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Wallace M, Hiam L, Aldridge R. Elevated mortality among the second-generation (children of migrants) in Europe: what is going wrong? A review. Br Med Bull 2023; 148:5-21. [PMID: 37933157 PMCID: PMC10724460 DOI: 10.1093/bmb/ldad027] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 09/21/2023] [Accepted: 09/30/2023] [Indexed: 11/08/2023]
Abstract
INTRODUCTION The 'second-generation' (i.e. the children of migrants) represent one of the fastest growing subpopulations of the child and young adult populations in Europe today. The research so far appears to indicate that their mortality risk is elevated relative to people with non-migrant backgrounds. SOURCES OF DATA Peer-reviewed publications. AREAS OF AGREEMENT Second-generation status is a clear marker of elevated mortality risk in Europe in early life (including stillbirth, perinatal, neonatal and infant mortality) and adulthood, particularly if the parent(s) were born outside of Europe. Socioeconomic inequality plays an important, albeit rarely defining, role in these elevated risks. AREAS OF CONTROVERSY It remains unclear what causes-of-death are driving these elevated mortality risks. The exact influence of (non-socioeconomic) explanatory factors (e.g. health care, racism & discrimination, and factors related to integration) on the elevated mortality risks of the second-generation also remains unclear. GROWING POINTS The second-generation will continue to grow and diversify in Europe; we must intervene to address these inequalities now. AREAS TIMELY FOR DEVELOPING RESEARCH Place more emphasis on the complexity of migration background, specific causes-of-death, and understanding the roles of explanatory factors beyond socioeconomic background.
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Affiliation(s)
- Matthew Wallace
- Sociology Department, Stockholm University, Frescativägen, Stockholm 114 19, Sweden
| | - Lucinda Hiam
- School of Geography and the Environment, Oxford University Centre for the Environment, University of Oxford, South Parks Road, Oxford, OX1 3QY, UK
| | - Robert Aldridge
- Institute of Health Informatics, University College London, 222 Euston Road London, NW1 2DA, UK
- The Institute for Health Metrics and Evaluation, Hans Rosling Center for Population Health, 3980 15th Ave NE, Seattle WA 98195, United States
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Stevenson K, Ogunlana K, Alomari M, Agoropopoola R, Stevenson F, Knight M, Aldridge R. Lessons learned from co-production in public health research: the MAMAH case study involving underserved migrant mothers in the UK. Lancet 2023; 402 Suppl 1:S87. [PMID: 37997133 DOI: 10.1016/s0140-6736(23)02107-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 09/07/2023] [Accepted: 09/22/2023] [Indexed: 11/25/2023]
Abstract
BACKGROUND Research suggests some migrant women are at increased risk of mortality and morbidity in the perinatal period; however, there is a gap in co-produced research to improve care. The UK National Institute for Health and Care Research (NIHR) defines co-production as "an approach in which researchers, practitioners, and members of the public work together, sharing power and responsibility". We summarise learnings from our study, which aimed to co-produce solutions to improve maternity care for migrant women in the UK, by working with women to identify the most important research priorities. METHODS We recruited 18 underserved migrant women living in the UK who had given birth in the UK within the past 15 years to create a patient advisory panel. They were recruited via national and local non-governmental organisations and snowball sampling using purposive methods to ensure representation from a range of backgrounds, including those who were refugees, asylum seekers, and undocumented. Underserved was defined as asylum seeking, refugee, undocumented, or low-income mothers (those who were experiencing homelessness or in receipt of welfare support). The women are involved in conceptualisation, analysis, and dissemination of the project. The project is a UK National Institute of Health and Care Research (NIHR) Doctoral Fellowship project lasting 3 years with a variety of research workstreams. FINDINGS The research funding application process began in January, 2021, and the project was funded and began in November, 2022. The research team struggled to access comprehensive training on co-production, particularly in how to counter power dynamics. We appointed a Lead Patient Advisor who manages the relationship between the academics and the patient advisors. Additionally, we reimburse women's time, childcare, and travel. We have found that online meetings are preferable, as women do not need to travel or arrange childcare. We meet our patient advisory panel four times per year. Some women have been directly involved in research such as systematic review screening and qualitative interviewing and have been given research training. Our initial research priorities did not align with those of the women, and this helped us to reshape our work. Women said that having a Lead Patient Advisor made it easier to participate, particularly as some issues are traumatic. To mitigate this, we have offered support resources and debriefing. Using online interpreters has been challenging, and we have recently split into different language groups to maximise engagement. INTERPRETATION Overall, as researchers, we have learned that taking a truly co-produced approach is time-consuming but has ensured our research prioritises the views of migrant women giving birth in the UK. FUNDING National Institute for Health and Care Research (NIHR).
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Affiliation(s)
- Kerrie Stevenson
- Institute for Health Informatics, University College London, London, UK; Collaborative Centre for Inclusion Health, University College London, London, UK.
| | - Kemi Ogunlana
- Institute for Health Informatics, University College London, London, UK; Collaborative Centre for Inclusion Health, University College London, London, UK
| | - Maha Alomari
- Institute for Health Informatics, University College London, London, UK; Collaborative Centre for Inclusion Health, University College London, London, UK
| | - Rukayat Agoropopoola
- Institute for Health Informatics, University College London, London, UK; Collaborative Centre for Inclusion Health, University College London, London, UK
| | - Fiona Stevenson
- Research Department of Primary Care and Population Health, London, UK
| | - Marian Knight
- National Perinatal Epidemiology Unit, University of Oxford, Headington, Oxford, UK
| | - Robert Aldridge
- Collaborative Centre for Inclusion Health, University College London, London, UK
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Lam J, Aldridge R, Blackburn R, Harron K. How is ethnicity reported, described, and analysed in health research in the UK? A bibliographical review and focus group discussions with young refugees. BMC Public Health 2023; 23:2025. [PMID: 37848866 PMCID: PMC10583485 DOI: 10.1186/s12889-023-16947-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 10/10/2023] [Indexed: 10/19/2023] Open
Abstract
BACKGROUND The ethnicity data gap pertains to 3 major challenges to address ethnic health inequality: 1) Under-representation of ethnic minorities in research; 2) Poor data quality on ethnicity; 3) Ethnicity data not being meaningfully analysed. These challenges are especially relevant for research involving under-served migrant populations in the UK. We aimed to review how ethnicity is captured, reported, analysed and theorised within policy-relevant research on ethnic health inequities. METHODS We reviewed a selection of the 1% most highly cited population health papers that reported UK data on ethnicity, and extracted how ethnicity was recorded and analysed in relation to health outcomes. We focused on how ethnicity was obtained (i.e. self reported or not), how ethnic groups were categorised, whether justification was provided for any categorisation, and how ethnicity was theorised to be related to health. We held three 1-h-long guided focus groups with 10 young people from Nigeria, Turkistan, Syria, Yemen and Iran. This engagement helped us shape and interpret our findings, and reflect on. 1) How should ethnicity be asked inclusively, and better recorded? 2) Does self-defined ethnicity change over time or context? If so, why? RESULTS Of the 44 included papers, most (19; 43%) used self-reported ethnicity, categorised in a variety of ways. Of the 27 papers that aggregated ethnicity, 13 (48%) provided justification. Only 8 of 33 papers explicitly theorised how ethnicity related to health. The focus groups agreed that 1) Ethnicity should not be prescribed by others; individuals could be asked to describe their ethnicity in free-text which researchers could synthesise to extract relevant dimensions of ethnicity for their research; 2) Ethnicity changes over time and context according to personal experience, social pressure, and nationality change; 3) Migrants and non-migrants' lived experience of ethnicity is not fully inter-changeable, even if they share the same ethnic category. CONCLUSIONS Ethnicity is a multi-dimensional construct, but this is not currently reflected in UK health research studies, where ethnicity is often aggregated and analysed without justification. Researchers should communicate clearly how ethnicity is operationalised for their study, with appropriate justification for clustering and analysis that is meaningfully theorised. We can only start to tackle ethnic health inequity by treating ethnicity as rigorously as any other variables in our research.
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Affiliation(s)
- Joseph Lam
- UCL Great Ormond Street Institute of Child Health, 30 Guilford St, London, WC1N 1EH, UK.
| | - Robert Aldridge
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, 98195, USA
- UCL Institute of Health Informatics, 222 Euston Rd, London, NW1 2DA, UK
| | - Ruth Blackburn
- UCL Great Ormond Street Institute of Child Health, 30 Guilford St, London, WC1N 1EH, UK
| | - Katie Harron
- UCL Great Ormond Street Institute of Child Health, 30 Guilford St, London, WC1N 1EH, UK
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Boukari Y, Beale S, Nguyen V, Fong WLE, Burns R, Yavlinsky A, Hoskins S, Lewis K, Geismar C, Navaratnam AM, Braithwaite I, Byrne TE, Oskrochi Y, Tweed S, Kovar J, Patel P, Hayward A, Aldridge R. SARS-CoV-2 infections in migrants and the role of household overcrowding: a causal mediation analysis of Virus Watch data. J Epidemiol Community Health 2023; 77:649-655. [PMID: 37463770 PMCID: PMC10511992 DOI: 10.1136/jech-2022-220251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 07/07/2023] [Indexed: 07/20/2023]
Abstract
BACKGROUND Migrants are over-represented in SARS-CoV-2 infections globally; however, evidence is limited for migrants in England and Wales. Household overcrowding is a risk factor for SARS-CoV-2 infection, with migrants more likely to live in overcrowded households than UK-born individuals. We aimed to estimate the total effect of migration status on SARS-CoV-2 infection and to what extent household overcrowding mediated this effect. METHODS We included a subcohort of individuals from the Virus Watch prospective cohort study during the second SARS-CoV-2 wave (1 September 2020-30 April 2021) who were aged ≥18 years, self-reported the number of rooms in their household and had no evidence of SARS-CoV-2 infection pre-September 2020. We estimated total, indirect and direct effects using Buis' logistic decomposition regression controlling for age, sex, ethnicity, clinical vulnerability, occupation, income and whether they lived with children. RESULTS In total, 23 478 individuals were included. 9.07% (187/2062) of migrants had evidence of infection during the study period vs 6.27% (1342/21 416) of UK-born individuals. Migrants had 22% higher odds of infection during the second wave (total effect; OR 1.22, 95% CI 1.01 to 1.47). Household overcrowding accounted for approximately 36% (95% CI -4% to 77%) of these increased odds (indirect effect, OR 1.07, 95% CI 1.03 to 1.12; proportion accounted for: indirect effect on log odds scale/total effect on log odds scale=0.36). CONCLUSION Migrants had higher odds of SARS-CoV-2 infection during the second wave compared with UK-born individuals and household overcrowding explained 36% of these increased odds. Policy interventions to reduce household overcrowding for migrants are needed as part of efforts to tackle health inequalities during the pandemic and beyond.
