without a record (n=10 442). Each bariatric surgery patient was matched to up to six controls by age, sex, practice, year, and body mass index. Patients were followed from the date of bariatric surgery for the occurrence of any fracture. We used time dependent Cox regression to calculate relative rates of fracture, adjusted for disease and previous drug treatment, and time-interaction terms to evaluate fracture timing patterns.
Main outcome measure Relative rates of any, osteoporotic, and non-osteoporotic fractures.
Results Mean follow-up time was 2.2 years. Overall, there was no significantly increased risk of fracture in patients who underwent bariatric surgery, compared with controls (8.8 v 8.2 per 1000 person years; adjusted relative risk 0.89, 95% confidence interval 0.60 to 1.33). Bariatric surgery also did not affect risk of osteoporotic and non-osteoporotic fractures. However, we saw a trend towards an increased fracture risk after three to five years following surgery, as well as in patients who had a greater decrease in body mass index after surgery, but this was not significant.
Conclusion Bariatric surgery does not have a significant effect on the risk of fracture. For the first few years after surgery, these results are reassuring for patients undergoing such operations, but do not exclude a more protracted adverse influence on skeletal health in the longer term.
doi:10.1136/bmj.e5085
PMCID: PMC3413006  PMID: 22867649

Results 1-11 (11)