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Seaton SE, Battersby C, Davis PJ, Fenton AC, Anderson J, van Hasselt TJ, Draper E. Characteristics of children requiring admission to neonatal care and paediatric intensive care before the age of 2 years in England and Wales: a data linkage study. Arch Dis Child 2024; 109:387-394. [PMID: 38346868 DOI: 10.1136/archdischild-2023-325986] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 01/13/2024] [Indexed: 04/20/2024]
Abstract
OBJECTIVE To quantify the characteristics of children admitted to neonatal units (NNUs) and paediatric intensive care units (PICUs) before the age of 2 years. DESIGN A data linkage study of routinely collected data. SETTING National Health Service NNUs and PICUs in England and Wales PATIENTS: Children born from 2013 to 2018. INTERVENTIONS None. MAIN OUTCOME MEASURE Admission to PICU before the age of 2 years. RESULTS A total of 384 747 babies were admitted to an NNU and 4.8% (n=18 343) were also admitted to PICU before the age of 2 years. Approximately half of all children admitted to PICU under the age of 2 years born in the same time window (n=18 343/37 549) had previously been cared for in an NNU.The main reasons for first admission to PICU were cardiac (n=7138) and respiratory conditions (n=5386). Cardiac admissions were primarily from children born at term (n=5146), while respiratory admissions were primarily from children born preterm (<37 weeks' gestational age, n=3550). A third of children admitted to PICU had more than one admission. CONCLUSIONS Healthcare professionals caring for babies and children in NNU and PICU see some of the same children in the first 2 years of life. While some children are following established care pathways (eg, staged cardiac surgery), the small proportion of children needing NNU care subsequently requiring PICU care account for a large proportion of the total PICU population. These differences may affect perceptions of risk for this group of children between NNU and PICU teams.
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Affiliation(s)
- Sarah E Seaton
- Department of Population Health Sciences, University of Leicester, Leicester, UK
| | - Cheryl Battersby
- Neonatal Medicine, School of Public Health, Imperial College London, London, UK
| | - Peter J Davis
- Paediatric Intensive Care Unit, Bristol Royal Hospital for Children, Bristol, Bristol, UK
| | - Alan C Fenton
- Newcastle Neonatal Service, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | | | - Tim J van Hasselt
- Department of Population Health Sciences, University of Leicester, Leicester, UK
| | - Elizabeth Draper
- Department of Population Health Sciences, University of Leicester, Leicester, UK
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2
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Iacobucci G. New death certification process for England and Wales will start in September. BMJ 2024; 385:q878. [PMID: 38626985 DOI: 10.1136/bmj.q878] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
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Alwafi H, Alsharif A. Trends in hospital admissions and prescribing due to diseases of the digestive system in England and Wales between 1999 and 2019: An ecological study. Medicine (Baltimore) 2024; 103:e37673. [PMID: 38608100 PMCID: PMC11018217 DOI: 10.1097/md.0000000000037673] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 02/29/2024] [Indexed: 04/14/2024] Open
Abstract
This study aimed to investigate the trends in diseases of the digestive system hospital admissions (DDSHA) in England and Wales between (1999-2019). Secondary objectives were to investigate the type of admission and medication prescribing related to the digestive system in England. This is an ecological study using data from the Hospital Episode Statistics (HES) database and the Patient Episode Database between April 1999 and March 2019. The rate of hospital admissions with 95% confidence intervals (CIs) was calculated by dividing the number of DDSHA by the mid-year population. The trend in hospital admissions was assessed using a Poisson model. Overall, the rate of DDSHA rose by 84.2% (from 2231.27 [95% CI 2227.26-2235.28] in 1999 to 4109.33 [95% CI 4104.29-4114.38] in 2019 per 100,000 persons, trend test, P < .001). The most remarkable rise in hospital admission was seen in liver diseases, followed by other diseases of intestines with 1.85-fold, and 1.59-fold, respectively. Between 2004 and 2019, the overall prescribing rate for medications related to the gastrointestinal system increased by 74.6%, and stoma care related medications prescribing rate increased by 2.25-fold, followed by drugs affecting intestinal secretions and antisecretory drugs and mucosal protectants. There was an increase in hospital admission rate due to GI diseases in the United Kingdom (UK) by 84.2% from 1999 to 2019. The most remarkable rise in the rate of hospital admissions was seen in diseases of the liver and intestine.
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Affiliation(s)
- Hassan Alwafi
- Department of Pharmacology and Toxicology, Faculty of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Alaa Alsharif
- Department of Pharmacy Practice, College of Pharmacy, Princess Noura Bint Abdulrahman University, Riyadh, Saudi Arabia
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Marchant E, Dowd J, Bray L, Rowlands G, Miles N, Crick T, James M, Dadaczynski K, Okan O. The well-being and work-related stress of senior school leaders in Wales and Northern Ireland during COVID-19 "educational leadership crisis": A cross-sectional descriptive study. PLoS One 2024; 19:e0291278. [PMID: 38598518 PMCID: PMC11006137 DOI: 10.1371/journal.pone.0291278] [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: 08/24/2023] [Accepted: 03/20/2024] [Indexed: 04/12/2024] Open
Abstract
The COVID-19 pandemic caused far-reaching societal changes, including significant educational impacts affecting over 1.6 billion pupils and 100 million education practitioners globally. Senior school leaders were at the forefront and were exposed to particularly high demands during a period of "crisis leadership". This occupation were already reporting high work-related stress and large numbers leaving the profession preceding COVID-19. This cross-sectional descriptive study through the international COVID-Health Literacy network aimed to examine the well-being and work-related stress of senior school leaders (n = 323) in Wales (n = 172) and Northern Ireland (n = 151) during COVID-19 (2021-2022). Findings suggest that senior school leaders reported high workloads (54.22±11.30 hours/week), low well-being (65.2% n = 202, mean WHO-5 40.85±21.57), depressive symptoms (WHO-5 34.8% n = 108) and high work-related stress (PSS-10: 29.91±4.92). High exhaustion (BAT: high/very high 89.0% n = 285) and specific psychosomatic complaints (experiencing muscle pain 48.2% n = 151) were also reported, and females had statistically higher outcomes in these areas. School leaders were engaging in self-endangering working behaviours; 74.7% (n = 239) gave up leisure activities in favour of work and 63.4% (n = 202) sacrificed sufficient sleep, which was statistically higher for females. These findings are concerning given that the UK is currently experiencing a "crisis" in educational leadership against a backdrop of pandemic-related pressures. Senior leaders' high attrition rates further exacerbate this, proving costly to educational systems and placing additional financial and other pressures on educational settings and policy response. This has implications for senior leaders and pupil-level outcomes including health, well-being and educational attainment, requiring urgent tailored and targeted support from the education and health sectors. This is particularly pertinent for Wales and Northern Ireland as devolved nations in the UK, who are both implementing or contemplating major education system level reforms, including new statutory national curricula, requiring significant leadership, engagement and ownership from the education profession.
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Affiliation(s)
- Emily Marchant
- Department of Education and Childhood Studies, Faculty of Humanities and Social Sciences, Swansea University, Swansea, United Kingdom
| | - Joanna Dowd
- Health Researcher (Freelance), Northern Ireland, United Kingdom
| | - Lucy Bray
- School of Nursing, Midwifery and Allied Health, Faculty of Health, Social Care and Medicine, Edge Hill University, Edge Hill, United Kingdom
| | - Gill Rowlands
- Public Health Sciences Institute, Newcastle University, Newcastle, United Kingdom
| | - Nia Miles
- National Academy for Educational Leadership Wales, United Kingdom
| | - Tom Crick
- Department of Education and Childhood Studies, Faculty of Humanities and Social Sciences, Swansea University, Swansea, United Kingdom
| | - Michaela James
- National Centre for Population Health and Wellbeing Research, Population Data Science, Faculty of Medicine, Health and Life Science, Swansea University, Swansea, United Kingdom
| | - Kevin Dadaczynski
- Department of Health Sciences, Fulda University of Applied Sciences, Fulda, Germany
- Centre for Applied Health Sciences, Leuphana University Lüneburg, Lüneburg, Germany
| | - Orkan Okan
- Department of Sport and Health Sciences, Center for Health and Medicine in Society, School of Medicine and Health, Munich, Germany
- Department of Sport and Health Sciences, Center for Health Promotion in Childhood and Adolescence, School of Medicine and Health, Munich, Germany
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Ward IL, Finning K, Ayoubkhani D, Hendry K, Sharland E, Appleby L, Nafilyan V. Sociodemographic inequalities of suicide: a population-based cohort study of adults in England and Wales 2011-21. Eur J Public Health 2024; 34:211-217. [PMID: 38326992 DOI: 10.1093/eurpub/ckad233] [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] [Subscribe] [Scholar Register] [Indexed: 02/09/2024] Open
Abstract
BACKGROUND The risk of suicide is complex and often a result of multiple interacting factors. Understanding which groups of the population are most at risk of suicide is important to inform the development of targeted public health interventions. METHODS We used a novel linked dataset that combined the 2011 Census with the population-level mortality data in England and Wales. We fitted generalized linear models with a Poisson link function to estimate the rates of suicide across different sociodemographic groups and to identify which characteristics are independent predictors of suicide. RESULTS Overall, the highest rates of suicide were among men aged 40-50 years, individuals who reported having a disability or long-term health problem, those who were unemployed long term or never had worked, and those who were single or separated. After adjusting for other characteristics such as employment status, having a disability or long-term health problem, was still found to increase the incidence of suicide relative to those without impairment [incidence rate ratio minimally adjusted (women) = 3.5, 95% confidence interval (CI) = 3.3-3.6; fully adjusted (women) 3.1, 95% CI = 3.0-3.3]. Additionally, while the absolute rate of suicide was lower in women compared with men, the relative risk in people reporting impairments compared with those who do not was higher in women compared with men. CONCLUSIONS The findings of this work provide novel population-level insights into the risk of suicide by sociodemographic characteristics in England and Wales. Our results highlight several sociodemographic groups who may benefit from more targeted suicide prevention policies and practices.
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Affiliation(s)
| | | | | | | | | | - Louis Appleby
- Division of Psychology and Mental Health, University of Manchester, Manchester, UK
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Duke K, MacGregor S. Responding to 'wicked problems': policy and governance on drug-related deaths in English and Welsh prisons, 2015-2021. Int J Drug Policy 2024; 126:104358. [PMID: 38401175 DOI: 10.1016/j.drugpo.2024.104358] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 02/09/2024] [Accepted: 02/10/2024] [Indexed: 02/26/2024]
Abstract
BACKGROUND Prison settings have been neglected in the growing literature on drug-related deaths. This paper explores policy and practice issues regarding the governance of drug-related deaths in prisons in England and Wales from 2015-2021. METHODS Thematic documentary analysis was conducted on national level policy documents published between 2015-2021 (e.g. drug strategies, prison policy documents, Her Majesty's Inspectorate of Prisons and Prison and Probation Ombudsman (PPO) annual reports and guidance for staff). At the local (prison) level, all of the PPO fatal investigation reports and their associated action plans relating to 171 drug-related deaths from 2015-2021 were analysed thematically. Various modes of governance were identified using Head's 'wicked problems' conceptual framework including avoidance and denial, coercive controls, compartmentalised micro-management, incremental and pragmatic adjustment and technocratic problem-solving. RESULTS There was strong evidence of the dominance of denial of the problem of drug-related deaths, coercive controls, micro-management and reliance on technological solutions in the early years (2015-2018). In some prisons, there developed a move towards the adoption of more pragmatic and incremental policies and push towards comprehensive policies over time. In others, remnants of denial and coercion remained. In our analysis, the focus on new psychoactive substances came to dominate attention, to the relative neglect of other substances and of the contribution of mental and physical illness to these deaths. Staff are not equipped, supported or resourced adequately to deal with the two 'wicked problems' of increasing rates of drug use and mental illness which collide in the prison setting. CONCLUSION The PPO investigations repeatedly recommend reducing supply and improving monitoring and surveillance and the emergency response. There is less focus on prevention and reducing demand or improving the wider environmental context and culture in which the deaths occur. Policy needs to pay more attention to the fundamental issues driving the current deterioration in conditions in prisons.