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Affiliation(s)
- Yamina Boukari
- Institute of Health Informatics, University College London, London, UK
| | - Sarah Beale
- Institute of Health Informatics, University College London, London, UK
- Institute of Epidemiology and Health Care, University College London, London, UK
| | - Vincent Nguyen
- Institute of Health Informatics, University College London, London, UK
- Institute of Epidemiology and Health Care, University College London, London, UK
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Rachel Burns
- Institute of Health Informatics, University College London, London, UK
| | - Alexei Yavlinsky
- Institute of Health Informatics, University College London, London, UK
| | - Susan Hoskins
- Institute of Epidemiology and Health Care, University College London, London, UK
| | - Kate Lewis
- Population, Policy and Practice Department, University College London Great Ormond Street Institute of Child Health, London, UK
| | - Cyril Geismar
- Institute of Epidemiology and Health Care, University College London, London, UK
| | - Annalan Md Navaratnam
- Institute of Health Informatics, University College London, London, UK
- Institute of Epidemiology and Health Care, University College London, London, UK
| | | | - Thomas E Byrne
- Institute of Health Informatics, University College London, London, UK
| | - Youssof Oskrochi
- Institute of Health Informatics, University College London, London, UK
| | - Sam Tweed
- Institute of Health Informatics, University College London, London, UK
| | - Jana Kovar
- Institute of Health Informatics, University College London, London, UK
| | - Parth Patel
- Institute of Health Informatics, University College London, London, UK
| | - Andrew Hayward
- Institute of Epidemiology and Health Care, University College London, London, UK
| | - Robert Aldridge
- Institute of Health Informatics, University College London, London, UK
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Zenner D, Brals D, Nederby-Öhd J, Menezes D, Aldridge R, Anderson SR, de Vries G, Erkens C, Marchese V, Matteelli A, Muzyamba M, van Rest J, Spruijt I, Were J, Migliori GB, Lönnroth K, Cobelens F, Abubakar I. Drivers determining tuberculosis disease screening yield in four European screening programmes: a comparative analysis. Eur Respir J 2023; 62:2202396. [PMID: 37230498 PMCID: PMC10568038 DOI: 10.1183/13993003.02396-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 05/03/2023] [Indexed: 05/27/2023]
Abstract
BACKGROUND The World Health Organization End TB Strategy emphasises screening for early diagnosis of tuberculosis (TB) in high-risk groups, including migrants. We analysed key drivers of TB yield differences in four large migrant TB screening programmes to inform TB control planning and feasibility of a European approach. METHODS We pooled individual TB screening episode data from Italy, the Netherlands, Sweden and the UK, and analysed predictors and interactions for TB case yield using multivariable logistic regression models. RESULTS Between 2005 and 2018 in 2 302 260 screening episodes among 2 107 016 migrants to four countries, the programmes identified 1658 TB cases (yield 72.0 (95% CI 68.6-75.6) per 100 000). In logistic regression analysis, we found associations between TB screening yield and age (≥55 years: OR 2.91 (95% CI 2.24-3.78)), being an asylum seeker (OR 3.19 (95% CI 1.03-9.83)) or on a settlement visa (OR 1.78 (95% CI 1.57-2.01)), close TB contact (OR 12.25 (95% CI 11.73-12.79)) and higher TB incidence in the country of origin. We demonstrated interactions between migrant typology and age, as well as country of origin. For asylum seekers, the elevated TB risk remained similar above country of origin incidence thresholds of 100 per 100 000. CONCLUSIONS Key determinants of TB yield included close contact, increasing age, incidence in country of origin and specific migrant groups, including asylum seekers and refugees. For most migrants such as UK students and workers, TB yield significantly increased with levels of incidence in the country of origin. The high, country of origin-independent TB risk in asylum seekers above a 100 per 100 000 threshold could reflect higher transmission and re-activation risk of migration routes, with implications for selecting populations for TB screening.
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Affiliation(s)
- Dominik Zenner
- Faculty of Population Health Sciences, University College London, London, UK
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
- Amsterdam University Medical Centers, location University of Amsterdam, Department of Global Health, Amsterdam, The Netherlands
- Amsterdam Public Health, Global Health, Amsterdam, The Netherlands
| | - Daniella Brals
- Amsterdam University Medical Centers, location University of Amsterdam, Department of Global Health, Amsterdam, The Netherlands
- Amsterdam Public Health, Global Health, Amsterdam, The Netherlands
| | - Joanna Nederby-Öhd
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Dee Menezes
- Institute of Health Informatics Research, University College London, London, UK
| | - Robert Aldridge
- Institute of Health Informatics Research, University College London, London, UK
| | | | - Gerard de Vries
- National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Connie Erkens
- KNCV Tuberculosis Foundation, The Hague, The Netherlands
| | - Valentina Marchese
- WHO Collaborating Center for TB/HIV and the TB Elimination Strategy, University of Brescia, Brescia, Italy
| | - Alberto Matteelli
- WHO Collaborating Center for TB/HIV and the TB Elimination Strategy, University of Brescia, Brescia, Italy
| | | | - Job van Rest
- KNCV Tuberculosis Foundation, The Hague, The Netherlands
| | - Ineke Spruijt
- KNCV Tuberculosis Foundation, The Hague, The Netherlands
| | - John Were
- Faculty of Population Health Sciences, University College London, London, UK
| | - Giovanni Battista Migliori
- Servizio di Epidemiologia Clinica delle Malattie Respiratorie, Istituti Clinici Scientifici Maugeri IRCCS, Tradate, Italy
| | - Knut Lönnroth
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Frank Cobelens
- Amsterdam University Medical Centers, location University of Amsterdam, Department of Global Health, Amsterdam, The Netherlands
- Amsterdam Public Health, Global Health, Amsterdam, The Netherlands
| | - Ibrahim Abubakar
- Faculty of Population Health Sciences, University College London, London, UK
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Devakumar D, Rajagopalan S, Strong KL, Requejo J, Diaz T, Gram L, Aldridge R, Dalglish SL. Racism, xenophobia, and discrimination: data disaggregation is a complex but crucial step to improving child health. Lancet 2023; 401:1321-1323. [PMID: 37004671 DOI: 10.1016/s0140-6736(23)00618-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 03/21/2023] [Indexed: 04/04/2023]
Affiliation(s)
- Delan Devakumar
- Institute for Global Health, University College London, London WC1N 1EH, UK.
| | - Srivatsan Rajagopalan
- Children in All Policies 2030, Institute for Global Health, University College London, London, UK
| | - Kathleen L Strong
- Department of Maternal, Newborn, Child and Adolescent Health and Ageing, WHO, Geneva, Switzerland
| | - Jennifer Requejo
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Global Financing Facility, World Bank Group, Washington DC, USA
| | - Theresa Diaz
- Department of Maternal, Newborn, Child and Adolescent Health and Ageing, WHO, Geneva, Switzerland
| | - Lu Gram
- Institute for Global Health, University College London, London WC1N 1EH, UK
| | - Robert Aldridge
- Institute of Health Informatics, University College London, London WC1N 1EH, UK
| | - Sarah L Dalglish
- Children in All Policies 2030, Institute for Global Health, University College London, London, UK
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Bark P, Ramasawmy M, Hayward A, Luchenski S, Aldridge R, Burridge S, Banerjee A. Integrated approach to cardiovascular disease in people experiencing homelessness: a qualitative study. Open Heart 2023; 10:openhrt-2022-002235. [PMID: 37055174 PMCID: PMC10106063 DOI: 10.1136/openhrt-2022-002235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 03/21/2023] [Indexed: 04/15/2023] Open
Abstract
BACKGROUND Homelessness is associated with an increased risk of cardiovascular disease (CVD), beyond impact of socioeconomic status. CVD is preventable and treatable, though barriers to interventions exist for people experiencing homelessness. Those with lived experience of homelessness and health professionals with relevant expertise can help to understand and address these barriers. OBJECTIVES To understand, and make recommendations to improve, CVD care in homeless populations through lived and professional expertise. METHOD Four focus groups were conducted in March-July 2019. Three groups included people currently or previously experiencing homelessness, each attended by a cardiologist (AB), a health services researcher (PB) and an 'expert by experience' (SB) who coordinated participants. One group included multidisciplinary health and social care professionals in and around London to explore solutions. PARTICIPANTS The three groups included 16 men and 9 women, aged 20-60 years, of whom 24 were homeless and currently living in hostels, and 1 rough sleeper. At least 14 discussed sleeping rough at some point. RESULTS Participants were aware of CVD risks and relevance of healthy habits but identified barriers to prevention and health access, starting with disorientation affecting planning and self-care, lack of facilities for food, hygiene and exercise, and experiences of discrimination. CONCLUSIONS CVD care for those experiencing homelessness should account for fundamental problems of the environment, be codesigned with service users and cover key principles: flexibility, public and staff education, integration of support and advocacy for health service rights.
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Affiliation(s)
- Pippa Bark
- Institute of Health Informatics, University College London, London, UK
- University College London Cancer Institute, London, UK
| | - Mel Ramasawmy
- Institute of Health Informatics, University College London, London, UK
| | - Andrew Hayward
- UCL Collaborative Centre for Inclusion Health, London, UK
| | - Serena Luchenski
- Institute of Epidemiology and Health Care, University College London, London, UK
| | - Robert Aldridge
- Institute of Health Informatics, University College London, London, UK
| | | | - Amitava Banerjee
- Farr Institute of Health Informatics Research, University College London, London, UK
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Nguyen V, Liu Y, Mumford R, Flanagan B, Patel P, Braithwaite I, Shrotri M, Byrne T, Beale S, Aryee A, Fong WLE, Fragaszy E, Geismar C, Navaratnam AMD, Hardelid P, Kovar J, Pope A, Cheng T, Hayward A, Aldridge R. Tracking Changes in Mobility Before and After the First SARS-CoV-2 Vaccination Using Global Positioning System Data in England and Wales (Virus Watch): Prospective Observational Community Cohort Study. JMIR Public Health Surveill 2023; 9:e38072. [PMID: 36884272 PMCID: PMC9997704 DOI: 10.2196/38072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 08/05/2022] [Accepted: 09/29/2022] [Indexed: 03/09/2023] Open
Abstract
BACKGROUND Evidence suggests that individuals may change adherence to public health policies aimed at reducing the contact, transmission, and spread of the SARS-CoV-2 virus after they receive their first SARS-CoV-2 vaccination when they are not fully vaccinated. OBJECTIVE We aimed to estimate changes in median daily travel distance of our cohort from their registered addresses before and after receiving a SARS-CoV-2 vaccine. METHODS Participants were recruited into Virus Watch starting in June 2020. Weekly surveys were sent out to participants, and vaccination status was collected from January 2021 onward. Between September 2020 and February 2021, we invited 13,120 adult Virus Watch participants to contribute toward our tracker subcohort, which uses the GPS via a smartphone app to collect data on movement. We used segmented linear regression to estimate the median daily travel distance before and after the first self-reported SARS-CoV-2 vaccine dose. RESULTS We analyzed the daily travel distance of 249 vaccinated adults. From 157 days prior to vaccination until the day before vaccination, the median daily travel distance was 9.05 (IQR 8.06-10.09) km. From the day of vaccination to 105 days after vaccination, the median daily travel distance was 10.08 (IQR 8.60-12.42) km. From 157 days prior to vaccination until the vaccination date, there was a daily median decrease in mobility of 40.09 m (95% CI -50.08 to -31.10; P<.001). After vaccination, there was a median daily increase in movement of 60.60 m (95% CI 20.90-100; P<.001). Restricting the analysis to the third national lockdown (January 4, 2021, to April 5, 2021), we found a median daily movement increase of 18.30 m (95% CI -19.20 to 55.80; P=.57) in the 30 days prior to vaccination and a median daily movement increase of 9.36 m (95% CI 38.6-149.00; P=.69) in the 30 days after vaccination. CONCLUSIONS Our study demonstrates the feasibility of collecting high-volume geolocation data as part of research projects and the utility of these data for understanding public health issues. Our various analyses produced results that ranged from no change in movement after vaccination (during the third national lock down) to an increase in movement after vaccination (considering all periods, up to 105 days after vaccination), suggesting that, among Virus Watch participants, any changes in movement distances after vaccination are small. Our findings may be attributable to public health measures in place at the time such as movement restrictions and home working that applied to the Virus Watch cohort participants during the study period.
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Affiliation(s)
- Vincent Nguyen
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, United Kingdom
- Institute of Epidemiology and Health Care, University College London, London, United Kingdom
| | - Yunzhe Liu
- SpaceTimeLab, Department of Civil, Environmental and Geomatic Engineering, University College London, London, United Kingdom
| | - Richard Mumford
- Technical Research Department, Esri, Edinburgh, United Kingdom
| | | | - Parth Patel
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, United Kingdom
| | - Isobel Braithwaite
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, United Kingdom
| | - Madhumita Shrotri
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, United Kingdom
| | - Thomas Byrne
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, United Kingdom
| | - Sarah Beale
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, United Kingdom
- Institute of Epidemiology and Health Care, University College London, London, United Kingdom
| | - Anna Aryee
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, United Kingdom
| | - Wing Lam Erica Fong
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, United Kingdom
| | - Ellen Fragaszy
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, United Kingdom
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Cyril Geismar
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, United Kingdom
- Institute of Epidemiology and Health Care, University College London, London, United Kingdom
| | - Annalan M D Navaratnam
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, United Kingdom
- Institute of Epidemiology and Health Care, University College London, London, United Kingdom
| | - Pia Hardelid
- Department of Population, Policy and Practice, University College London Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Jana Kovar
- Institute of Epidemiology and Health Care, University College London, London, United Kingdom
| | - Addy Pope
- Technical Research Department, Esri, Edinburgh, United Kingdom
| | - Tao Cheng
- SpaceTimeLab, Department of Civil, Environmental and Geomatic Engineering, University College London, London, United Kingdom
| | - Andrew Hayward
- Institute of Epidemiology and Health Care, University College London, London, United Kingdom
| | - Robert Aldridge
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, United Kingdom
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Jellen B, Aldridge R, Hollon M, Sadikovic M, Camilo G. Love is in the air: additional evidence for a volatile sex-attractant pheromone in snakes. AMPHIBIA-REPTILIA 2022. [DOI: 10.1163/15685381-bja10117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Abstract
Many taxa utilise chemosensation as their primary sensory modality and communicate with one another using pheromones. Sex-attractant pheromones facilitate mate location and provide information regarding the reproductive status of the potential mate. Snakes have adaptively radiated to many different habitats, some of which preclude the possibility of depositing a continuous terrestrial pheromone trail (e.g., arboreal, semi-aquatic). We suggest that volatile signals are present in species inhabiting such environments. The majority of investigations into snake sex-attractant pheromones have examined terrestrial species, largely ignoring non-terrestrial species and their signal modality. We examined the potential existence of terrestrial and volatile signals in the northern watersnake (Nerodia sipedon) with a modified Y-maze. During the mating period, males of this semi-aquatic species successfully trailed both the terrestrial and volatile signals from estrous females but did not successfully trail the terrestrial or volatile signals from non-estrous females and other males. Whether a single multimodal sex-attractant pheromone (or multiple sex-attractant pheromones) produced this result remains unknown. However, we feel future investigations into the volatile nature of sex-attractant pheromones in the Ophidia would prove fruitful; particularly for arboreal, aquatic, and semi-aquatic taxa providing a greater understanding of communication and mating system dynamics.
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Affiliation(s)
- Benjamin Jellen
- Department of Basic Sciences, College of Arts and Sciences, University of Health Sciences and Pharmacy in St. Louis, 1 Pharmacy Place, St. Louis, MO, 63110, USA
| | - Robert Aldridge
- Department of Biology, Saint Louis University, 1 North Grand Blvd, St. Louis, MO, 63103, USA
| | - Michelle Hollon
- Department of Basic Sciences, College of Arts and Sciences, University of Health Sciences and Pharmacy in St. Louis, 1 Pharmacy Place, St. Louis, MO, 63110, USA
| | - Maja Sadikovic
- Cardiac Rhythm Management, Boston Scientific, 300 Boston Scientific Way, Marlborough, MA, 01752, USA
| | - Gerardo Camilo
- Department of Biology, Saint Louis University, 1 North Grand Blvd, St. Louis, MO, 63103, USA
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Mitchell A, Erfanian M, Soelistyo C, Oberman T, Kang J, Aldridge R, Xue JH, Aletta F. Effects of Soundscape Complexity on Urban Noise Annoyance Ratings: A Large-Scale Online Listening Experiment. Int J Environ Res Public Health 2022; 19:14872. [PMID: 36429588 PMCID: PMC9690752 DOI: 10.3390/ijerph192214872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 10/28/2022] [Accepted: 11/08/2022] [Indexed: 06/16/2023]
Abstract
Noise annoyance has been often reported as one of the main adverse effects of noise exposure on human health, and there is consensus that it relates to several factors going beyond the mere energy content of the signal. Research has historically focused on a limited set of sound sources (e.g., transport and industrial noise); only more recently is attention being given to more holistic aspects of urban acoustic environments and the role they play in the noise annoyance perceptual construct. This is the main approach promoted in soundscape studies, looking at both wanted and unwanted sounds. In this study, three specific aspects were investigated, namely: (1) the effect of different sound sources combinations, (2) the number of sound sources present in the soundscape, and (3) the presence of individual sound source, on noise annoyance perception. For this purpose, a large-scale online experiment was carried out with 1.2k+ participants, using 2.8k+ audio recordings of complex urban acoustic environments to investigate how they would influence the perceived noise annoyance. Results showed that: (1) the combinations of different sound sources were not important, compared, instead, to the number of sound sources identified in the soundscape recording (regardless of sound sources type); (2) the annoyance ratings expressed a minimum when any two clearly distinguishable sound sources were present in a given urban soundscape; and (3) the presence (either in isolation or combination) of traffic-related sound sources increases noise annoyance, while the presence (either in isolation or combination) of nature-related sound sources decreases noise annoyance.
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Affiliation(s)
- Andrew Mitchell
- Institute for Environmental Design and Engineering, The Bartlett, University College London, London WC1H 0NN, UK
| | - Mercede Erfanian
- Institute for Environmental Design and Engineering, The Bartlett, University College London, London WC1H 0NN, UK
| | - Christopher Soelistyo
- Institute for the Physics of Living Systems, University College London, London WC1E 6BT, UK
| | - Tin Oberman
- Institute for Environmental Design and Engineering, The Bartlett, University College London, London WC1H 0NN, UK
| | - Jian Kang
- Institute for Environmental Design and Engineering, The Bartlett, University College London, London WC1H 0NN, UK
| | - Robert Aldridge
- Institute of Health Informatics, University College London, London NW1 2DA, UK
| | - Jing-Hao Xue
- Department of Statistical Science, University College London, London W1T 7PJ, UK
| | - Francesco Aletta
- Institute for Environmental Design and Engineering, The Bartlett, University College London, London WC1H 0NN, UK
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11
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Ogunlana K, Stevenson K, Ciftci Y, Knight M, Aldridge R, Stevenson F. Engaging the less-often-heard in public health research grant writing: a case study of co-production involving underserved migrant mothers in the UK. Lancet 2022; 400 Suppl 1:S4. [PMID: 36929984 DOI: 10.1016/s0140-6736(22)02214-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND In the UK, one-in-three births are to a non-UK born woman. A gap exists in co-produced research to understand their experiences. The UK National Institute for Health and Care Research (NIHR) defines co-production as "an approach in which researchers, practitioners, and members of the public work together, sharing power and responsibility". This project co-produced a grant proposal to improve maternity care for underserved migrant women in the UK. We reflect on transferrable learning for engaging those whose voices are less-often-heard in grant writing. METHODS An expert by experience, an underserved migrant woman who had given birth in the UK, joined the research team. Four online engagement workshops were conducted; two involved only migrant women and two were multi-disciplinary. 26 underserved migrant women attended the online engagement workshops. NIHR INVOLVE guidance was consulted. FINDINGS Women said they were often asked about negative experiences that felt disempowering, and rarely asked about solutions. Thus, our proposal will focus on co-designing solutions. Women felt that having an expert by experience co-host workshops encouraged engagement, so we integrated an expert into our methods. Women were uncomfortable in professional groups. Thus, our proposed steering and focus groups will have an expert by experience subgroup with elected members attending multi-disciplinary groups. We plan to engage mostly online as women preferred this method to enable flexibility with childcare. The lead expert by experience helped to form the proposal through brainstorming, co-drafting, and feedback; experts by experience commented on the draft via email and workshops. The lead expert by experience wished to gain further experience of research methods, for which we requested additional funding. INTERPRETATION The findings from this project are limited and not fully representative of all migrant groups, as only migrant women who have given birth in the UK were engaged. However, the work has highlighted the immense potential for co-production in public health research, and the value of adapting how investigators plan research to maximise the voices of the less-often-heard. FUNDING National Institute for Health and Care Research Design Service London Public Involvement Fund.