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Affiliation(s)
- Karen Duke
- Drug and Alcohol Research Centre, Middlesex University, London, UK.
| | - Susanne MacGregor
- London School of Hygiene and Tropical Medicine, University of London, UK
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7
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Iacobucci G. Healthy life expectancy has fallen in England and Wales, data show. BMJ 2024; 384:q774. [PMID: 38548293 DOI: 10.1136/bmj.q774] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
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8
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Hiam L, McKee M, Dorling D. Influenza: cause or excuse? An analysis of flu's influence on worsening mortality trends in England and Wales, 2010-19. Br Med Bull 2024; 149:72-89. [PMID: 38224198 PMCID: PMC10938544 DOI: 10.1093/bmb/ldad028] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 10/20/2023] [Accepted: 10/27/2023] [Indexed: 01/16/2024]
Abstract
BACKGROUND England and Wales experienced a stagnation of previously improving life expectancy during the 2010s. Public bodies cited influenza as an important cause. SOURCES OF DATA We used data from the Office for National Statistics to examine mortality attributed directly to influenza and to all influenza-like diseases for the total population of England and Wales 2010-19. Several combinations of ICD-10 codes were used to address the possibility of under-counting influenza deaths. AREAS OF AGREEMENT Deaths from influenza and influenza-like diseases declined between 2010 and 2019, while earlier improvements in mortality from all causes of death were stalling and, with some causes, worsening. Our findings support existing research showing that influenza is not an important cause of the stalling of mortality rates 2010-19. AREAS OF CONTROVERSY Influenza was accepted by many as an important cause of stalling life expectancy for much of the 2010s, while few in public office have accepted austerity as a key factor in the changes seen during that time. GROWING POINTS This adds to the mounting evidence that austerity damaged health prior to COVID-19 and left the population more vulnerable when it arrived. AREAS FOR DEVELOPING TIMELY RESEARCH Future research should explore why so many in public office were quick to attribute the change in trends in overall mortality in the UK in this period to influenza, and why many continue to do so through to 2023 and to deny the key role of austerity in harming population health.
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Affiliation(s)
- Lucinda Hiam
- University of Oxford, School of Geography and the Environment, South Parks Road, Oxford OX1 3QY, UK
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK
| | - Martin McKee
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK
| | - Danny Dorling
- University of Oxford, School of Geography and the Environment, South Parks Road, Oxford OX1 3QY, UK
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9
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Wilkinson E. Covid inquiry: What we have learnt about Wales's response? BMJ 2024; 384:q608. [PMID: 38467400 DOI: 10.1136/bmj.q608] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/13/2024]
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10
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McLintock K, Sheard L. Prison healthcare in England and Wales is in perpetual crisis. BMJ 2024; 384:q562. [PMID: 38467403 DOI: 10.1136/bmj.q562] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/13/2024]
Affiliation(s)
- Kate McLintock
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Laura Sheard
- Department of Health Sciences, University of York, York, UK
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11
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Janssen F, Van Hemelrijck W, Kagenaar E, Sizer A. Enabling the examination of long-term mortality trends by educational level for England and Wales in a time-consistent and internationally comparable manner. Popul Health Metr 2024; 22:4. [PMID: 38461232 PMCID: PMC10925007 DOI: 10.1186/s12963-024-00324-2] [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: 05/16/2023] [Accepted: 02/26/2024] [Indexed: 03/11/2024] Open
Abstract
BACKGROUND Studying long-term trends in educational inequalities in health is important for monitoring and policy evaluation. Data issues regarding the allocation of people to educational groups hamper the study and international comparison of educational inequalities in mortality. For the UK, this has been acknowledged, but no satisfactory solution has been proposed. OBJECTIVE To enable the examination of long-term mortality trends by educational level for England and Wales (E&W) in a time-consistent and internationally comparable manner, we propose and implement an approach to deal with the data issues regarding mortality data by educational level. METHODS We employed 10-year follow-ups of individuals aged 20+ from the Office for National Statistics Longitudinal Study (ONS-LS), which include education information from each decennial census (1971-2011) linked to individual death records, for a 1% representative sample of the E&W population. We assigned the individual cohort data to single ages and calendar years, and subsequently obtained aggregate all-cause mortality data by education, sex, age (30+), and year (1972-2017). Our data adjustment approach optimised the available education information at the individual level, and adjusts-at the aggregate level-for trend discontinuities related to the identified data issues, and for differences with country-level mortality data for the total population. RESULTS The approach resulted in (1) a time-consistent and internationally comparable categorisation of educational attainment into the low, middle, and high educated; (2) the adjustment of identified data-quality related discontinuities in the trends over time in the share of personyears and deaths by educational level, and in the crude and the age-standardised death rate by and across educational levels; (3) complete mortality data by education for ONS-LS members aged 30+ in 1972-2017 which aligns with country-level mortality data for the total population; and (4) the estimation of inequality measures using established methods. For those aged 30+ , both absolute and relative educational inequalities in mortality first increased and subsequently decreased. CONCLUSION We obtained additional insights into long-term trends in educational inequalities in mortality in E&W, and illustrated the potential effects of different data issues. We recommend the use of (part of) the proposed approach in other contexts.
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Affiliation(s)
- Fanny Janssen
- Netherlands Interdisciplinary Demographic Institute, KNAW/University of Groningen, Lange Houtstraat 19, 2511 CV, The Hague, The Netherlands.
- Population Research Centre, Faculty of Spatial Sciences, University of Groningen, Groningen, The Netherlands.
| | - Wanda Van Hemelrijck
- Netherlands Interdisciplinary Demographic Institute, KNAW/University of Groningen, Lange Houtstraat 19, 2511 CV, The Hague, The Netherlands
| | - Eva Kagenaar
- Netherlands Interdisciplinary Demographic Institute, KNAW/University of Groningen, Lange Houtstraat 19, 2511 CV, The Hague, The Netherlands
| | - Alison Sizer
- Centre for Longitudinal Study Information & User Support (CeLSIUS), Department of Information Studies, University College London (UCL), London, UK
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Chen Y, Brunner EJ. Do age-standardised dementia incidence rates really increase in England and Wales? - Authors' reply. Lancet Public Health 2024; 9:e154. [PMID: 38429015 DOI: 10.1016/s2468-2667(24)00021-5] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 01/29/2024] [Indexed: 03/03/2024]
Affiliation(s)
- Yuntao Chen
- Department of Epidemiology and Public Health, University College London, London, UK.
| | - Eric J Brunner
- Department of Epidemiology and Public Health, University College London, London, UK
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Disease surveillance in England and Wales, March 2024. Vet Rec 2024; 194:255-9. [PMID: 38551271 DOI: 10.1002/vetr.4111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
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Matthews K, Heravi S, Morgan P, Page N, Shepherd J, Sivarajasingam V. Alcohol prices, the April effect, and the environment, in violence-related injury in England and Wales. Eur J Health Econ 2024; 25:237-255. [PMID: 36988743 PMCID: PMC10052256 DOI: 10.1007/s10198-023-01583-w] [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: 11/02/2022] [Accepted: 03/13/2023] [Indexed: 06/19/2023]
Abstract
Violent injury varies widely across England and Wales as does the price of alcohol. While the links between alcohol consumption and violence are well established in the medical and epidemiological literature, a causal link is questionable. This paper cuts through the causative argument by reporting a link between the general price of alcohol and violence-related injury across the economic regions of England and Wales. It examines the influence of the real price of alcohol and identifies an 'April effect' that coincides with the annual uprating of alcohol prices for excise duties, on violence-related injuries recorded at Emergency Department attendance. The data are monthly frequency of violent injury rates covering the period 2005-2014 across the economic regions. The principal finding is that a one-way relationship between the real price of alcohol and violent injury is established, and tax policy can be used to reduce the incidence of violent injury and the associated health costs.
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Affiliation(s)
- Kent Matthews
- Cardiff Business School, Cardiff University, Colum Drive, Cardiff, CF10 3EU, UK.
- Nottingham University Business School China, University of Nottingham Ningbo China, 199 Taikang East Road, Ningbo, 315100, China.
| | - Saeed Heravi
- Cardiff Business School, Cardiff University, Colum Drive, Cardiff, CF10 3EU, UK
| | - Peter Morgan
- Cardiff Business School, Cardiff University, Colum Drive, Cardiff, CF10 3EU, UK
| | - Nicholas Page
- School of Social Sciences, Cardiff University, Spark, Maindy Road, Cardiff, CF24 4HQ, UK
| | - Jonathan Shepherd
- School of Dentistry, Cardiff University, University Hospital Wales, Heath Park, Cardiff, CF14 4XY, UK
| | - Vaseekaran Sivarajasingam
- School of Dentistry, Cardiff University, University Hospital Wales, Heath Park, Cardiff, CF14 4XY, UK
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Ahmadi-Abhari S, Kivimäki M. Do age-standardised dementia incidence rates really increase in England and Wales? Lancet Public Health 2024; 9:e152-e153. [PMID: 38429014 DOI: 10.1016/s2468-2667(24)00019-7] [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] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 01/24/2024] [Indexed: 03/03/2024]
Affiliation(s)
- Sara Ahmadi-Abhari
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK.
| | - Mika Kivimäki
- University College London, Brain Sciences, University College London, London, UK
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16
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Wilson E, Baker A, Stockley L, Allgar V, Richfield E. Place of death in Parkinson's disease and related disorders in England and Wales: post-pandemic trends and implications for care planning. Age Ageing 2024; 53:afae048. [PMID: 38497239 DOI: 10.1093/ageing/afae048] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Indexed: 03/19/2024] Open
Abstract
BACKGROUND With growing emphasis on palliative care for neurodegenerative conditions, understanding trends in place of death helps improve quality of end-of-life care for people with Parkinson's disease and related disorders (PDRDs), focusing allocation of resources and training and identifying inequalities. OBJECTIVES Review national and regional place of death trends for people with PDRD including pre- and post-pandemic trends. METHODS Mortality data for England and Wales (March 2018 and July 2022) were analysed with summary statistics and interrupted time series, exploring place of death for those who died with PDRD, with and without coexisting dementia, with reference to all deaths in England and Wales. RESULTS Of 2,415,566 adult deaths, 56,790 included mention of PDRD. Hospital deaths were most common in people with PDRD (39.17%), followed by care homes (38.84%). People with PDRD were half as likely to die in hospice compared with the general population (2.03 vs 4.94%). Proportion of care home deaths fell significantly after March 2020 (40.6-37%, P = 0.035). Regionally, London was an outlier with a lower proportion of deaths occurring in care homes with a higher proportion of hospital deaths. CONCLUSION Place of death for people with PDRD is changing, with more hospice and home deaths. People with PDRD, particularly those with co-existent dementia, are less likely to access inpatient hospice care than the general population. Since the COVID-19 pandemic, the proportion of care home deaths has reduced significantly with an increase in home deaths, with implications for service and resource allocation.