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Affiliation(s)
- Kemi Ogunlana
- Institute for Health Informatics, University College London, London, UK
| | - Kerrie Stevenson
- Institute for Health Informatics, University College London, London, UK; Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Marian Knight
- National Perinatal Epidemiology Unit, University of Oxford, Oxford, UK
| | - Robert Aldridge
- Institute for Health Informatics, University College London, London, UK
| | - Fiona Stevenson
- Research Department of Primary Care and Population Health, University College London, London, UK.
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12
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Stevenson K, Ogunlana K, Ciftici Y, Knight M, Aldridge R, Stevenson F. Co-production in public health research grant writing: engaging underserved migrant mothers in the UK. Eur J Public Health 2022; 32:ckac131.515. [PMCID: PMC9830981 DOI: 10.1093/eurpub/ckac131.515] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/12/2023] Open
Abstract
Background In the UK, one in three births is to a non-UK born woman, but there is a gap in co-produced research to explore their experiences. The National Institute for Health and Care Research (NIHR) defines co-production as ‘an approach in which researchers, practitioners, and members of the public work together, sharing power and responsibility'. This project co-produced a grant proposal to improve maternity care for underserved migrant women in the UK. We reflect on transferrable learning for engaging those whose voices are less often heard in grant writing. Methods An expert by experience, an underserved migrant woman who gave birth in the UK, joined the research team. Four online engagement workshops were conducted; two involved only migrant women, two were multi-disciplinary. 26 underserved migrant women attended. NIHR INVOLVE public involvement guidance was consulted. Results Women said they were often asked about negative experiences which felt disempowering, and rarely asked about solutions. Thus, we shifted the focus of our work to co-designing solutions. Women said that having an expert by experience co-host workshops encouraged engagement, so we integrated this into our methods. Some women were uncomfortable in professional groups. Thus, our proposed steering and focus groups will have an expert by experience subgroup with elected members attending multi-disciplinary groups. We will engage mostly online as women preferred this to enable flexibility with childcare. The lead expert by experience helped form the proposal through brainstorming, co-drafting, and feedback; experts by experience commented on the draft via email and workshops. The lead expert by experience wished to gain further experience of research methods, for which we requested additional funding. Conclusions This project highlights the immense potential for co-production in public health research, and the value of adapting research planning to maximise the voices of the less often heard. Key messages • Engaging experts by experiences in public health research planning is key to ensuring our work addresses the needs of underserved communities. • Co-Production of research requires determination to involve those whose voices are less often heard from the beginning of the research process, and to commit to joined working throughout.
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Affiliation(s)
- K Stevenson
- Faculty of Public Health and Policy, LSHTM, London, UK
- Institute for Health Informatics, University College London, London, UK
| | - K Ogunlana
- Institute for Health Informatics, University College London, London, UK
| | | | - M Knight
- National Perinatal Epidemiology Unit, University of Oxford, Oxford, UK
| | - R Aldridge
- Institute for Health Informatics, University College London, London, UK
| | - F Stevenson
- Primary Care and Population Health, University College London, London, UK
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Menezes D, Zenner D, Aldridge R, Anderson S, de Vries G, Erkens C, Marchese V, Matteeli A, Muzyamba M, Nederby-Öhd J, van Rest J, Spruijt I, Were J, Lönnroth K, Abubakar I, Cobelens F. Country differences and determinants of yield in programmatic migrant TB screening in four European countries. Int J Tuberc Lung Dis 2022; 26:942-948. [PMID: 36163670 PMCID: PMC7615138 DOI: 10.5588/ijtld.22.0186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION The WHO End TB Strategy emphasises early diagnosis and screening of TB in high-risk groups, including migrants. We analysed TB yield data from four large migrant TB screening programmes to inform TB policy.METHODS We pooled routinely collected individual TB screening episode data from Italy, the Netherlands, Sweden and the United Kingdom under the European Union Commission E-DETECT.TB grant, described characteristics of the screened population, and analysed TB case yield.RESULTS We collected data on 2,302,260 screening episodes among 2,107,016 migrants, mostly young adults aged 18-44 years (77.8%) from Asia (78%) and Africa (18%). There were 1,658 TB cases detected through screening, with substantial yield variation (per 100,000): 201.1 for Sweden (95% confidence intervals CI 111.4-362.7), 68.9 (95% CI 65.4-72.7) for the United Kingdom, 83.2 (95% CI 73.3-94.4) for the Netherlands and 653.6 (95% CI 445.4-958.2) in Italy. Most TB cases were notified among migrants from Asia (n = 1,206, 75/100,000) or Africa (n = 370, 76.4/100,000), and among asylum seekers (n = 174, 131.5/100,000), migrants to the Netherlands (n = 101, 61.9/100,000) and settlement visa migrants to the United Kingdom (n = 590, 120.3/100,000).CONCLUSIONS We found considerable variations in yield across programmes, types of migrants and country of origin. These variations may be partly explained by differences in migration patterns and programmatic characteristics.
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Affiliation(s)
- Dee Menezes
- Institute of Health Informatics Research, University College London, UK
| | - Dominik Zenner
- Wolfson Institute of Population Health, Queen Mary University London, UK
- Universitair Medische Centra, Universiteit van Amsterdam, The Netherlands
| | - Robert Aldridge
- Institute of Health Informatics Research, University College London, UK
| | | | - Gerard de Vries
- National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | | | | | | | | | | | | | | | | | | | - Ibrahim Abubakar
- Faculty of Population Health Sciences, University College London, UK
| | - Frank Cobelens
- Universitair Medische Centra, Universiteit van Amsterdam, The Netherlands
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14
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Beale S, Patel P, Rodger A, Braithwaite I, Byrne T, Fong WLE, Fragaszy E, Geismar C, Kovar J, Navaratnam A, Nguyen V, Shrotri M, Aryee A, Aldridge R, Hayward A. Occupation, work-related contact and SARS-CoV-2 anti-nucleocapsid serological status: findings from the Virus Watch prospective cohort study. Occup Environ Med 2022; 79:oemed-2021-107920. [PMID: 35450951 PMCID: PMC9072780 DOI: 10.1136/oemed-2021-107920] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 03/28/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Risk of SARS-CoV-2 infection varies across occupations; however, investigation into factors underlying differential risk is limited. We aimed to estimate the total effect of occupation on SARS-CoV-2 serological status, whether this is mediated by workplace close contact, and how exposure to poorly ventilated workplaces varied across occupations. METHODS We used data from a subcohort (n=3775) of adults in the UK-based Virus Watch cohort study who were tested for SARS-CoV-2 anti-nucleocapsid antibodies (indicating natural infection). We used logistic decomposition to investigate the relationship between occupation, contact and seropositivity, and logistic regression to investigate exposure to poorly ventilated workplaces. RESULTS Seropositivity was 17.1% among workers with daily close contact vs 10.0% for those with no work-related close contact. Compared with other professional occupations, healthcare, indoor trade/process/plant, leisure/personal service, and transport/mobile machine workers had elevated adjusted total odds of seropositivity (1.80 (1.03 to 3.14) - 2.46 (1.82 to 3.33)). Work-related contact accounted for a variable part of increased odds across occupations (1.04 (1.01 to 1.08) - 1.23 (1.09 to 1.40)). Occupations with raised odds of infection after accounting for work-related contact also had greater exposure to poorly ventilated workplaces. CONCLUSIONS Work-related close contact appears to contribute to occupational variation in seropositivity. Reducing contact in workplaces is an important COVID-19 control measure.
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Affiliation(s)
- Sarah Beale
- UCL Institute of Epidemiology and Health Care, University College London, London, UK
| | - Parth Patel
- UCL Institute of Health Informatics, University College London, London, UK
| | - Alison Rodger
- UCL Institute of Health Informatics, University College London, London, UK
| | - Isobel Braithwaite
- Extreme Events and Health Protection Team, Centre for Radiation, Chemicals and Environmental Hazards, Public Health England, London, UK
| | - Thomas Byrne
- UCL Institute of Health Informatics, University College London, London, UK
| | | | - Ellen Fragaszy
- UCL Institute of Health Informatics, University College London, London, UK
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Cyril Geismar
- UCL Institute of Health Informatics, University College London, London, UK
| | - Jana Kovar
- UCL Institute of Epidemiology and Health Care, University College London, London, UK
- UCL Institute of Health Informatics, University College London, London, UK
| | - Annalan Navaratnam
- UCL Institute of Health Informatics, University College London, London, UK
| | - Vincent Nguyen
- UCL Institute of Health Informatics, University College London, London, UK
| | - Madhumita Shrotri
- UCL Institute of Health Informatics, University College London, London, UK
| | - Anna Aryee
- UCL Institute of Health Informatics, University College London, London, UK
| | - Robert Aldridge
- UCL Institute of Health Informatics, University College London, London, UK
| | - Andrew Hayward
- UCL Institute of Epidemiology and Health Care, University College London, London, UK
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15
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Beale S, Braithwaite I, Navaratnam AM, Hardelid P, Rodger A, Aryee A, Byrne TE, Fong EWL, Fragaszy E, Geismar C, Kovar J, Nguyen V, Patel P, Shrotri M, Aldridge R, Hayward A. Deprivation and exposure to public activities during the COVID-19 pandemic in England and Wales. J Epidemiol Community Health 2021; 76:319-326. [PMID: 34642240 PMCID: PMC8520599 DOI: 10.1136/jech-2021-217076] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 09/19/2021] [Indexed: 11/24/2022]
Abstract
Background Differential exposure to public activities may contribute to stark deprivation-related inequalities in SARS-CoV-2 infection and outcomes but has not been directly investigated. We set out to investigate whether participants in Virus Watch—a large community cohort study based in England and Wales—reported differential exposure to public activities and non-household contacts during the autumn–winter phase of the COVID-19 pandemic according to postcode-level socioeconomic deprivation. Methods Participants (n=20 120–25 228 across surveys) reported their daily activities during 3 weekly periods in late November 2020, late December 2020 and mid-February 2021. Deprivation was quantified based on participants’ residential postcode using English or Welsh Index of Multiple Deprivation quintiles. We used Poisson mixed-effect models with robust standard errors to estimate the relationship between deprivation and risk of exposure to public activities during each survey period. Results Relative to participants in the least deprived areas, participants in the most deprived areas exhibited elevated risk of exposure to vehicle sharing (adjusted risk ratio (aRR) range across time points: 1.73–8.52), public transport (aRR: 3.13–5.73), work or education outside of the household (aRR: 1.09–1.21), essential shops (aRR: 1.09–1.13) and non-household contacts (aRR: 1.15–1.19) across multiple survey periods. Conclusion Differential exposure to essential public activities—such as attending workplaces and visiting essential shops—is likely to contribute to inequalities in infection risk and outcomes. Public health interventions to reduce exposure during essential activities and financial and practical support to enable low-paid workers to stay at home during periods of intense transmission may reduce COVID-related inequalities.