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Affiliation(s)
- Elisabeth Wilson
- Medicine for Older People, North Bristol NHS Trust, Bristol BS105NB, UK
| | - Amy Baker
- Medical Statistics Group, Peninsula Medical School, University of Plymouth, Plymouth Science Park, Plymouth PL6 8BX, UK
| | - Lauren Stockley
- Medical Statistics Group, Peninsula Medical School, University of Plymouth, Plymouth Science Park, Plymouth PL6 8BX, UK
| | - Victoria Allgar
- Medical Statistics Group, Peninsula Medical School, University of Plymouth, Plymouth Science Park, Plymouth PL6 8BX, UK
| | - Edward Richfield
- Medicine for Older People, North Bristol NHS Trust, Bristol BS105NB, UK
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Merrick R, McKerr C, Song J, Donnelly K, Gerrard R, Morgan M, Williams C, Craine N. Transferring inpatients between wards drives large nosocomial COVID-19 outbreaks, Wales, 2020-22: a matched case-control study using routine and enhanced surveillance data. J Hosp Infect 2024; 145:1-10. [PMID: 38081454 DOI: 10.1016/j.jhin.2023.11.014] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 11/27/2023] [Accepted: 11/28/2023] [Indexed: 01/19/2024]
Abstract
BACKGROUND The role of the hospital environment in the spread of COVID-19 is unclear. AIM To measure associations between ward characteristics and outbreak size to inform mitigations. METHODS Wards with large (case wards) and small (control wards) outbreaks in three acute hospitals were compared. Cases were healthcare-associated COVID-19 inpatients (positive polymerase chain reaction test ≥8 days post admission). Case wards were adult medical/surgical wards with ≥10 cases within rolling 14-day periods, between April 1st, 2020 and April 30th, 2022. Control wards were equivalents with 2-9 cases. Demographic and laboratory data were extracted from routine surveillance systems. Continuous data were aggregated fortnightly and analysed as binary variables according to median values. Each case ward was compared with two control wards matched on outbreak start date (±14 days) to calculate odds ratios (ORs) and 95% confidence intervals (95% CIs) using univariable and conditional multivariable logistic regression. FINDINGS From 170 outbreaks (median: 5 cases; interquartile range: 2-9), 35 case wards were identified. Community admissions were lower in case wards vs control wards (5 vs 10 median admissions; P<0.01, respectively), whereas transfers between wards within the same hospital were higher (58 vs 29 median transfers; P<0.01, respectively). Wards with more transfers in the preceding fortnight were significantly more likely to experience a large outbreak (≥35 vs <35 transfers; adjusted OR: 9.08; 95% CI: 2.5-33). CONCLUSION We recommend safely minimizing patient movements, such as by asking clinicians to record the rationale for transfer, to reduce the likelihood of disease transmission.
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Affiliation(s)
- R Merrick
- UK Field Epidemiology Training Programme (UKFETP), UK Health Security Agency, UK; Public Health Wales, UK
| | | | | | | | | | - M Morgan
- UK Field Epidemiology Training Programme (UKFETP), UK Health Security Agency, UK; Public Health Wales, UK
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Vigna E, Meek A, Beyer S. The impact of COVID-19 pandemic on jobs for people with intellectual disabilities and autism in Wales. J Appl Res Intellect Disabil 2024; 37:e13194. [PMID: 38369315 DOI: 10.1111/jar.13194] [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: 03/14/2023] [Revised: 12/14/2023] [Accepted: 12/18/2023] [Indexed: 02/20/2024]
Abstract
BACKGROUND The study reports the impact of the Covid-19 pandemic and lockdowns on jobs for people with intellectual disabilities and autism. The study focuses on the impact of the first and the fire-break lockdowns and the actions taken to support young people. METHOD Data was collected from the cohort of young people currently working in Wales, and that received job coach support from the Engage to Change Project, on furlough arrangements, job retainment and job losses. Innovative initiatives to support young people are described. RESULTS Review of the working situation during the pandemic was conducted for 184 jobs, evaluating the proportion of young people being furloughed or working remotely and compared with the general population in Wales. CONCLUSIONS Supported employment agencies adapted their practice during the COVID-19 pandemic, offering new and innovative ways to support young people and facilitate their return to work.
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Affiliation(s)
- Elisa Vigna
- National Centre for Mental Health, School of Medicine, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - Andrea Meek
- National Centre for Mental Health, School of Medicine, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - Stephen Beyer
- National Centre for Mental Health, School of Medicine, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
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Stephens C, Stanyer A, Anderson R, Bishop A. Changing policy landscape around elder abuse in England and Wales. BMJ 2024; 384:q463. [PMID: 38418091 DOI: 10.1136/bmj.q463] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/01/2024]
Affiliation(s)
- Carolyn Stephens
- UCL Bartlett Development Planning Unit, London School of Hygiene and Tropical Medicine, London, UK
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20
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Williams O, Gray BJ, Perrett SE. Identifying the public health needs of a UK probation cohort: a cross-sectional analysis. J Public Health (Oxf) 2024; 46:12-19. [PMID: 37738133 DOI: 10.1093/pubmed/fdad183] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 08/14/2023] [Accepted: 08/28/2023] [Indexed: 09/24/2023] Open
Abstract
BACKGROUND The health needs of those under probation are likely high, but they have received very little public health attention. Limited evidence exists on the public health needs and interventions to support this cohort. METHODS Surveys were completed by 257 people on probation as part of a local health needs assessment. Results were compared with the general population responses from the National Survey for Wales (2021-22). RESULTS People on probation were 4.2 times more likely to self-report not-good general health (fair, bad or very bad) than the general population (adjusted Odds Ratio [aOR] 4.2, 95% Confidence Intervals [CI] 3.2-5.4). The odds of having a mental health condition were over eight times higher than the general population (aOR 8.8, 95% CI 6.8-11.4). Prevalence of smoking (52%), drug use (60%), attention-deficit hyperactivity disorder (21%), autism (4%) and dyslexia (15%) were all higher than the general population. General Practitioner usage and hospital stays were higher, but dentist or optician usage lower than the general population (P < 0.05). Emergency departments were accessed by 35%, with 9% frequenting them three or more times. CONCLUSIONS People on probation have poorer self-reported health, higher prevalence of unhealthy behaviours and higher accessing of reactive health services than the general population.
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Affiliation(s)
- O Williams
- Public Health Wales, 2 Capital Quarter, Tyndall Street, Cardiff, CF10 4BZ, Wales
| | - B J Gray
- Public Health Wales, 2 Capital Quarter, Tyndall Street, Cardiff, CF10 4BZ, Wales
| | - S E Perrett
- Public Health Wales, 2 Capital Quarter, Tyndall Street, Cardiff, CF10 4BZ, Wales
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21
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Huang F, Song J, Davies AR. Health of unpaid carers in Wales, UK: a population data linkage study. J Public Health (Oxf) 2024; 46:144-150. [PMID: 37934971 PMCID: PMC10901266 DOI: 10.1093/pubmed/fdad207] [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: 05/16/2023] [Revised: 08/15/2023] [Accepted: 10/06/2023] [Indexed: 11/09/2023] Open
Abstract
BACKGROUND The population of unpaid carers in Wales increased to record. There is no systematic approach to record unpaid caring status, resulting in limited quantitative evidence on unpaid carers' health. The aim of this study is to: (i) create an e-cohort of unpaid carers by linking routinely collected health and administrative datasets in Wales, UK. (ii) investigate whether long-term health conditions and multimorbidity are more prevalent amongst unpaid carers than non-carers. METHODS Unpaid carers were identified by linking primary care dataset, National Survey for Wales data with demographic characteristics in the Secure Anonymise Information Linkage Databank. The clinical codes identified in Cambridge Multimorbidity Score were used to explore the prevalence of long-term health conditions. RESULTS A total of 91 220 unpaid carers in Wales were identified between 1 January 2010 and 1 March 2022. Unpaid carers were found at higher risk of managing 35 of 37 long-term health conditions and multimorbidity than non-carers, exacerbated amongst younger age groups and deprived communities. CONCLUSIONS The creation of the first e-cohort of unpaid carers in Wales provides opportunities to perform rapid analysis to systematically understand health needs and evaluate initiatives in future. To better support unpaid carers, flexible approaches focusing on early identification and prevention is crucial.
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Affiliation(s)
- Fangzhou Huang
- School of Management, Swansea University, Swansea SA1 8EN, UK
| | - Jiao Song
- The Communicable Disease Surveillance Centre, Public Health Wales, Cardiff CF10 4BZ, UK
| | - Alisha R Davies
- Research and Evaluation Division, Knowledge Directorate, Public Health Wales, Cardiff CF10 4BZ, UK
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22
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Hodgson S, O'Mahony K, Nicholson J, Williams P. Thematic analysis of 'Prevention of Future Deaths' reports related to emergency departments in England and Wales 2013-2022. Emerg Med J 2024; 41:184-186. [PMID: 38050124 DOI: 10.1136/emermed-2023-213445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2023] [Indexed: 12/06/2023]
Affiliation(s)
- Sarah Hodgson
- Emergency Department, Raigmore Hospital, Inverness, UK
| | | | - James Nicholson
- Highland Medical Education Centre, Raigmore Hospital, Inverness, UK
- Resuscitation Research Group, The University of Edinburgh Edinburgh Medical School, Edinburgh, UK
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23
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van Blankenstein E, Sodiwala T, Lanoue J, Modi N, Uthaya SN, Battersby C. Two-year neurodevelopmental data for preterm infants born over an 11-year period in England and Wales, 2008-2018: a retrospective study using the National Neonatal Research Database. Arch Dis Child Fetal Neonatal Ed 2024; 109:143-150. [PMID: 37788897 PMCID: PMC10894848 DOI: 10.1136/archdischild-2023-325746] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 08/16/2023] [Indexed: 10/05/2023]
Abstract
OBJECTIVE United Kingdom guidelines recommend all infants born <30 weeks' gestation receive neurodevelopmental follow-up at 2 years corrected age. In this study, we describe completeness and results of 2-year neurodevelopmental records in the National Neonatal Research Database (NNRD). DESIGN This retrospective cohort study uses data from the NNRD, which holds data on all neonatal admissions in England and Wales, including 2year follow-up status. PATIENTS We included all preterm infants born <30 weeks' gestation between 1 January 2008 and 31 December 2018 in England and Wales, who survived to discharge from neonatal care. MAIN OUTCOME MEASURES Presence of a 2-year neurodevelopmental assessment record in the NNRD, use of standardised assessment tools, results of functional 2-year neurodevelopmental assessments (visual, auditory, neuromotor, communication, overall development). RESULTS Of the 41 505 infants included, 24 125 (58%) had a 2-year neurodevelopmental assessment recorded. This improved over time, from 32% to 71% for births in 2008 and 2018, respectively.Of those with available data: 0.4% were blind; 1% had a hearing impairment not correctable with aids; 13% had <5 meaningful words, vocalisations or signs; 8% could not walk without assistance and 9% had severe (≥12 months) developmental delay. CONCLUSIONS The proportion of infants admitted to neonatal units in England and Wales with a 2-year neurodevelopmental record has improved over time. Rates of follow-up data from recent years are comparable to those of bespoke observational studies. With continual improvement in data completeness, the potential for use of NNRD as a source of longer-term outcome data can be realised.