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Affiliation(s)
- Sarah Beale
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, UK.,Department of Epidemiology and Public Health, University College London, London, UK
| | - Isobel Braithwaite
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, UK
| | - Annalan Md Navaratnam
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, UK
| | - Pia Hardelid
- Centre for Paediatric Epidemiology and Biostatistics, UCL Institute of Child Health, London, UK
| | - Alison Rodger
- Research Department of Infection and Population Health, Royal Free Campus, University College London, London, UK
| | - Anna Aryee
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, UK
| | - Thomas E Byrne
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, UK
| | - Erica Wing Lam Fong
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, UK
| | - Ellen Fragaszy
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, UK.,Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medecine, London, UK
| | - Cyril Geismar
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, UK
| | - Jana Kovar
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, UK
| | - Vincent Nguyen
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, UK
| | - Parth Patel
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, UK
| | - Madhumita Shrotri
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, UK
| | - Robert Aldridge
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, UK
| | - Andrew Hayward
- Department of Epidemiology and Public Health, University College London, London, UK
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16
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Zhang CX, Wurie F, Browne A, Haworth S, Burns R, Aldridge R, Zenner D, Tran A, Campos-Matos I. Social prescribing for migrants in the United Kingdom: A systematic review and call for evidence. J Migr Health 2021; 4:100067. [PMID: 34746902 PMCID: PMC8556515 DOI: 10.1016/j.jmh.2021.100067] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 10/06/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The health needs of international migrants living in the United Kingdom (UK) extend beyond mainstream healthcare to services that address the wider determinants of health and wellbeing. Social prescribing, which links individuals to these wider services, is a key component of the UK National Health Service (NHS) strategy, yet little is known about social prescribing approaches and outcomes for international migrants. This review describes the evidence base on social prescribing for migrants in the UK. METHODS A systematic review was undertaken, which identified studies through a systematic search of 4 databases and 8 grey literature sources (January 2000 to June 2020) and a call for evidence on the UK government website (July to October 2020). Published and unpublished studies of evaluated social prescribing programmes in the UK were included where at least 1 participant was identified as a migrant. Screening, data extraction and quality appraisal were performed by one reviewer, with a second reviewer checking 20% of studies. A narrative synthesis was conducted. FINDINGS Of the 4544 records identified, 32 were included in this review. The overall body of evidence was low in quality. Social prescribing approaches for migrants in the UK varied widely between programmes. Link workers who delivered services to migrants often took on additional support roles and/or actively delivered parts of the prescribed activities themselves, which is outside of the scope of the typical link worker role. Evidence for improvements to health and wellbeing and changes in healthcare utilisation were largely anecdotal and lacked measures of effect. Improved self-esteem, confidence, empowerment and social connectivity were frequently described. Facilitators of successful implementation included provider responsiveness to migrants' preferences in relation to language, culture, gender and service delivery format. Barriers included limited funding and provider capability. CONCLUSIONS Social prescribing programmes should be tailored to the individual needs of migrants. Link workers also require appropriate training on how to support migrants to address the wider determinants of health. Robust evaluation built into future social prescribing programmes for migrants should include better data collection on participant demographics and measurement of outcomes using validated and culturally and linguistically appropriate tools. Future research is needed to explore reasons for link workers taking on additional responsibilities when providing services to migrants, and whether migrants' needs are better addressed through a single-function link worker role or transdisciplinary support roles.
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Affiliation(s)
- Claire X. Zhang
- Office for Health Improvement and Disparities, Department of Health and Social Care, 39 Victoria Street, London, United Kingdom SW1H 0EU
- Institute of Health Informatics, University College London, London, United Kingdom NW1 2DA
| | - Fatima Wurie
- Office for Health Improvement and Disparities, Department of Health and Social Care, 39 Victoria Street, London, United Kingdom SW1H 0EU
- UK Health Security Agency, Wellington House, 133-155 Waterloo Road, London, United Kingdom SE1 8UG
- Institute of Epidemiology & Health Care, University College London, London, United Kingdom WC1E 7HB
| | - Annabel Browne
- UK Health Security Agency, Wellington House, 133-155 Waterloo Road, London, United Kingdom SE1 8UG
| | - Steven Haworth
- Office for Health Improvement and Disparities, Department of Health and Social Care, 39 Victoria Street, London, United Kingdom SW1H 0EU
- Institute for Social and Economic Research, University of Essex, Essex, United Kingdom CO4 3SQ
| | - Rachel Burns
- Institute of Health Informatics, University College London, London, United Kingdom NW1 2DA
| | - Robert Aldridge
- Institute of Health Informatics, University College London, London, United Kingdom NW1 2DA
| | - Dominik Zenner
- Wolfson Institute of Population Health, Queen Mary University of London, London, United Kingdom E1 4NS
| | - Anh Tran
- UK Health Security Agency, Wellington House, 133-155 Waterloo Road, London, United Kingdom SE1 8UG
| | - Ines Campos-Matos
- Office for Health Improvement and Disparities, Department of Health and Social Care, 39 Victoria Street, London, United Kingdom SW1H 0EU
- UK Health Security Agency, Wellington House, 133-155 Waterloo Road, London, United Kingdom SE1 8UG
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17
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Lewer D, Menezes D, Cornes M, Blackburn RM, Byng R, Clark M, Denaxas S, Evans H, Fuller J, Hewett N, Kilmister A, Luchenski SA, Manthorpe J, McKee M, Neale J, Story A, Tinelli M, Whiteford M, Wurie F, Yavlinsky A, Hayward A, Aldridge R. Hospital readmission among people experiencing homelessness in England: a cohort study of 2772 matched homeless and housed inpatients. J Epidemiol Community Health 2021; 75:681-688. [PMID: 33402395 PMCID: PMC8223662 DOI: 10.1136/jech-2020-215204] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 11/06/2020] [Accepted: 12/04/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Inpatients experiencing homelessness are often discharged to unstable accommodation or the street, which may increase the risk of readmission. METHODS We conducted a cohort study of 2772 homeless patients discharged after an emergency admission at 78 hospitals across England between November 2013 and November 2016. For each individual, we selected a housed patient who lived in a socioeconomically deprived area, matched on age, sex, hospital, and year of discharge. Counts of emergency readmissions, planned readmissions, and Accident and Emergency (A&E) visits post-discharge were derived from national hospital databases, with a median of 2.8 years of follow-up. We estimated the cumulative incidence of readmission over 12 months, and used negative binomial regression to estimate rate ratios. RESULTS After adjusting for health measured at the index admission, homeless patients had 2.49 (95% CI 2.29 to 2.70) times the rate of emergency readmission, 0.60 (95% CI 0.53 to 0.68) times the rate of planned readmission and 2.57 (95% CI 2.41 to 2.73) times the rate of A&E visits compared with housed patients. The 12-month risk of emergency readmission was higher for homeless patients (61%, 95% CI 59% to 64%) than housed patients (33%, 95% CI 30% to 36%); and the risk of planned readmission was lower for homeless patients (17%, 95% CI 14% to 19%) than for housed patients (30%, 95% CI 28% to 32%). While the risk of emergency readmission varied with the reason for admission for housed patients, for example being higher for admissions due to cancers than for those due to accidents, the risk was high across all causes for homeless patients. CONCLUSIONS Hospital patients experiencing homelessness have high rates of emergency readmission that are not explained by health. This highlights the need for discharge arrangements that address their health, housing and social care needs.
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Affiliation(s)
- Dan Lewer
- Institute of Health Informatics, University College London, London, UK
- Collaborative Centre for Inclusion Health, University College London, London, UK
- Institute of Epidemiology and Health Care, University College London, London, UK
| | - Dee Menezes
- Institute of Health Informatics, University College London, London, UK
| | - Michelle Cornes
- NIHR Policy Research Unit in Health and Social Care Workforce, King's College London, London, UK
| | - Ruth M Blackburn
- Institute of Health Informatics, University College London, London, UK
| | - Richard Byng
- Community and Primary Care Research Group, University of Plymouth, Plymouth, UK
| | - Michael Clark
- Care Policy and Evaluation Centre, The London School of Economics and Political Science, London, UK
| | - Spiros Denaxas
- Institute of Health Informatics, University College London, London, UK
- Alan Turing Institute, British Library, London, UK
| | - Hannah Evans
- Institute of Health Informatics, University College London, London, UK
| | - James Fuller
- NIHR Policy Research Unit in Health and Social Care Workforce, King's College London, London, UK
| | | | - Alan Kilmister
- NIHR Policy Research Unit in Health and Social Care Workforce, King's College London, London, UK
| | | | - Jill Manthorpe
- NIHR Policy Research Unit in Health and Social Care Workforce, King's College London, London, UK
| | - Martin McKee
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Joanne Neale
- National Addiction Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Alistair Story
- Find & Treat, University College London Hospitals NHS Foundation Trust, London, UK
| | - Michela Tinelli
- Care Policy and Evaluation Centre, The London School of Economics and Political Science, London, UK
| | - Martin Whiteford
- Department of Nursing & Community Health, Glasgow Caledonian University, Glasgow, UK
| | - Fatima Wurie
- Institute of Epidemiology and Health Care, University College London, London, UK
| | - Alexei Yavlinsky
- Institute of Health Informatics, University College London, London, UK
| | - Andrew Hayward
- Collaborative Centre for Inclusion Health, University College London, London, UK
- Institute of Epidemiology and Health Care, University College London, London, UK
| | - Robert Aldridge
- Institute of Health Informatics, University College London, London, UK
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18
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Clark M, Cornes M, Whiteford M, Aldridge R, Biswell E, Byng R, Foster G, Fuller JS, Hayward A, Hewett N, Kilminster A, Manthorpe J, Neale J, Tinelli M. Homelessness and integrated care: an application of integrated care knowledge to understanding services for wicked issues. JICA 2021. [DOI: 10.1108/jica-03-2021-0012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PurposePeople experiencing homelessness often have complex needs requiring a range of support. These may include health problems (physical illness, mental health and/or substance misuse) as well as social, financial and housing needs. Addressing these issues requires a high degree of coordination amongst services. It is, thus, an example of a wicked policy issue. The purpose of this paper is to examine the challenge of integrating care in this context using evidence from an evaluation of English hospital discharge services for people experiencing homelessness.Design/methodology/approachThe paper undertakes secondary analysis of qualitative data from a mixed methods evaluation of hospital discharge schemes and uses an established framework for understanding integrated care, the Rainbow Model of Integrated Care (RMIC), to help examine the complexities of integration in this area.FindingsSupporting people experiencing homelessness to have a good discharge from hospital was confirmed as a wicked policy issue. The RMIC provided a strong framework for exploring the concept of integration, demonstrating how intertwined the elements of the framework are and, hence, that solutions need to be holistically organised across the RMIC. Limitations to integration were also highlighted, such as shortages of suitable accommodation and the impacts of policies in aligned areas of the welfare state.Research limitations/implicationsThe data for this secondary analysis were not specifically focussed on integration which meant the themes in the RMIC could not be explored directly nor in as much depth. However, important issues raised in the data directly related to integration of support, and the RMIC emerged as a helpful organising framework for understanding integration in this wicked policy context.Practical implicationsIntegration is happening in services directly concerned with the discharge from hospital of people experiencing homelessness. Key challenges to this integration are reported in terms of the RMIC, which would be a helpful framework for planning better integrated care for this area of practice.Social implicationsAddressing homelessness not only requires careful planning of integration of services at specific pathway points, such as hospital discharge, but also integration across wider systems. A complex set of challenges are discussed to help with planning the better integration desired, and the RMIC was seen as a helpful framework for thinking about key issues and their interactions.Originality/valueThis paper examines an application of integrated care knowledge to a key complex, or wicked policy issue.
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Menezes D, Lewer D, Yavlinsky A, Tinelli M, Aldridge R. Mortality Outcomes in People Experiencing Homelessness Across England: a population-based study. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa165.1350] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
The number of people experiencing homelessness in England has increased since 2010 and a recent systematic review and meta-analysis demonstrated high levels of mortality in this group across high-income countries. In this study we examine the death rates in people experiencing homelessness after discharge from hospital.
Methods
This is a study of linked hospital admission records and mortality data for two groups. First, a “Homeless group”: people seen by 17 specialist homeless discharge schemes between 1 November 2013 and 30 November 2016. Second, an “IMD5 group”: A matched group of patients who live in deprived areas and have the same age and sex, and were discharged from the same hospital in the same year as the homeless patient. Our analysis entailed calculating mortality rates across each group and by the number of comorbidities.
Results
The mortality rate for the IMD5 group was 1,935 deaths per 100,000 person years, compared with 5,691 for the homeless group, giving a rate ratio of 2.9 (95% CI 2.5-3.5). The mortality risk increased with the number of comorbidities. Individuals in the IMD5 group with zero comorbidities had a death rate of 831 per 100,000 person-years, compared with the homeless group for which the corresponding figure was 2,598 and or those with 4+ comorbidities were 7,324 (IMD5) and 12,714 (homeless). This suggests a 'super-additive' interaction in which the effect of morbidity on mortality risk after discharge is greater for homeless patients. Survival at 5 years for the homelessness group was for men 80% (95% CI 77-85) and women 85 (95% CI 81-87).
Conclusions
This study shows that the well-established inequity in mortality for people experiencing homelessness exists after discharge from hospital and is greatest for the most unwell patients. Our results suggest a need for greater emphasis on prevention of homelessness, early healthcare interventions and improved hospital discharge arrangements for this population.
Key messages
The well-established inequity in mortality for people experiencing homelessness exists after discharge from hospital and is greatest for the most unwell patients. Our results suggest a need for greater emphasis on prevention of homelessness, early healthcare interventions and improved hospital discharge arrangements for this population.
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Affiliation(s)
- D Menezes
- Institute of Health Informatics, University College London, London, UK
| | - D Lewer
- Collaborative Centre for Inclusion Health, University College London, London, UK
| | - A Yavlinsky
- Institute of Health Informatics, University College London, London, UK
| | - M Tinelli
- London School of Economics, London, UK
| | - R Aldridge
- Institute of Health Informatics, University College London, London, UK
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20
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Nguyen V, Aldridge R, Blackburn R, Hayward A, Greaves F, Flowers J. Does the NHS Diabetes Prevention Programme prevent diabetes? A population-based matched cohort study. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa165.1184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
To reduce the incidence of type 2 diabetes (T2DM) in England, the National Health Service piloted the Diabetes Prevention Programme (DPP). The DPP aims to prevent T2DM by providing high-risk adults with access to 13 face-to-face sessions over nine months that focus on diet and weight management. The DPP has been shown to improve intermediate outcomes for T2DM prevention (weight loss and glycated haemoglobin (HbA1c) reduction). However, there is a lack of evidence examining incident T2DM as the outcome.
Methods
We conducted a retrospective observational cohort study using linked electronic health records from primary (Clinical Practice Research Datalink) and secondary (Hospital Episode Statistics) care for June 2016 to January 2019. We compared rates of new T2DM diagnoses among eligible adults who were referred to the DPP with rates for propensity score-matched (ratio of 1:4) controls who were eligible for the DPP but were not invited. DPP eligibility was defined as having HbA1c levels of 42-47 mmol/mol or fasting plasma glucose (FPG) levels of 5.5-6.9 mmol/L. Adults with pre-existing T2DM were excluded. Time to the first record of T2DM was modelled using Cox regression with age, alcohol intake, body mass index, ethnicity, sex, HbA1c, index of multiple deprivation and smoking status included as covariates.
Results
We identified 2205 individuals who participated in the DPP and 8820 matched controls with a similar breakdown in age, sex, HbA1c and FPG. During the 2.5-year study period, 4.13% of DPP individuals developed T2DM vs 6.42% of controls. Our results indicate that DPP referrals were associated with a 59% reduction T2DM incidence rates [adjusted hazard ratio=0.41;95%CI=0.38-0.44].
Conclusions
This is the first study to investigate the impact of the DPP on T2DM, relative to usual care. Our results provide support for the effectiveness of DPP in preventing T2DM onset and are compatible with findings for similar interventions in other settings.
Key messages
The evidence suggests that providing consistent face-to-face sessions which concentrate on diet and weight management can reduce short-term T2DM incidences in high-risk adults. With a 59% reduction in T2DM rates in DPP referees relative to eligible adults who were not referred, the DPP is effective in reducing short-term T2DM incidences in high-risk adults.
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Affiliation(s)
- V Nguyen
- Institute of Health Informatics, University College London, London, UK
| | - R Aldridge
- Institute of Health Informatics, University College London, London, UK
| | - R Blackburn
- Institute of Health Informatics, University College London, London, UK
| | - A Hayward
- Institute of Epidemiology and Health Care, University College London, London, UK
| | - F Greaves
- Public Health Data Science, Public Health England, London, UK
| | - J Flowers
- Public Health Data Science, Public Health England, London, UK
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21
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Pathak N, Patel P, Mathur R, Burns R, Gonzalez-Izquierdo A, Denaxas S, Sonnenberg P, Hayward A, Aldridge R. Validity of UK electronic health records to study migrant health: a population-based cohort study. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa166.768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
An estimated 14.3% (9.4 million people) of people living in the UK in 2019 were international migrants. Despite this, little is known about how migrants access and use healthcare services. To use electronic healthcare records (EHRs) to study migration health, a valid migration phenotype is necessary: a transparent reproducible algorithm using clinical terminology codes to determine migration status. We have previously described the validity of a migration phenotype in CALIBER data using the Clinical Practice Research Datalink (CPRD), the largest UK primary care EHR. This study further evaluates the phenotype by examining certainty of migration status.
Methods
This is a population-based cohort study of individuals in CPRD Gold (1997-2018) with a Read term indicating migration to the UK. We describe completeness of recording of migration over time: percentage of individuals recorded as migrants. We also describe cohort size based on certainty of migration status: “definite” (country of birth or visa status terms), “probable” (non-English first/main language terms), and “possible” (non-UK origin terms).
Results
Overall, 2.5% (403,768/16,071,111) of CPRD had ≥1 of 434 terms indicating migration to the UK. The percentage of recorded migrants per year increased from 0.2% (4,417/2,210,551) in 1997 to 3.64% (100,626/2,761,397) in 2018, following a similar trend to national migration data. 44.27% (178,749/403,768) were “definite” migrants and 53.68% (216,731/403,768) were “probable” migrants. Only 2.05%(8,288/16,071,111) were “possible” migrants.
Conclusions
We have created a large cohort of international migrants in the UK and certainty of migration status is high. This cohort can be used to study migration health in UK primary care EHR. The large contribution of language terms make this phenotype particularly suitable for understanding healthcare access and use by non-English speaking migrants who may face additional barriers to care.
Key messages
We have developed a way to study migration health in UK primary care electronic health records. Our method is particularly useful to study healthcare for non-English speaking migrants who may face additional barriers to care.
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Affiliation(s)
- N Pathak
- Institute of Health Informatics, University College London, London, UK
| | - P Patel
- Institute of Health Informatics, University College London, London, UK
| | - R Mathur
- Department of Non-communicable Disease Epidemiology, LSHTM, London, UK
| | - R Burns
- Institute of Health Informatics, University College London, London, UK
| | | | - S Denaxas
- Institute of Health Informatics, University College London, London, UK
| | - P Sonnenberg
- Institute for Global Health, University College London, London, UK
| | - A Hayward
- Institute for Epidemiology and Healthcare, University College London, London, UK
| | - R Aldridge
- Institute of Health Informatics, University College London, London, UK
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Wright J, Hayward A, West J, Pickett K, McEachan RM, Mon-Williams M, Christie N, Vaughan L, Sheringham J, Haklay M, Sheard L, Dickerson J, Barber S, Small N, Cookson R, Garnett P, Bywater T, Pleace N, Brunner EJ, Cameron C, Ucci M, Cummins S, Fancourt D, Kandt J, Longley P, Morris S, Ploubidis G, Savage R, Aldridge R, Hopewell D, Yang T, Mason D, Santorelli G, Romano R, Bryant M, Crosby L, Sheldon T. ActEarly: a City Collaboratory approach to early promotion of good health and wellbeing. Wellcome Open Res 2019; 4:156. [PMID: 31840089 PMCID: PMC6904987 DOI: 10.12688/wellcomeopenres.15443.1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/02/2019] [Indexed: 11/20/2022] Open
Abstract
Economic, physical, built, cultural, learning, social and service environments have a profound effect on lifelong health. However, policy thinking about health research is dominated by the ‘biomedical model’ which promotes medicalisation and an emphasis on diagnosis and treatment at the expense of prevention. Prevention research has tended to focus on ‘downstream’ interventions that rely on individual behaviour change, frequently increasing inequalities. Preventive strategies often focus on isolated leverage points and are scattered across different settings. This paper describes a major new prevention research programme that aims to create City Collaboratory testbeds to support the identification, implementation and evaluation of upstream interventions within a whole system city setting. Prevention of physical and mental ill-health will come from the cumulative effect of multiple system-wide interventions. Rather than scatter these interventions across many settings and evaluate single outcomes, we will test their collective impact across multiple outcomes with the goal of achieving a tipping point for better health. Our focus is on early life (ActEarly) in recognition of childhood and adolescence being such critical periods for influencing lifelong health and wellbeing.