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Affiliation(s)
- Emily van Blankenstein
- Neonatal Medicine, Department of Primary Care and Public Health, Imperial College London, London, UK
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Tia Sodiwala
- Neonatal Medicine, Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Julia Lanoue
- Neonatal Medicine, Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Neena Modi
- Neonatal Medicine, Department of Primary Care and Public Health, Imperial College London, London, UK
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Sabita N Uthaya
- Neonatal Medicine, Department of Primary Care and Public Health, Imperial College London, London, UK
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Cheryl Battersby
- Neonatal Medicine, Department of Primary Care and Public Health, Imperial College London, London, UK
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
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White RT, Bull MJ, Barker CR, Arnott JM, Wootton M, Jones LS, Howe RA, Morgan M, Ashcroft MM, Forde BM, Connor TR, Beatson SA. Genomic epidemiology reveals geographical clustering of multidrug-resistant Escherichia coli ST131 associated with bacteraemia in Wales. Nat Commun 2024; 15:1371. [PMID: 38355632 PMCID: PMC10866875 DOI: 10.1038/s41467-024-45608-1] [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: 10/13/2021] [Accepted: 01/30/2024] [Indexed: 02/16/2024] Open
Abstract
Antibiotic resistance is a significant global public health concern. Uropathogenic Escherichia coli sequence type (ST)131, a widely prevalent multidrug-resistant clone, is frequently associated with bacteraemia. This study investigates third-generation cephalosporin resistance in bloodstream infections caused by E. coli ST131. From 2013-2014 blood culture surveillance in Wales, 142 E. coli ST131 genomes were studied alongside global data. All three major ST131 clades were represented across Wales, with clade C/H30 predominant (n = 102/142, 71.8%). Consistent with global findings, Welsh strains of clade C/H30 contain β-lactamase genes from the blaCTX-M-1 group (n = 65/102, 63.7%), which confer resistance to third-generation cephalosporins. Most Welsh clade C/H30 genomes belonged to sub-clade C2/H30Rx (58.3%). A Wales-specific sub-lineage, named GB-WLS.C2, diverged around 1996-2000. An introduction to North Wales around 2002 led to a localised cluster by 2009, depicting limited genomic diversity within North Wales. This investigation emphasises the value of genomic epidemiology, allowing the detection of genetically similar strains in local areas, enabling targeted and timely public health interventions.
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Affiliation(s)
- Rhys T White
- School of Chemistry and Molecular Biosciences, The University of Queensland, Brisbane, QLD, 4072, Australia
- Australian Infectious Disease Research Centre, The University of Queensland, Brisbane, QLD, 4072, Australia
- Australian Centre for Ecogenomics, The University of Queensland, Brisbane, QLD, 4072, Australia
- Health Group, Institute of Environmental Science and Research, 5022, Porirua, New Zealand
| | - Matthew J Bull
- Microbiomes, Microbes and Informatics Group, Organisms and Environment Division, School of Biosciences, Cardiff University, Cardiff, CF10 3AX, United Kingdom
- Public Health Wales Microbiology, University Hospital of Wales, Cardiff, Wales, CF14 4XW, United Kingdom
| | - Clare R Barker
- Microbiomes, Microbes and Informatics Group, Organisms and Environment Division, School of Biosciences, Cardiff University, Cardiff, CF10 3AX, United Kingdom
| | - Julie M Arnott
- Healthcare Associated Infection, Antimicrobial Resistance & Prescribing Programme (HARP), Public Health Wales, 2 Capital Quarter, Tyndall Street, Cardiff, Wales, CF10 4BZ, United Kingdom
| | - Mandy Wootton
- Public Health Wales Microbiology, University Hospital of Wales, Cardiff, Wales, CF14 4XW, United Kingdom
| | - Lim S Jones
- Public Health Wales Microbiology, University Hospital of Wales, Cardiff, Wales, CF14 4XW, United Kingdom
| | - Robin A Howe
- Public Health Wales Microbiology, University Hospital of Wales, Cardiff, Wales, CF14 4XW, United Kingdom
| | - Mari Morgan
- Healthcare Associated Infection, Antimicrobial Resistance & Prescribing Programme (HARP), Public Health Wales, 2 Capital Quarter, Tyndall Street, Cardiff, Wales, CF10 4BZ, United Kingdom
| | - Melinda M Ashcroft
- Department of Microbiology and Immunology, The University of Melbourne at The Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia
| | - Brian M Forde
- Australian Infectious Disease Research Centre, The University of Queensland, Brisbane, QLD, 4072, Australia
- The University of Queensland, UQ Centre for Clinical Research (UQCCR), Royal Brisbane & Women's Hospital Campus, Brisbane, QLD, 4029, Australia
| | - Thomas R Connor
- Microbiomes, Microbes and Informatics Group, Organisms and Environment Division, School of Biosciences, Cardiff University, Cardiff, CF10 3AX, United Kingdom.
- Public Health Genomics Programme, Public Health Wales, 2 Capital Quarter, Tyndall Street, Cardiff, Wales, CF10 4BZ, United Kingdom.
| | - Scott A Beatson
- School of Chemistry and Molecular Biosciences, The University of Queensland, Brisbane, QLD, 4072, Australia.
- Australian Infectious Disease Research Centre, The University of Queensland, Brisbane, QLD, 4072, Australia.
- Australian Centre for Ecogenomics, The University of Queensland, Brisbane, QLD, 4072, Australia.
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Kerr S, Bedston S, Cezard G, Sampri A, Murphy S, Bradley DT, Morrison K, Akbari A, Whiteley W, Sullivan C, Patterson L, Khunti K, Denaxas S, Bolton T, Khan S, Keys A, Weatherill D, Mooney K, Davies J, Ritchie L, McMenamin J, Kee F, Wood A, Lyons RA, Sudlow C, Robertson C, Sheikh A. Undervaccination and severe COVID-19 outcomes: meta-analysis of national cohort studies in England, Northern Ireland, Scotland, and Wales. Lancet 2024; 403:554-566. [PMID: 38237625 DOI: 10.1016/s0140-6736(23)02467-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 10/31/2023] [Accepted: 11/02/2023] [Indexed: 02/12/2024]
Abstract
BACKGROUND Undervaccination (receiving fewer than the recommended number of SARS-CoV-2 vaccine doses) could be associated with increased risk of severe COVID-19 outcomes-ie, COVID-19 hospitalisation or death-compared with full vaccination (receiving the recommended number of SARS-CoV-2 vaccine doses). We sought to determine the factors associated with undervaccination, and to investigate the risk of severe COVID-19 outcomes in people who were undervaccinated in each UK nation and across the UK. METHODS We used anonymised, harmonised electronic health record data with whole population coverage to carry out cohort studies in England, Northern Ireland, Scotland, and Wales. Participants were required to be at least 5 years of age to be included in the cohorts. We estimated adjusted odds ratios for undervaccination as of June 1, 2022. We also estimated adjusted hazard ratios (aHRs) for severe COVID-19 outcomes during the period June 1 to Sept 30, 2022, with undervaccination as a time-dependent exposure. We combined results from nation-specific analyses in a UK-wide fixed-effect meta-analysis. We estimated the reduction in severe COVID-19 outcomes associated with a counterfactual scenario in which everyone in the UK was fully vaccinated on June 1, 2022. FINDINGS The numbers of people undervaccinated on June 1, 2022 were 26 985 570 (45·8%) of 58 967 360 in England, 938 420 (49·8%) of 1 885 670 in Northern Ireland, 1 709 786 (34·2%) of 4 992 498 in Scotland, and 773 850 (32·8%) of 2 358 740 in Wales. People who were younger, from more deprived backgrounds, of non-White ethnicity, or had a lower number of comorbidities were less likely to be fully vaccinated. There was a total of 40 393 severe COVID-19 outcomes in the cohorts, with 14 156 of these in undervaccinated participants. We estimated the reduction in severe COVID-19 outcomes in the UK over 4 months of follow-up associated with a counterfactual scenario in which everyone was fully vaccinated on June 1, 2022 as 210 (95% CI 94-326) in the 5-15 years age group, 1544 (1399-1689) in those aged 16-74 years, and 5426 (5340-5512) in those aged 75 years or older. aHRs for severe COVID-19 outcomes in the meta-analysis for the age group of 75 years or older were 2·70 (2·61-2·78) for one dose fewer than recommended, 3·13 (2·93-3·34) for two fewer, 3·61 (3·13-4·17) for three fewer, and 3·08 (2·89-3·29) for four fewer. INTERPRETATION Rates of undervaccination against COVID-19 ranged from 32·8% to 49·8% across the four UK nations in summer, 2022. Undervaccination was associated with an elevated risk of severe COVID-19 outcomes. FUNDING UK Research and Innovation National Core Studies: Data and Connectivity.
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Davies G, Akbari A, Bailey R, Evans L, Smith K, Goodfellow J, Thomas M, Lutchman Singh K. Cardiac interventions in Wales: A comparison of benefits between NHS Wales specialties. PLoS One 2024; 19:e0297049. [PMID: 38335178 PMCID: PMC10857708 DOI: 10.1371/journal.pone.0297049] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 12/24/2023] [Indexed: 02/12/2024] Open
Abstract
OBJECTIVES The study aimed to assess if specialised healthcare service interventions in Wales benefit the population equitably in work commissioned by the Welsh Health Specialised Services Committee (WHSSC). APPROACH The study utilised anonymised individual-level, population-scale, routinely collected electronic health record (EHR) data held in the Secure Anonymised Information Linkage (SAIL) Databank to identify patients resident in Wales receiving specialist cardiac interventions. Measurement was undertaken of associated patient outcomes 2-years before and after the intervention (minus a 6-month clearance period on either side) by measuring events in primary care, hospital attendance, outpatient and emergency department. The analysis controlled for comorbidity (Charlson) and deprivation (Welsh Index of Multiple Deprivation), stratified by admission type (elective or emergency) and membership of top 5% post-intervention costs. Costs were estimated by multiplying events by mean person cost estimates. RESULTS We identified 5,999 percutaneous coronary interventions (PCI) and 1,640 coronary artery bypass graft (CABG) between 2014-06-01 to 2020-02-29. The ratio of emergency to elective interventions was 2.85 for PCI and 1.04 for CABG. In multivariate analysis significant associations were identified for comorbidity (OR = 1.52, CI = (1.01-2.27)), deprivation (OR = 1.34, CI = (1.03-1.76)) and rurality (OR = 0.81, CI = (0.70-0.95)) for PCI interventions, and comorbidity (OR = 1.47, CI = (1.10-1.98)) for CABG. Higher costs post-intervention were associated with increased comorbidity for PCI and CABG in the top 5% cost groups, but for PCI this was not seen outside the top 5%. For PCI, moderate cost increase was associated with increased deprivation, but the picture was more mixed following CABG interventions. For both interventions, lower costs post intervention were seen in rural locations. CONCLUSION We identified and compared health outcomes for selected specialist cardiac interventions amongst patients resident in Wales, with these methods and analyses, providing a template for comparing other cardiac interventions.