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Affiliation(s)
- John Wright
- Bradford Institute for Health Research, Bradford, BD9 6RJ, UK
| | - Andrew Hayward
- Institute of Epidemiology and Health Care, UCL, London, WC1E 6BT, UK
| | - Jane West
- Bradford Institute for Health Research, Bradford, BD9 6RJ, UK
| | - Kate Pickett
- Department of Health Sciences, University of York, UK, York, YO10 5DD, UK
| | | | | | - Nicola Christie
- Centre for Transport Studies, Department of Civil, Environmental and Geomatic Engineering, UCL, London, WC1E 6BT, UK
| | - Laura Vaughan
- Space Syntax Laboratory, Bartlett School of Architecture, UCL, London, WC1E 6BT, UK
| | - Jess Sheringham
- Institute of Epidemiology and Health Care, UCL, London, WC1E 6BT, UK
| | - Muki Haklay
- Extreme Citizen Science Group, Department of Geography, UCL, London, WC1E 6BT, UK
| | - Laura Sheard
- Bradford Institute for Health Research, Bradford, BD9 6RJ, UK
| | - Josie Dickerson
- Bradford Institute for Health Research, Bradford, BD9 6RJ, UK
| | - Sally Barber
- Bradford Institute for Health Research, Bradford, BD9 6RJ, UK
| | - Neil Small
- University of Bradford, Bradford, BD7 1DP, UK
| | - Richard Cookson
- Centre for Health Economics, University of York, York, YO10 5DD, UK
| | - Philip Garnett
- York Cross-disciplinary Centre for Systems Analysis and School of Management, University of York, York, YO10 5GD, UK
| | - Tracey Bywater
- Department of Health Sciences, University of York, UK, York, YO10 5DD, UK
| | - Nicholas Pleace
- Centre for Housing Policy, University of York, UK, York, YO10 5DD, UK
| | - Eric J Brunner
- Institute of Epidemiology and Health Care, UCL, London, WC1E 6BT, UK
| | - Claire Cameron
- Department of Social Science, UCL Institute of Education, UCL, London, WC1H 0AA, UK
| | - Marcella Ucci
- UCL Institute for Environmental Design and Engineering, The Bartlett Faculty of the Built Environment, UCL, London, WC1H 0NN, UK
| | - Steve Cummins
- Population Health Innovation Lab, Department of Public Health, Environments & Society, London School of Hygiene & Tropical Medicine, London, WC1H 9SH, UK
| | - Daisy Fancourt
- Institute of Epidemiology and Health Care, UCL, London, WC1E 6BT, UK
| | - Jens Kandt
- Space Syntax Laboratory, Bartlett School of Architecture, UCL, London, WC1E 6BT, UK
| | - Paul Longley
- Consumer Data Research Centre Department of Geography, UCL, London, WC1E 6BT, UK
| | - Steve Morris
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, CB1 8RN, UK
| | | | | | | | | | - Tiffany Yang
- Bradford Institute for Health Research, Bradford, BD9 6RJ, UK
| | - Dan Mason
- Bradford Institute for Health Research, Bradford, BD9 6RJ, UK
| | | | - Richard Romano
- Institute for Transport Studies, University of Leeds, Leeds, LS2 9JT, UK
| | - Maria Bryant
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, LS2 9JT, UK
| | - Liam Crosby
- Institute of Epidemiology and Health Care, UCL, London, WC1E 6BT, UK
| | - Trevor Sheldon
- Department of Health Sciences, University of York, UK, York, YO10 5DD, UK
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Evans H, Blackburn R, Cornes M, Menezes D, Story A, Hayward A, Aldridge R. Intermediate-linkage steps used to obtain longitudinal data (containing heath service use, morbidity and mortality) for a large cohort of patients who are homeless that visited, and were discharged from hospital in England. Int J Popul Data Sci 2018. [DOI: 10.23889/ijpds.v3i4.961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
IntroductionIn England, details on hospital admissions and mortality are recorded nationally, but housing status and patients’ hospital discharge arrangements are only recorded locally within discharge services. These data are required to evaluate specialist homeless hospital discharge (HHD) services in England, and can be obtained through linkage within and across sectors.
Objectives and ApproachWe aimed to improve linkage to enable the evaluation of HHD schemes. 16 sites with a scheme were recruited along with a specialist facility that deliver screening and treatment services to homeless hostels (Find\&Treat). Linkage fields including National Health Service number (NHS number), name, gender and birthdate for clinical contacts between November 2013 and November 2016 were collected and linked to national hospital data, Hospital Episodes Statistics (HES). To improve linkage with HES, intermediate-linkage to a gender-names dictionary and a national demographic database (NDD) was performed. Ethics, access permissions were obtained through HRA-REC (REC16/EE/0018) and NHS CAG (16/CAG/0021).
Results47,569 clinical contacts among people who were homeless were collected from Find&Treat and 12,931 from sites. The median age at mid-study period (15th May 2015) among contacts with sites compared to Find&Treat were similar at 44 (IQR 34-53, n=12,905) and 45 (IQR 35-54, n=47,569), respectively. Among Find&Treat, 82% (n=38,905) were contacts with Males and 18% (n=8,650) with Females. Gender was not collected at all HHD sites or for all admissions. 70% of contacts had missing gender and among these contacts, gender was assigned using the gender-names dictionary. After imputing gender, 52% of contacts all linkage fields and 47% had all but NHS number. These data were linked to the NDD, an approximate 60% linkage rate was achieved retrieving complete linkage fields for these contacts.
Conclusion/ImplicationsIntermediate linkage steps described here provides the largest dataset of it’s kind, enabling investigations into effectiveness of hospital discharge schemes in England. The study provides generally a proof of concept that large cohorts of hard-to-reach population groups can be obtained through data linkage.
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Juarez S, Honkaniemi H, Dunlavy A, Aldridge R, Barreto M, Katikireddi S, Rostila M. 1.3-O2A systematic review of evaluations of the health impacts of migration-oriented public policies. Eur J Public Health 2018. [DOI: 10.1093/eurpub/cky047.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- S Juarez
- Centre for Health Equity Studies, Stockholm University, Sweden
| | - H Honkaniemi
- Centre for Health Equity Studies, Stockholm University, Sweden
| | - A Dunlavy
- Centre for Health Equity Studies, Stockholm University, Sweden
| | - R Aldridge
- University College London, United Kingdom
| | - M Barreto
- Universidade Federal de Bahia, Brazil
| | - S Katikireddi
- MRC/CSO Social & Public Health Sciences Unit, University of Glasgow, United Kingdom
| | - M Rostila
- Centre for Health Equity Studies, Stockholm University, Sweden
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Cornes M, Whiteford M, Manthorpe J, Neale J, Byng R, Hewett N, Clark M, Kilmister A, Fuller J, Aldridge R, Tinelli M. Improving hospital discharge arrangements for people who are homeless: A realist synthesis of the intermediate care literature. Health Soc Care Community 2018; 26:e345-e359. [PMID: 28730744 DOI: 10.1111/hsc.12474] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/19/2017] [Indexed: 06/07/2023]
Abstract
This review presents a realist synthesis of "what works and why" in intermediate care for people who are homeless. The overall aim was to update an earlier synthesis of intermediate care by capturing new evidence from a recent UK government funding initiative (the "Homeless Hospital Discharge Fund"). The initiative made resources available to the charitable sector to enable partnership working with the National Health Service (NHS) in order to improve hospital discharge arrangements for people who are homeless. The synthesis adopted the RAMESES guidelines and reporting standards. Electronic searches were carried out for peer-reviewed articles published in English from 2000 to 2016. Local evaluations and the grey literature were also included. The inclusion criteria was that articles and reports should describe "interventions" that encompassed most of the key characteristics of intermediate care as previously defined in the academic literature. Searches yielded 47 articles and reports. Most of these originated in the UK or the USA and fell within the realist quality rating of "thick description". The synthesis involved using this new evidence to interrogate the utility of earlier programme theories. Overall, the results confirmed the importance of (i) collaborative care planning, (ii) reablement and (iii) integrated working as key to effective intermediate care delivery. However, the additional evidence drawn from the field of homelessness highlighted the potential for some theory refinements. First, that "psychologically informed" approaches to relationship building may be necessary to ensure that service users are meaningfully engaged in collaborative care planning and second, that integrated working could be managed differently so that people are not "handed over" at the point at which the intermediate care episode ends. This was theorised as key to ensuring that ongoing care arrangements do not break down and that gains are not lost to the person or the system vis-à-vis the prevention of readmission to hospital.
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Affiliation(s)
- Michelle Cornes
- Social Care Workforce Research Unit, King's College London, London, UK
| | - Martin Whiteford
- Health Services Research, University of Liverpool, Liverpool, UK
| | - Jill Manthorpe
- Social Care Workforce Research Unit, King's College London, London, UK
| | - Joanne Neale
- National Addiction Centre, Institute of Psychiatry, King's College London, London, UK
| | - Richard Byng
- Clinical Trials and Health Research, University of Plymouth, Plymouth, UK
| | - Nigel Hewett
- Pathway, University College Hospital Homeless Team, London, UK
| | - Michael Clark
- The London School of Economics & Political Science, London, UK
| | - Alan Kilmister
- Social Care Workforce Research Unit, King's College London, London, UK
| | - James Fuller
- Social Care Workforce Research Unit, King's College London, London, UK
| | - Robert Aldridge
- Public Health Informatics, University College London, London, UK
| | - Michela Tinelli
- The London School of Economics & Political Science, London, UK
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Hagger-Johnson G, Harron K, Goldstein H, Aldridge R, Gilbert R. Probabilistic linkage to enhance deterministic algorithms and reduce data linkage errors in hospital administrative data. J Innov Health Inform 2017; 24:891. [PMID: 28749318 PMCID: PMC6217911 DOI: 10.14236/jhi.v24i2.891] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2016] [Revised: 12/15/2016] [Accepted: 05/15/2017] [Indexed: 11/18/2022] Open
Abstract
Background The pseudonymisation algorithm used to link together episodes of care belonging to the same patient in England [Hospital Episode Statistics ID (HESID)] has never undergone any formal evaluation to determine the extent of data linkage error. Objective To quantify improvements in linkage accuracy from adding probabilistic linkage to existing deterministic HESID algorithms. Methods Inpatient admissions to National Health Service (NHS) hospitals in England (HES) over 17 years (1998 to 2015) for a sample of patients (born 13th or 28th of months in 1992/1998/2005/2012). We compared the existing deterministic algorithm with one that included an additional probabilistic step, in relation to a reference standard created using enhanced probabilistic matching with additional clinical and demographic information. Missed and false matches were quantified and the impact on estimates of hospital readmission within one year was determined. Results HESID produced a high missed match rate, improving over time (8.6% in 1998 to 0.4% in 2015). Missed matches were more common for ethnic minorities, those living in areas of high socio-economic deprivation, foreign patients and those with ‘no fixed abode’. Estimates of the readmission rate were biased for several patient groups owing to missed matches, which were reduced for nearly all groups. Conclusion Probabilistic linkage of HES reduced missed matches and bias in estimated readmission rates, with clear implications for commissioning, service evaluation and performance monitoring of hospitals. The existing algorithm should be modified to address data linkage error, and a retrospective update of the existing data would address existing linkage errors and their implications.