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Affiliation(s)
- Gareth Davies
- Population Data Science, Swansea University Medical School, Faculty of Medicine, Health & Life Science, Swansea University, Swansea, Wales
| | - Ashley Akbari
- Population Data Science, Swansea University Medical School, Faculty of Medicine, Health & Life Science, Swansea University, Swansea, Wales
| | - Rowena Bailey
- Population Data Science, Swansea University Medical School, Faculty of Medicine, Health & Life Science, Swansea University, Swansea, Wales
| | - Lloyd Evans
- NHS Wales Executive, Wales Cardiovascular Network, Cardiff, Wales
| | - Kendal Smith
- Welsh Health Specialised Services Committee, Pontypridd, Wales
| | | | - Michael Thomas
- Hywel Dda University Health Board, Hafan Derwen, Carmarthen, Wales
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27
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Garstang JJ, Menka M. Infant death from accidental suffocation and strangulation in bed in England and Wales: rare or unrecognised events? BMJ Paediatr Open 2024; 8:e002419. [PMID: 38316470 PMCID: PMC10860092 DOI: 10.1136/bmjpo-2023-002419] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Accepted: 01/24/2024] [Indexed: 02/07/2024] Open
Abstract
BACKGROUND Mandatory joint police and healthcare investigations of sudden unexpected death in infancy (SUDI) have been in place since 2008 in England. These include death scene examination with cause of death determined at multiprofessional case conference. Detailed evidence on sleep arrangements is available for most cases potentially leading to more being identified as due to accidental suffocation. SUDI remaining unexplained following investigation are classified as SIDS (sudden infant death syndrome) or unspecified deaths.Our objective was to determine whether detailed SUDI investigation has led to an increase in deaths classified as accidental suffocation or strangulation in bed (ASSB)? METHODS We obtained official mortality data for England and Wales for infants dying aged 0-364 days for International Statistical Classification of Diseases and Related Health Problems, 10th revision codes R95 (SIDS), R96, R98, R99 (unspecified causes of mortality) and W75 (ASSB) for the years 2000-2019.We calculated the mortality rate for ASSB, SIDS and unspecified causes based on total live births each year. RESULTS Unexplained SUDI decreased from 353 in 2000 to 175 in 2019, with the mortality rate falling from 0.58 to 0.29 per 1000 live births. The total postneonatal mortality rate fell during this time from 1.9 to 0.9 per 1000 live births suggesting this is a genuine fall. SIDS accounted for 70% of unexplained SUDI in 2000 falling to 49% in 2020 with a corresponding increase in R99 unspecified deaths.Few deaths were recorded as ASSB (W75), ranging between 4 in 2010 and 24 in 2001. The rate for ASSB ranged from 0.6 to 4.0 per 100000 live births. CONCLUSIONS There is a shift away from SIDS (R95) towards unspecified causes of death (R96, R98, R99). Improved investigation of deaths has not led to increased numbers of death identified as due to ASSB. There needs to be clear guidelines on accurate classification of deaths from ASSB to facilitate learning from deaths and inform prevention efforts.
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Affiliation(s)
- Joanna Jane Garstang
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- Children and Family Services, Birmingham Community Healthcare NHS Trust, Aston, UK
| | - Marivjena Menka
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
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Demetriou C, Avraam A, Symonds P, Eardley W, Hing CB. Maternal outcomes of pregnant patients after trauma: a retrospective study of the Trauma Registry of England and Wales. Ann R Coll Surg Engl 2024; 106:160-166. [PMID: 37609686 PMCID: PMC10833001 DOI: 10.1308/rcsann.2023.0047] [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] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/21/2023] [Indexed: 08/24/2023] Open
Abstract
INTRODUCTION Trauma accounts for 20% of deaths in pregnant women. Injury characterisation and outcome in pregnant women following trauma is poorly described. To understand and inform optimum care of this key injury population, a study was conducted using the Trauma Audit Research Network (TARN) database. METHODS In total, 341 pregnant and 26,774 non-pregnant female patients aged 15 to 46 years were identified for comparison from the TARN database. Mortality, cross-sectional imaging, blood product administration and EQ-5D scores were compared between the two groups. Mechanism of injury, Injury Severity Score (ISS) and mortality rate before and after the creation of regional trauma networks were reported for pregnant patients. RESULTS Pregnancy was recorded in 1.3% (341/27,115) of included patients, with the most common cause of injury being road traffic collisions. A reduction in crude maternal mortality was observed over the course of the study period (7.3% to 2.9%). Baseline mean EQ-5D (0.47) and EQ-VAS (54.08) improved to 0.81 (p < 0.001) and 85.75 (p = 0.001), respectively, at 6 months following injury. CONCLUSION The incidence of trauma in pregnancy is small and mortality in injured pregnant women decreased over the study period. Pregnant patients have significantly improved patient-reported outcome measures 6 months after injury although this is limited in impact because of poor response rates and outcome reporting. Construction and validation of tools aiding in outcome reporting will help considerably in understanding further gains in the care of pregnant women.
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Affiliation(s)
- C Demetriou
- East Suffolk and North Essex NHS Foundation Trust, UK
| | - A Avraam
- School of Medicine, National Kapodistrian University of Athens, Greece
| | - P Symonds
- Trauma Audit & Research Network, Northern Care Alliance NHS Foundation Trust, UK
| | - W Eardley
- South Tees Hospitals NHS Foundation Trust, UK
| | - CB Hing
- St George’s University Hospitals NHS Foundation Trust, UK
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Lepori GM, Morgan S, Assarian BA, Mishra T. Economic activity and suicides: Causal evidence from macroeconomic shocks in England and Wales. Soc Sci Med 2024; 342:116538. [PMID: 38181719 DOI: 10.1016/j.socscimed.2023.116538] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Revised: 12/03/2023] [Accepted: 12/20/2023] [Indexed: 01/07/2024]
Abstract
The relationship between economic activity and suicides has been the subject of much scrutiny, but the focus in the extant literature has been almost exclusively on estimating associations rather than causal effects. In this paper, using data from England and Wales between January 1, 1997 and December 31, 2017, we propose a plausible set of assumptions to estimate the causal impacts of well-known macroeconomic variables on the daily suicide rate. Our identification strategy relies on scheduled macroeconomic announcements and professional economic forecasts. An important advantage of using these variables to model suicide rates is that they can efficiently capture the elements of 'surprise or shock' via the observed difference between how the economy actually performed and how it was expected to perform. Provided that professional forecasts are unbiased and efficient, the estimated 'surprises or shocks' are 'as good as random', and therefore are exogenous. We employ time series regressions and present robust evidence that these exogenous macroeconomic shocks affect the suicide rate. Overall, our results are consistent with economic theory that shocks that reduce estimated permanent income, and therefore expected lifetime utility, can propel suicide rates. Specifically, at the population level, negative shocks to consumer confidence and house prices accelerate the suicide rate. However, there is evidence of behavioural heterogeneity between sexes, states of the economy, and levels of public trust in government. Negative shocks to the retail price index (RPI) raise the suicide rate for males. Negative shocks to the growth rate in gross domestic product (GDP) raise the population suicide rate when the economy is doing poorly. When public trust in government is low, increases in the unemployment rate increase the suicide rate for females.
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Affiliation(s)
| | | | - Borna A Assarian
- University of Southampton, Southampton, UK; University Hospital of Southampton, NHS, Southampton, UK.
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Schiff I, Shangaris P, Grinsted M, Sankaran S. Feticide Before Termination of Pregnancy in Singleton Pregnancy - Trends in England and Wales 2012-2020, a Cross-sectional Study. Reprod Sci 2024; 31:441-451. [PMID: 37749446 PMCID: PMC10827943 DOI: 10.1007/s43032-023-01352-3] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 09/07/2023] [Indexed: 09/27/2023]
Abstract
Feticide is the practice of inducing fetal demise before the termination of pregnancy. In England and Wales, it is recommended for terminations of pregnancy beyond 21+6 weeks of gestation. This project analyses the trends in feticide in singleton pregnancy in England and Wales between 2012 and 2020. This project was a retrospective study that analysed data extracted from the Health and Social Act 4 (HSA4) forms submitted to the Department of Health and Social Care (DHSC). The data extracted by the DHSC included the prevalence of feticide, methods of feticide and termination, statutory grounds, gestation, service provider, maternal age, ethnicity and obstetric history. In addition, data analysis was carried out to identify trends. Between 2012 and 2020, there were 9310 feticides in England and Wales, undertaken in 0.5% of all abortions. The prevalence of feticide fluctuated; however, there was an overall decrease from 1084 cases in 2012 to 1000 cases in 2020. Intracardiac injection of potassium chloride was the most frequent method of achieving feticide (67.2%). Just over half (55.8%) of feticides took place under Ground E of the Abortion Act 1967, with the main indication being congenital malformations of the nervous system. Two-fifths (40.2%) of feticides took place at 23 weeks, 22.8% at 22 weeks and 13.5% between 20 and 21 weeks. The remainder occurred at later gestations: 17.5% at 24-29 weeks and 5.9% beyond 29 weeks. During our study period, it was more common for feticides to be carried out as part of a medical termination than a surgical termination and 60.3% occurred in NHS hospitals. Women undergoing feticide were mostly aged 30-34 years (38.3%) and of White ethnicity (78.6%). Feticide is an essential component of comprehensive abortion care for women undergoing late second and third-trimester abortions. This study provides insight into how feticide is carried out in England and Wales and demonstrates the effect of the COVID-19 pandemic on reducing feticide prevalence. Future research should analyse in more detail the use of the different methods of feticide.
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Affiliation(s)
- Isabelle Schiff
- GKT School of Medical Education, King's College London, Guy's Campus, Great Maze Pond, London, UK
| | - Panicos Shangaris
- Peter Gorer Department of Immunobiology, School of Immunology and Microbial Sciences, Guy's Campus, Great Maze Pond, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom.
- School of Life Course and Population Sciences, King's College London, 10th Floor North Wing St Thomas' Hospital, London, London, UK.
- Fetal Medicine Research Institute, King's College Hospital, London, UK.
- Department of Women and Children, Guy's and St Thomas' NHS Foundation Trust, London, UK.
| | | | - Srividhya Sankaran
- Department of Women and Children, Guy's and St Thomas' NHS Foundation Trust, London, UK
- Department of Health and Social Care, London, UK
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Gilbody S, Littlewood E, McMillan D, Atha L, Bailey D, Baird K, Brady S, Burke L, Chew-Graham CA, Coventry P, Crosland S, Fairhurst C, Henry A, Hollingsworth K, Newbronner E, Ryde E, Shearsmith L, Wang HI, Webster J, Woodhouse R, Clegg A, Dexter-Smith S, Gentry T, Hewitt C, Hill A, Lovell K, Sloan C, Traviss-Turner G, Pratt S, Ekers D. Behavioural activation to mitigate the psychological impacts of COVID-19 restrictions on older people in England and Wales (BASIL+): a pragmatic randomised controlled trial. Lancet Healthy Longev 2024; 5:e97-e107. [PMID: 38310902 PMCID: PMC10834375 DOI: 10.1016/s2666-7568(23)00238-6] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 10/27/2023] [Accepted: 11/09/2023] [Indexed: 02/06/2024] Open
Abstract
BACKGROUND Older adults were more likely to be socially isolated during the COVID-19 pandemic, with increased risk of depression and loneliness. We aimed to investigate whether a behavioural activation intervention delivered via telephone could mitigate depression and loneliness in at-risk older people during the COVID-19 pandemic. METHODS BASIL+ (Behavioural Activation in Social Isolation) was a pragmatic randomised controlled trial conducted among patients recruited from general practices in England and Wales, and was designed to assess the effectiveness of behavioural activation in mitigating depression and loneliness among older people during the COVID-19 pandemic. Eligible participants were aged 65 years and older, socially isolated, with a score of 5 or higher on the Patient Health Questionnaire-9 (PHQ-9), and had multiple long-term conditions. Participants were allocated in a 1:1 ratio to the intervention (behavioural activation) or control groups by use of simple randomisation without stratification. Behavioural activation was delivered by telephone; participants were offered up to eight weekly sessions with trained BASIL+ Support Workers. Behavioural activation was adapted to maintain social connections and encourage socially reinforcing activities. Participants in the control group received usual care with existing COVID-19 wellbeing resources. The primary clinical outcome was self-reported depression severity, assessed by the PHQ-9, at 3 months. Outcomes were assessed masked to allocation and analysis was by treatment allocation. This trial is registered with the ISRCTN registry (ISRCTN63034289). FINDINGS Between Feb 8, 2021, and Feb 28, 2022, 449 eligible participants were identified and 435 from 26 general practices were recruited and randomly assigned (1:1) to the behavioural activation intervention (n=218) or to the control group (usual care with signposting; n=217). The mean age of participants was 75·7 years (SD 6·7); 270 (62·1%) of 435 participants were female, and 418 (96·1%) were White. Participants in the intervention group attended an average of 5·2 (SD 2·9) of eight remote behavioural activation sessions. The adjusted mean difference in PHQ-9 scores between the control and intervention groups at 3 months was -1·65 (95% CI -2·54 to -0·75, p=0·0003). No adverse events were reported that were attributable to the behavioural activation intervention. INTERPRETATION Behavioural activation is an effective and potentially scalable intervention that can reduce symptoms of depression and emotional loneliness in at-risk groups in the short term. The findings of this trial add to the range of strategies to improve the mental health of older adults with multiple long-term conditions. These results can be helpful to policy makers beyond the pandemic in reducing the global burden of depression and addressing the health impacts of loneliness, particularly in at-risk groups. FUNDING UK National Institute for Health and Care Research.