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Affiliation(s)
| | | | - Harvey Goldstein
- 1. University of Bristol 2. Administrative Data Research Centre England (ADRC-E), UCL.
| | | | - Ruth Gilbert
- Administrative Data Research Centre England (ADRC-E), UCL.
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Ferenando G, Hemming S, Yates S, Possas L, Garber E, Gant V, Aldridge R, Geretti A, Harvey J, Hayward A, Lipman M, McHugh T, Story A. S61 High Levels Of Latent Tb Infection, Blood Borne Viruses, Poor Treatment Outcomes And Unmet Need Among Hard To Reach Groups In London: The Tb Reach Study. Thorax 2014. [DOI: 10.1136/thoraxjnl-2014-206260.67] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Aldridge R, Yates S, Hemming S, Possas L, Ferenando G, Garber E, Hayward A, McHugh T, Lipman M, Story A. S80 Impact Of Peer Educators On Uptake Of Mobile X-ray Tuberculosis Screening At Homeless Hostels: A Cluster Randomised Controlled Trial. Thorax 2014. [DOI: 10.1136/thoraxjnl-2014-206260.86] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Smith GM, Carroll D, Mukherjee S, Aldridge R, Jayakumar S, McCarthy L, Chandran H, Parashar K. Health-related quality of life in patients reliant upon mitrofanoff catheterisation. Eur J Pediatr Surg 2011; 21:263-5. [PMID: 21590655 DOI: 10.1055/s-0031-1275748] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Aim of the study was determine health care outcomes from the patients' perspective in patients reliant on Mitrofanoff catheterisation for bladder emptying. SUBJECTS/PATIENTS Patients over the age of 16 dependent on Mitrofanoff catheterisation for bladder emptying were asked to complete a health care outcome questionnaire, the SF-36 (®) Health Survey v2. Quality of life measures for 8 health concepts were compared against published data for the normal population. RESULTS Out of a total of 25 patients who were eligible for enrolment into our study, we were able to contact 19 patients. The norm-based score for Physical Functioning (PF=50.4), Role Physical (RP=53.8), Bodily Pain (BP=55.6), Vitality (VT=56.9), Social Functioning (SF=51.5), Role Emotional (RE=52.2), and Mental Health (MH=54.6) were all higher than those reported within the normal population (normal=50.0). Physical and mental component summary measures were higher than in the normal population. When compared against age-matched norms our patient group scored higher than the normal population for all measures except Physical Functioning (50.4 vs. 53.4) and physical component summary (51.9 vs. 53.5). The self-reported scores for Vitality, Mental Health and the mental component summary were all statistically significantly better than those seen in the age-matched control population (p<0.01). CONCLUSIONS Quality of life in patients dependent on Mitrofanoff catheterisation for bladder emptying is good. The SF-36 measures 8 major health care outcomes and in our patients these measures of health were similar to those seen in the general population, rather than the poorer outcomes reported in patients with other chronic medical conditions.
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Affiliation(s)
- G M Smith
- Birmingham Children's Hospital, Paediatric Urology, Birmingham, United Kingdom.
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English J, Aldridge R, Gawkrodger DJ, Kownacki S, Statham B, White JML, Williams J. Consensus statement on the management of chronic hand eczema. Clin Exp Dermatol 2010; 34:761-9. [PMID: 19747339 DOI: 10.1111/j.1365-2230.2009.03649.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The management of chronic hand eczema is often inadequate. There are currently no evidence-based guidelines specifically for the management of chronic hand eczema, and evidence for established treatments for hand eczema is not of sufficient quality to guide clinical practice. This consensus statement, based on a review of published data and clinical practice in both primary and secondary care, is intended to guide the management of chronic hand eczema. It describes the epidemiology and pathogenesis of hand eczema, its diagnosis and its effect on patients' quality of life. Management strategies include a skin education programme, lifestyle changes, and the use of emollients, barriers and soap substitutes. Topical drug therapy includes topical steroids and calcineurin inhibitors. Treatment with psoralen ultraviolet A and systemic therapies may then be appropriate, although there is no strong evidence of efficacy. Alitretinoin has been shown to be effective in a randomized controlled trial, and is currently the only treatment specifically licensed for the treatment of hand eczema. Recommendations for management are summarized in a treatment algorithm.
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Affiliation(s)
- J English
- Department of Dermatology, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK.
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Abstract
KCNE1 associates with the pore-forming alpha-subunit KCNQ1 to generate the slow (I(Ks)) current in cardiac myocytes. Mutations in either KCNQ1 or KCNE1 can alter the biophysical properties of I(Ks) and mutations in KCNE1 underlie cases of long QT syndrome type 5 (LQT5). We previously investigated a mutation in KCNE1, T58P/L59P, which causes severe attenuation of I(Ks). However, how T58P/L59P acts to disrupt I(Ks) has not been determined. In this study, we investigate and compare the effects of T58P/L59P with three other LQT5 mutations (G52R, S74L, and R98W) on the biophysical properties of the current, trafficking of KCNQ1, and assembly of the I(Ks) channel. G52R and T58P/L59P produce currents that lack the kinetic behavior of I(Ks). In contrast, S74L and R98W both produce I(Ks)-like currents but with rightward shifted voltage dependence of activation. All of the LQT5 mutants express protein robustly, and T58P/L59P and R98W cause modest, but significant, defects in the trafficking of KCNQ1. Despite defects in trafficking, in the presence of KCNQ1, T58P/L59P and the other LQT5 mutants are present at the plasma membrane. Interestingly, in comparison to KCNE1 and the other LQT5 mutants, T58P/L59P associates only weakly with KCNQ1. In conclusion, we identify the disease mechanisms for each mutation and reveal that T58P/L59P causes disease through a novel mechanism that involves defective I(Ks) complex assembly.
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Affiliation(s)
- Stephen C Harmer
- Department of Medicine, University College London, London, WC1E 6JJ, UK
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Aldridge R, Bufalino AD, Robison C, Salgado C, Khayyat P. Female sex-pheromone volatility and male uric acid excretion during courtship in captive African brown house snakes, Lamprophis fuliginosus. AMPHIBIA-REPTILIA 2005. [DOI: 10.1163/156853805774806340] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Lapeer RJ, Tan AC, Aldridge R. Active Watersheds: Combining 3D Watershed Segmentation and Active Contours to Extract Abdominal Organs from MR Images. Medical Image Computing and Computer-Assisted Intervention — MICCAI 2002 2002. [DOI: 10.1007/3-540-45786-0_74] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
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Abstract
1203 patients attending for routine patch testing at 3 hospitals and 105 volunteers were tested with 0.5% and 0.05% gold sodium thiosulfate (GST). 38 patients (3.2%) and 5 volunteers (4.8%) had positive patch tests to GST. There were no significant differences between volunteers and patients with respect to age, sex, atopy or exposure to gold in dental restorations, jewellery or through occupation. There were no significant differences in prevalence of GST hypersensitivity in the 3 hospitals, or between patients and controls. This is the 1st controlled study of hypersensitivity to GST, and suggests that routine patch testing to gold is of limited clinical benefit.
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Affiliation(s)
- C Fleming
- University Department of Dermatology Western Infirmary, Glasgow, Scotland, UK
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Aldridge R. From darkness with courage... Nurs N Z 1997; 3:21-22. [PMID: 9386466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
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Abstract
The objectives of this study were to estimate the prevalence of obesity in school-aged children in Jefferson County, Alabama; to learn when school-aged children become obese; to determine the susceptible groups; and to study the association between obesity and blood pressure. During the school year, 5,953 children, ranging in age from 5 years to 11 years, were screened for weight, height, and blood pressure, using standardized techniques. We found that obesity, defined as > or = 120% of ideal body weight for height, is prevalent in 5-year-old to 11-year-old children. The prevalence of obesity in girls at age 5 was 23% in blacks and 10% in whites, rising to 47% in blacks and 27% in whites by age 11. In boys, the prevalence of obesity at age 5 was 13% in blacks and 6% in whites, rising to 29% in blacks and 22% in whites by age 11. The prevalence of obesity is significantly greater in black than in white children and is also significantly greater in girls than boys. The systolic and diastolic blood pressures were significantly higher in obese than in non-obese children. We conclude that the significant prevalence of childhood obesity and an associated complication, increased blood pressure, emerge in school-aged children. Thus, we recommend investigations of prevention and intervention programs to be used in the school setting.
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Affiliation(s)
- R Figueroa-Colon
- Department of Pediatrics, University of Alabama at Birmingham, Children's Hospital of Alabama 35233, USA
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Farid A, Aldridge R, Kashyap A. Foreign body lodged in the palate. Am Fam Physician 1996; 54:874, 878. [PMID: 8784161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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Kashyap A, Farid A, Aldridge R, King AB. Lingual tonsil causing airway obstruction. Ear Nose Throat J 1994; 73:830-1, 834. [PMID: 7828476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Affiliation(s)
- A Kashyap
- Department of Surgery, Guthrie Clinic, Sayre, Pennsylvania 18840
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Abstract
A 65-year-old man with paroxysmal atrial flutter was treated with digoxin and flecainide. The atrial flutter rate was slowed to 190 beats per minute but at times 1:1 AV conduction occurred.
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Affiliation(s)
- A Ahsan
- Department of Cardiology, Northern General Hospital, Sheffield, UK
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Aldridge R, Cady EB, Jones DA, Obletter G. Muscle pain after exercise is linked with an inorganic phosphate increase as shown by 31P NMR. Biosci Rep 1986; 6:663-7. [PMID: 3779042 DOI: 10.1007/bf01114761] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
31P nuclear magnetic resonance (NMR) spectra were obtained from the forearm muscles of 5 subjects before and after performing a muscle stretching (eccentric) exercise routine. Spectra collected before and immediately after exercise showed normal resting phosphorylated metabolite levels and unchanged intracellular pH (pHi). Measurements made on the day following exercise, when muscular pain was apparent, revealed an elevated inorganic phosphate level. No significant changes in other metabolites or pHi were detected. This study gives the first indication of biochemical change following a form of exercise that is associated with considerable muscle pain and damage. The findings may help in understanding pathological processes resulting in pain and damage in muscle.
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Aldridge R, Coombes H, Prowle B. Assessment of the Oxoid I.M. reagent card for infectious mononucleosis. Med Lab Technol 1973; 30:57-60. [PMID: 4718029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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