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Affiliation(s)
- Simon Gilbody
- Department of Health Sciences, University of York, York, UK; Hull York Medical School, University of York, York, UK.
| | - Elizabeth Littlewood
- Department of Health Sciences, University of York, York, UK; Tees, Esk and Wear Valleys NHS Foundation Trust, Research & Development, Flatts Lane Centre, Middlesbrough, UK
| | - Dean McMillan
- Department of Health Sciences, University of York, York, UK; Hull York Medical School, University of York, York, UK; Tees, Esk and Wear Valleys NHS Foundation Trust, Research & Development, Flatts Lane Centre, Middlesbrough, UK
| | - Lucy Atha
- Department of Health Sciences, University of York, York, UK
| | - Della Bailey
- Department of Health Sciences, University of York, York, UK
| | - Kalpita Baird
- Department of Health Sciences, University of York, York, UK
| | - Samantha Brady
- Department of Health Sciences, University of York, York, UK
| | - Lauren Burke
- Department of Health Sciences, University of York, York, UK
| | | | - Peter Coventry
- Department of Health Sciences, University of York, York, UK; York Environmental Sustainability Institute, University of York, York, UK
| | | | | | - Andrew Henry
- Department of Health Sciences, University of York, York, UK; Tees, Esk and Wear Valleys NHS Foundation Trust, Research & Development, Flatts Lane Centre, Middlesbrough, UK
| | - Kelly Hollingsworth
- Department of Health Sciences, University of York, York, UK; Tees, Esk and Wear Valleys NHS Foundation Trust, Research & Development, Flatts Lane Centre, Middlesbrough, UK
| | | | - Eloise Ryde
- Department of Health Sciences, University of York, York, UK; Tees, Esk and Wear Valleys NHS Foundation Trust, Research & Development, Flatts Lane Centre, Middlesbrough, UK
| | | | - Han-I Wang
- Department of Health Sciences, University of York, York, UK
| | | | | | - Andrew Clegg
- School of Medicine, University of Leeds, Leeds, UK
| | - Sarah Dexter-Smith
- Tees, Esk and Wear Valleys NHS Foundation Trust, Research & Development, Flatts Lane Centre, Middlesbrough, UK
| | | | | | - Andrew Hill
- School of Medicine, University of Leeds, Leeds, UK
| | - Karina Lovell
- Division of Nursing, Midwifery & Social Work, University of Manchester, Manchester, UK
| | - Claire Sloan
- Department of Health Sciences, University of York, York, UK
| | | | | | - David Ekers
- Department of Health Sciences, University of York, York, UK; Tees, Esk and Wear Valleys NHS Foundation Trust, Research & Development, Flatts Lane Centre, Middlesbrough, UK
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Ferretti L, Wymant C, Petrie J, Tsallis D, Kendall M, Ledda A, Di Lauro F, Fowler A, Di Francia A, Panovska-Griffiths J, Abeler-Dörner L, Charalambides M, Briers M, Fraser C. Digital measurement of SARS-CoV-2 transmission risk from 7 million contacts. Nature 2024; 626:145-150. [PMID: 38122820 PMCID: PMC10830410 DOI: 10.1038/s41586-023-06952-2] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 12/07/2023] [Indexed: 12/23/2023]
Abstract
How likely is it to become infected by SARS-CoV-2 after being exposed? Almost everyone wondered about this question during the COVID-19 pandemic. Contact-tracing apps1,2 recorded measurements of proximity3 and duration between nearby smartphones. Contacts-individuals exposed to confirmed cases-were notified according to public health policies such as the 2 m, 15 min guideline4,5, despite limited evidence supporting this threshold. Here we analysed 7 million contacts notified by the National Health Service COVID-19 app6,7 in England and Wales to infer how app measurements translated to actual transmissions. Empirical metrics and statistical modelling showed a strong relation between app-computed risk scores and actual transmission probability. Longer exposures at greater distances had risk similar to that of shorter exposures at closer distances. The probability of transmission confirmed by a reported positive test increased initially linearly with duration of exposure (1.1% per hour) and continued increasing over several days. Whereas most exposures were short (median 0.7 h, interquartile range 0.4-1.6), transmissions typically resulted from exposures lasting between 1 h and several days (median 6 h, interquartile range 1.4-28). Households accounted for about 6% of contacts but 40% of transmissions. With sufficient preparation, privacy-preserving yet precise analyses of risk that would inform public health measures, based on digital contact tracing, could be performed within weeks of the emergence of a new pathogen.
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Affiliation(s)
- Luca Ferretti
- Pandemic Sciences Institute, Nuffield Department for Medicine, University of Oxford, Oxford, UK.
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Nuffield Department for Medicine, University of Oxford, Oxford, UK.
| | - Chris Wymant
- Pandemic Sciences Institute, Nuffield Department for Medicine, University of Oxford, Oxford, UK
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Nuffield Department for Medicine, University of Oxford, Oxford, UK
| | - James Petrie
- Pandemic Sciences Institute, Nuffield Department for Medicine, University of Oxford, Oxford, UK
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Nuffield Department for Medicine, University of Oxford, Oxford, UK
| | | | | | | | - Francesco Di Lauro
- Pandemic Sciences Institute, Nuffield Department for Medicine, University of Oxford, Oxford, UK
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Nuffield Department for Medicine, University of Oxford, Oxford, UK
| | - Adam Fowler
- Pandemic Sciences Institute, Nuffield Department for Medicine, University of Oxford, Oxford, UK
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Nuffield Department for Medicine, University of Oxford, Oxford, UK
| | | | - Jasmina Panovska-Griffiths
- Pandemic Sciences Institute, Nuffield Department for Medicine, University of Oxford, Oxford, UK
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Nuffield Department for Medicine, University of Oxford, Oxford, UK
- UK Health Security Agency, London, UK
| | - Lucie Abeler-Dörner
- Pandemic Sciences Institute, Nuffield Department for Medicine, University of Oxford, Oxford, UK
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Nuffield Department for Medicine, University of Oxford, Oxford, UK
| | | | | | - Christophe Fraser
- Pandemic Sciences Institute, Nuffield Department for Medicine, University of Oxford, Oxford, UK.
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Nuffield Department for Medicine, University of Oxford, Oxford, UK.
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Mahase E. Life expectancy fell during pandemic across England, Wales, and Northern Ireland. BMJ 2024; 384:q248. [PMID: 38286466 DOI: 10.1136/bmj.q248] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2024]
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Davies M, Lawrence T, Edwards A, McKay C, Lecky FE, Stokes KA, Williams S. Sport-related major trauma incidence in young people and adults in England and Wales: a national registry-based study. Inj Prev 2024; 30:60-67. [PMID: 37875378 PMCID: PMC10850652 DOI: 10.1136/ip-2023-044887] [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: 03/03/2023] [Accepted: 08/24/2023] [Indexed: 10/26/2023]
Abstract
OBJECTIVES Data on sport and physical activity (PA) injury risk can guide intervention and prevention efforts. However, there are limited national-level data, and no estimates for England or Wales. This study sought to estimate sport and PA-related major trauma incidence in England and Wales. METHODS Nationwide, hospital registry-based cohort study between January 2012 and December 2017. Following Trauma Audit and Research Network Registry Research Committee approval, data were extracted in April 2018 for people ≥16 years of age, admitted following sport or PA-related injury in England and Wales. The population-based Active Lives Survey was used to estimate national sport and PA participation (ie, running, cycling, fitness activities). The cumulative injury incidence rate was estimated for each activity. Injury severity was described by Injury Severity Score (ISS) >15. RESULTS 11 702 trauma incidents occurred (mean age 41.2±16.2 years, 59.0% male), with an ISS >15 for 28.0% of cases, and 1.3% were fatal. The overall annual injury incidence rate was 5.40 injuries per 100 000 participants. The incidence rate was higher in men (6.44 per 100 000) than women (3.34 per 100 000), and for sporting activities (9.88 per 100 000) than cycling (2.81 per 100 000), fitness (0.21 per 100 000) or walking (0.03 per 100 000). The highest annual incidence rate activities were motorsports (532.31 per 100 000), equestrian (235.28 per 100 000) and gliding (190.81 per 100 000). CONCLUSION Injury incidence was higher in motorsports, equestrian activity and gliding. Targeted prevention in high-risk activities may reduce admissions and their associated burden, facilitating safer sport and PA participation.
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Affiliation(s)
- Madeleine Davies
- Institute of Sport, Exercise and Health, UCL, London, UK
- Department for Health, University of Bath, Bath, UK
| | - Tom Lawrence
- National Institute for Health and Care Excellence, London, UK
- Division of Population Health, Trauma Audit and Research Network, The University of Manchester, Manchester, UK
| | - Antoinette Edwards
- Division of Population Health, Trauma Audit and Research Network, The University of Manchester, Manchester, UK
| | - Carly McKay
- Department for Health, University of Bath, Bath, UK
- Centre for Sport, Exercise and Osteoarthritis Research Versus Arthritis, University of Nottingham, Nottingham, UK
| | - Fiona E Lecky
- Division of Population Health, Trauma Audit and Research Network, The University of Manchester, Manchester, UK
- Centre for Urgent and Emergency Care Research, University of Sheffield School of Health and Related Research, Sheffield, UK
| | - Keith A Stokes
- Department for Health, University of Bath, Bath, UK
- Rugby Football Union, London, UK
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Barry SM, Davies GR, Underwood J, Davies CR, Lewis KE. COVID-19 managed on respiratory wards and intensive care units: Results from the national COVID-19 outcome report in Wales from March 2020 to December 2021. PLoS One 2024; 19:e0294895. [PMID: 38241260 PMCID: PMC10798461 DOI: 10.1371/journal.pone.0294895] [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: 02/21/2023] [Accepted: 11/12/2023] [Indexed: 01/21/2024] Open
Abstract
BACKGROUND A COVID-19 hospital guideline was implemented across all 18 acute hospitals in Wales in March 2020, promoting ward management of COVID pneumonitis and data collected across the first 3 Waves of the pandemic (Wave 1 March 1st 2020 to November 1st 2020, Wave 2 November 2st 2020 to February 21st 2021 and Wave 3 June 1st 2021 to December 14th 2021). The aim of this paper is to compare outcomes for patients by admission setting and type of ventilatory support given, with a particular focus on CPAP therapy. METHODS This is a retrospective observational study of those aged over 18 admitted to hospital with community acquired COVID-19 between March 2020 and December 2021. The outcome of interest was in-hospital mortality. Univariate logistic regression models were used to compare crude outcomes across the waves. Multivariable logistic regression models were used to assess outcomes by different settings and treatments after adjusting for Wave, age, sex, co-morbidity and deprivation. RESULTS Of the 7,803 records collected, 5,887 (75.4%) met the inclusion criteria. Analysis of those cases identified statistically significant outcome improvements across the waves for all patients combined (Waves 1 to 3: 31.5% to 18.8%, p<0.01), all ward patients (28.9% to 17.7%, p<0.01), and all ICU patients (44.3% to 32.2%, p = 0.03). Sub group analyses identified outcome improvements in ward patients without any oxygen therapy (Waves 1 to 3: 22.2% to 12.7%, p<0.01), with oxygen therapy only (34.0% to 12.9%, p<0.01) and with CPAP only (63.5% to 39.2%, p<0.01). The outcome improvements for ICU patients receiving CPAP only (35.7% to 24.6%, p = 0.31) or invasive ventilation (61.6% to 54.6%, p = 0.43) were not statistically significant though the numbers being admitted to ICU were small. The logistic regression models identified important age and comorbidity effects on outcomes. The multivariable model that took these into account suggested no statistically significantly greater risk of death for those receiving CPAP on the ward compared to those receiving CPAP in ICU (OR 0.89, 95% CI: 0.49 to 1.60). CONCLUSIONS There were successive reductions in mortality in inpatients over the three Waves reflecting new treatments and better management of complications. Mortality for those requiring CPAP was similar in respiratory wards and ICUs after adjusting for differences in their respective patient populations.
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Affiliation(s)
- Simon M. Barry
- Department of Respiratory Medicine, Cardiff and Vale University Health Board, Cardiff, Wales, United Kingdom
- Respiratory Health Implementation Group, Cardiff, Wales, United Kingdom
| | | | - Jonathan Underwood
- Division of Infection and Immunity, Cardiff University, Cardiff, Wales, United Kingdom
- Department of Infectious Diseases, Cardiff and Vale University Health Board, Cardiff, Wales, United Kingdom
| | - Chris R. Davies
- Institute for Clinical Science and Technology, Cardiff, Wales, United Kingdom
| | - Keir E. Lewis
- Respiratory Innovation Wales, Llanelli, Wales, United Kingdom
- Department of Respiratory Medicine, Hywel Dda University Health Board, Carmarthen, Wales, United Kingdom
- School of Medicine, Swansea University, Swansea, Wales, United Kingdom
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Jones H, Seaborne MJ, Kennedy NL, James M, Dredge S, Bandyopadhyay A, Battaglia A, Davies S, Brophy S. Cohort profile: Born in Wales-a birth cohort with maternity, parental and child data linkage for life course research in Wales, UK. BMJ Open 2024; 14:e076711. [PMID: 38238056 PMCID: PMC10806724 DOI: 10.1136/bmjopen-2023-076711] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 01/03/2024] [Indexed: 01/23/2024] Open
Abstract
PURPOSE Using Wales's national dataset for maternity and births as a core dataset, we have linked related datasets to create a more complete and comprehensive entire country birth cohort. Data of anonymised identified persons are linked on the individual level to data from health, social care and education data within the Secure Anonymised Information Linkage (SAIL) Databank. Each individual is assigned an encrypted Anonymised Linking Field; this field is used to link anonymised individuals across datasets. We present the descriptive data available in the core dataset, and the future expansion plans for the database beyond its initial development stage. PARTICIPANTS Descriptive information from 2011 to 2023 has been gathered from the National Community Child Health Database (NCCHD) in SAIL. This comprehensive dataset comprises over 400 000 child electronic records. Additionally, survey responses about health and well-being from a cross-section of the population including 2500 parents and 30 000 primary school children have been collected for enriched personal responses and linkage to the data spine. FINDINGS TO DATE The electronic cohort comprises all children born in Wales since 2011, with follow-up conducted until they finish primary school at age 11. The child cohort is 51%: 49% female: male, and 7.8% are from ethnic minority backgrounds. When considering age distribution, 26.8% of children are under the age of 5, while 63.2% fall within the age range of 5-11. FUTURE PLANS Born in Wales will expand by 30 000 new births annually in Wales (in NCCHD), while including follow-up data of children and parents already in the database. Supplementary datasets complement the existing linkage, including primary care, hospital data, educational attainment and social care. Future research includes exploring the long-term implications of COVID-19 on child health and development, and examining the impact of parental work environment on child health and development.
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Affiliation(s)
- Hope Jones
- National Centre for Population Health and Wellbeing Research, Swansea University Medical School, Swansea, UK
| | - Mike J Seaborne
- National Centre for Population Health and Wellbeing Research, Swansea University Medical School, Swansea, UK
| | - Natasha L Kennedy
- National Centre for Population Health and Wellbeing Research, Swansea University Medical School, Swansea, UK
- Swansea University Medical School, Administrative Data Research Wales, Swansea, UK
| | - Michaela James
- National Centre for Population Health and Wellbeing Research, Swansea University Medical School, Swansea, UK
| | - Sam Dredge
- National Centre for Population Health and Wellbeing Research, Swansea University Medical School, Swansea, UK
| | - Amrita Bandyopadhyay
- National Centre for Population Health and Wellbeing Research, Swansea University Medical School, Swansea, UK
| | | | - Sarah Davies
- Betsi Cadwaladr University Health Board, Bangor, UK
- Health and Care Research Wales, Cardiff, UK
| | - Sinead Brophy
- National Centre for Population Health and Wellbeing Research, Swansea University Medical School, Swansea, UK
- Swansea University Medical School, Administrative Data Research Wales, Swansea, UK
- Health Data Research UK, London, UK
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Disease surveillance in England and Wales, December 2023. Vet Rec 2024; 194:26-30. [PMID: 38180221 DOI: 10.1002/vetr.3820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2024]
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Dobbs TD, Jovic M, Ekakkaravichit N, Ali SR, Gibson JAG, Ibrahim N, Hemington-Gorse S, Whitaker IS. Service implications of the revised 2022 National Institute for Health and Care Excellence (NICE) follow-up guidelines for stage IA-IIC melanoma. Br J Surg 2024; 111:znad402. [PMID: 38271073 PMCID: PMC10810063 DOI: 10.1093/bjs/znad402] [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: 05/24/2023] [Revised: 10/08/2023] [Accepted: 11/12/2023] [Indexed: 01/27/2024]
Abstract
BACKGROUND The 2022 National Institute for Health and Care Excellence melanoma guideline update made significant changes to follow-up. The aim of this study was to assess the impact these changes will have on a national melanoma cohort over a 5-year follow-up interval. METHODS Anonymized, individual-level, population-scale, linkable primary and secondary care National Health Service data for an 18-year interval (2000-2018) in Wales, UK were analysed. These data were used to predict the number of patients over a 10-year interval (2020-2030) that would be diagnosed with melanoma. Follow-up schedules for the 2015 and 2022 National Institute for Health and Care Excellence melanoma guidelines were then used to calculate the number of clinician-led appointments, the number of radiological investigations, and the total healthcare cost between 2025 and 2030, corresponding to a 5-year patient follow-up interval, for those with stage IA-IIC melanoma. RESULTS Between 2025 and 2030 it is predicted that implementation of the 2022 guidelines would lead to 21 122 (range 19 194-23 083) fewer clinician-led appointments for patients with stage IA-IIC melanoma. However, there would be a significant increase in the number of radiological investigations (7812; range 7444-8189). These changes would lead to a €2.74 million (€1.87 million-€3.61 million) reduction in the total cost of follow-up over the interval 2025-2030. CONCLUSION Melanoma follow-up guideline changes will result in a substantial reduction in the number of clinical follow-up appointments, but a significant additional burden to radiological services. The overall cost of follow-up at a national level will be reduced.
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Affiliation(s)
- Thomas D Dobbs
- Reconstructive Surgery and Regenerative Medicine Research Centre, Institute of Life Sciences, Swansea University Medical School, Swansea, UK
- Welsh Centre for Burns and Plastic Surgery, Morriston Hospital, Swansea, UK
| | - Mathew Jovic
- Reconstructive Surgery and Regenerative Medicine Research Centre, Institute of Life Sciences, Swansea University Medical School, Swansea, UK
| | | | - Stephen R Ali
- Reconstructive Surgery and Regenerative Medicine Research Centre, Institute of Life Sciences, Swansea University Medical School, Swansea, UK
- Welsh Centre for Burns and Plastic Surgery, Morriston Hospital, Swansea, UK
| | - John A G Gibson
- Reconstructive Surgery and Regenerative Medicine Research Centre, Institute of Life Sciences, Swansea University Medical School, Swansea, UK
- Welsh Centre for Burns and Plastic Surgery, Morriston Hospital, Swansea, UK
| | - Nader Ibrahim
- Reconstructive Surgery and Regenerative Medicine Research Centre, Institute of Life Sciences, Swansea University Medical School, Swansea, UK
- Welsh Centre for Burns and Plastic Surgery, Morriston Hospital, Swansea, UK
| | | | - Iain S Whitaker
- Reconstructive Surgery and Regenerative Medicine Research Centre, Institute of Life Sciences, Swansea University Medical School, Swansea, UK
- Welsh Centre for Burns and Plastic Surgery, Morriston Hospital, Swansea, UK
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Koimtzis G, Geropoulos G, Chalklin C, Karniadakis I, Szabo L, Ilham MA, Stephens M, Asderakis A, Khalid U. The influence of socioeconomic deprivation on outcomes in transplant patients infected with SARS-CoV-2 in Wales. Clin Transplant 2024; 38:e15245. [PMID: 38289884 DOI: 10.1111/ctr.15245] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 01/03/2024] [Accepted: 01/08/2024] [Indexed: 02/01/2024]
Abstract
INTRODUCTION SARS-CoV-2 infection has had a significant impact on vulnerable individuals including transplant patients. Socioeconomic deprivation negatively affects outcomes of many health conditions. The aim of this study was to evaluate the effect of socioeconomic deprivation on the incidence and severity of SARS-CoV-2 infection among Welsh transplant patients. METHODS This study is a retrospective, cross-sectional study on the transplant population of Wales. The Welsh Index of Multiple Deprivation (WIMD) was used to assess the influence of socioeconomic deprivation on outcomes of Welsh transplant patients who developed SARS-CoV-2 infection. Outcome measures were the incidence of SARS-CoV-2 infection, rates of hospital and ICU admission, development of acute kidney injury (AKI) and mortality. A logistic binomial regression analysis was used to correlate the various risk factors with the incidence of SARS-CoV-2 infection. RESULTS Two hundred and sixty-six (25%) of regular follow up patients had SARS-CoV-2 infection; of these 55 (20.7%) were admitted, 15 (5.6%) to ICU, 37 (13.9%) developed AKI, and 23 (8.6%) died. In a regression analysis, patients of younger age were associated with more (p = .001) and those with SPK (simultaneous pancreas kidney) transplant less chance of infection (p = .038), whereas social deprivation was not associated with the chance of infection (p = .14). In regression analysis increased social deprivation was associated with higher chance of AKI post SARS-CoV-2 (p = .049). CONCLUSIONS Socioeconomic deprivation did not affect the rates or severity of SARS-CoV-2 infection apart from the degree of AKI in Welsh Transplant patients. Adherence to the preventive measures for this high-risk population must continue to remain a priority.
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Affiliation(s)
- Georgios Koimtzis
- Cardiff Transplant Unit, Cardiff & Vale University Health Board, University Hospital of Wales, Cardiff, UK
| | - Georgios Geropoulos
- Cardiff Transplant Unit, Cardiff & Vale University Health Board, University Hospital of Wales, Cardiff, UK
| | - Christopher Chalklin
- Cardiff Transplant Unit, Cardiff & Vale University Health Board, University Hospital of Wales, Cardiff, UK
| | - Ioannis Karniadakis
- Cardiff Transplant Unit, Cardiff & Vale University Health Board, University Hospital of Wales, Cardiff, UK
| | - Laszlo Szabo
- Cardiff Transplant Unit, Cardiff & Vale University Health Board, University Hospital of Wales, Cardiff, UK
| | - Mohammed Adel Ilham
- Cardiff Transplant Unit, Cardiff & Vale University Health Board, University Hospital of Wales, Cardiff, UK
| | - Michael Stephens
- Cardiff Transplant Unit, Cardiff & Vale University Health Board, University Hospital of Wales, Cardiff, UK
| | - Argiris Asderakis
- Cardiff Transplant Unit, Cardiff & Vale University Health Board, University Hospital of Wales, Cardiff, UK
- Wales Kidney Research Unit, Division of Infection and Immunity, Cardiff University, Cardiff, UK
| | - Usman Khalid
- Cardiff Transplant Unit, Cardiff & Vale University Health Board, University Hospital of Wales, Cardiff, UK
- Wales Kidney Research Unit, Division of Infection and Immunity, Cardiff University, Cardiff, UK
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Rubeshkumar P, Beer J, McClure V, Morgan M. Mortality amongst hospitalized COVID-19 cases by acquisition and pandemic wave in Wales, UK, February 2020-March 2022. J Hosp Infect 2024; 143:48-52. [PMID: 37852537 DOI: 10.1016/j.jhin.2023.10.007] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 09/28/2023] [Accepted: 10/03/2023] [Indexed: 10/20/2023]
Abstract
BACKGROUND Hospital populations are vulnerable to COVID-19, but the relative severity of hospital acquisition compared to community is unknown. We investigated differences in mortality between hospital and community acquired cases in Wales. METHODS Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) polymerase chain reaction tests from February 2020 to March 2022 were linked with hospital admissions to identify likely hospital-acquired cases. All-cause mortality within 28 days of a positive SARS-CoV-2 were measured by source of acquisition. Multi-variable logistic regression was used to compare mortality by source of acquisition, adjusting for confounders, computing adjusted odds ratios (aOR) with 95% confidence intervals (CI). RESULTS There were 25,263 hospital-acquired cases of COVID-19 and 5490 (22%) deaths in the study period. Although significant on univariate analysis, adjustment for confounding showed no association with increased mortality for hospital-acquired cases compared with cases admitted with COVID-19 (aOR 0.8, 95% CI 0.7-0.8). Vaccination (aOR 0.6, 95% CI 0.5-0.7) and infection in later pandemic waves (aOR 0.5, 95% CI 0.4-0.6) were associated with lower mortality; older age (≥85 vs <25 years: aOR 76.4, 95% CI 41.8-160.5) and male sex (aOR 1.5, 95% CI 1.4-1.6) were associated with higher mortality. CONCLUSION One in five hospitalised COVID-19 cases died within a month of infection. Mortality in nosocomial cases was not worse than those admitted with COVID-19, possibly reflecting early identification of nosocomial cases through screening.
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Affiliation(s)
- P Rubeshkumar
- Health Protection, Public Health Wales NHS Trust, Cardiff, UK.
| | - J Beer
- Health Protection, Public Health Wales NHS Trust, Cardiff, UK
| | - V McClure
- Health Protection, Public Health Wales NHS Trust, Cardiff, UK
| | - M Morgan
- Health Protection, Public Health Wales NHS Trust, Cardiff, UK
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Gandy S, Medlock J, Cull B, Smith R, Gibney Z, Sewgobind S, Parekh I, Harding S, Johnson N, Hansford K. Detection of Babesia species in questing Ixodes ricinus ticks in England and Wales. Ticks Tick Borne Dis 2024; 15:102291. [PMID: 38061320 DOI: 10.1016/j.ttbdis.2023.102291] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 11/23/2023] [Accepted: 11/28/2023] [Indexed: 12/18/2023]
Abstract
Babesiosis, a disease in humans and animals is caused by piroplasms from the genus Babesia and is transmitted by ixodid ticks. Bovine babesiosis, commonly called redwater fever, is reported in cattle from many regions of the British Isles. The presence of Babesia in questing ticks in the United Kingdom (UK) and its potential impact on public and animal health has not been widely studied. Therefore, this study aimed to assess the presence of Babesia spp. in England and Wales using ticks collected over a six-year period. Questing Ixodes ricinus nymphs were collected at 20 recreational areas between 2014 and 2019 and screened for Babesia. Of 3912 nymphs tested, Babesia spp. were detected in 15, giving an overall prevalence of 0.38% [95%CI: 0.21-0.63%]. A number of Babesia species were identified including B. venatorum (n = 9), B. divergens/capreoli (n = 5) and B. odocoilei-like species (n = 1). Based on the low prevalence of Babesia detected in questing I. ricinus nymphs in the recreational areas studied, the likelihood of exposure to Babesia-infected ticks is lower compared to other pathogens more widely studied in the UK (e.g. Borrelia burgdorferi s.l.). However, localized areas of elevated risk may occur in pockets in England and Wales.
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Affiliation(s)
- Sara Gandy
- Medical Entomology and Zoonoses Ecology, UK Health Security Agency, Porton Down, United Kingdom.
| | - Jolyon Medlock
- Medical Entomology and Zoonoses Ecology, UK Health Security Agency, Porton Down, United Kingdom; NIHR Health Protection Research Unit in Environmental Change and Health, United Kingdom
| | - Benjamin Cull
- Medical Entomology and Zoonoses Ecology, UK Health Security Agency, Porton Down, United Kingdom
| | - Rob Smith
- Health Protection Division, Public Health Wales, Cardiff, United Kingdom
| | - Zoë Gibney
- Emerging Infections and Zoonoses Team, UK Health Security Agency, United Kingdom
| | | | - Insiyah Parekh
- Animal and Plant Health Agency, Addlestone, United Kingdom
| | - Sophie Harding
- Animal and Plant Health Agency, Addlestone, United Kingdom
| | - Nicholas Johnson
- Animal and Plant Health Agency, Addlestone, United Kingdom; Faculty of Health and Medicine, University of Surrey, Guildford, United Kingdom
| | - Kayleigh Hansford
- Medical Entomology and Zoonoses Ecology, UK Health Security Agency, Porton Down, United Kingdom
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Appleyard T, Avery P, Baker P, Clement ND, Mason J, Deehan DJ. Hinge prostheses in the revision of unicompartmental knee replacement: a descriptive analysis of data from the national joint registry for England, Wales and Northern Ireland. Arch Orthop Trauma Surg 2024; 144:23-30. [PMID: 37561165 DOI: 10.1007/s00402-023-05010-w] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Accepted: 07/23/2023] [Indexed: 08/11/2023]
Abstract
INTRODUCTION Unicompartmental knee replacement (UKR) is an effective surgical strategy in patients with isolated medial or lateral compartment osteoarthritis. Study aims were to (1) describe the epidemiology of patients undergoing revision of UKR to a hinge knee replacement (HKR); (2) identify factors influencing time to revision; (3) evaluate HKR survival. MATERIALS AND METHODS An analysis of National Joint Registry data was undertaken, exploring revision of UKR to HKR between 2007 and April 2021. Descriptive analysis of eligible patients and Cox Regression to identify key determinants of time to revision were performed. Failure of HKR post-revision was assessed using survival analysis. RESULTS 111 patients underwent revision of UKR to HKR. Median age at revision was 70 years and most common indications were instability (n = 42) and infection (n = 22). The most common implant was a rotating HKR. Significant independent factors associated with earlier revision were periprosthetic fracture (p = 0.03) and malalignment (p = 0.03). Progressive osteoarthritis (p = 0.01) and higher ASA grades (3: p = 0.01, 4: p < 0.01) delayed time to revision; patient sex and age were not significant factors. Ten patients required subsequent re-revision; median age at re-revision was 61 years. HKR revised from UKR had an 89.3% revision-free risk at 5 years. Male sex (p < 0.01) and younger age (p < 0.01) were associated with re-revision. CONCLUSIONS Factors associated with time to revision may be used to counsel patients prior to UKR. The survivorship of the HKR of 89.3% at 5 years is concerning and careful consideration should be given when using this level of constraint when revising UKR in younger or male patients.
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Affiliation(s)
- Tom Appleyard
- Newcastle Upon Tyne NHS Trust, Freeman Hospital, Freeman Road, Newcastle Upon Tyne, UK.
- School of Medicine, Keele University, Newcastle-under-Lyme, UK.
| | - Peter Avery
- School of Mathematics and Statistics, Newcastle University, Newcastle Upon Tyne, UK
| | - Paul Baker
- South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK
- University of York, York, UK
- Teesside University, Middlesbrough, UK
| | - Nick D Clement
- Department of Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK
- Musculoskeletal Department, Freeman Hospital, Newcastle Upon Tyne, UK
| | | | - David J Deehan
- Newcastle Upon Tyne NHS Trust, Freeman Hospital, Freeman Road, Newcastle Upon Tyne, UK
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Lo Iacono G, Cook AJC, Derks G, Fleming LE, French N, Gillingham EL, Gonzalez Villeta LC, Heaviside C, La Ragione RM, Leonardi G, Sarran CE, Vardoulakis S, Senyah F, van Vliet AHM, Nichols G. A mathematical, classical stratification modeling approach to disentangling the impact of weather on infectious diseases: A case study using spatio-temporally disaggregated Campylobacter surveillance data for England and Wales. PLoS Comput Biol 2024; 20:e1011714. [PMID: 38236828 PMCID: PMC10796013 DOI: 10.1371/journal.pcbi.1011714] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 11/27/2023] [Indexed: 01/22/2024] Open
Abstract
Disentangling the impact of the weather on transmission of infectious diseases is crucial for health protection, preparedness and prevention. Because weather factors are co-incidental and partly correlated, we have used geography to separate out the impact of individual weather parameters on other seasonal variables using campylobacteriosis as a case study. Campylobacter infections are found worldwide and are the most common bacterial food-borne disease in developed countries, where they exhibit consistent but country specific seasonality. We developed a novel conditional incidence method, based on classical stratification, exploiting the long term, high-resolution, linkage of approximately one-million campylobacteriosis cases over 20 years in England and Wales with local meteorological datasets from diagnostic laboratory locations. The predicted incidence of campylobacteriosis increased by 1 case per million people for every 5° (Celsius) increase in temperature within the range of 8°-15°. Limited association was observed outside that range. There were strong associations with day-length. Cases tended to increase with relative humidity in the region of 75-80%, while the associations with rainfall and wind-speed were weaker. The approach is able to examine multiple factors and model how complex trends arise, e.g. the consistent steep increase in campylobacteriosis in England and Wales in May-June and its spatial variability. This transparent and straightforward approach leads to accurate predictions without relying on regression models and/or postulating specific parameterisations. A key output of the analysis is a thoroughly phenomenological description of the incidence of the disease conditional on specific local weather factors. The study can be crucially important to infer the elusive mechanism of transmission of campylobacteriosis; for instance, by simulating the conditional incidence for a postulated mechanism and compare it with the phenomenological patterns as benchmark. The findings challenge the assumption, commonly made in statistical models, that the transformed mean rate of infection for diseases like campylobacteriosis is a mere additive and combination of the environmental variables.
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Affiliation(s)
- Giovanni Lo Iacono
- Department of Comparative Biomedical Sciences, School of Veterinary Medicine, University of Surrey, Guildford, United Kingdom
- Institute for Sustainability, University of Surrey, Guildford, United Kingdom
- People-Centred Artificial Intelligence Institute, University of Surrey, Guilford, United Kingdom
- Centre for Mathematical and Computational Biology, University of Surrey, Guilford, United Kingdom
| | - Alasdair J. C. Cook
- Department of Comparative Biomedical Sciences, School of Veterinary Medicine, University of Surrey, Guildford, United Kingdom
| | - Gianne Derks
- Centre for Mathematical and Computational Biology, University of Surrey, Guilford, United Kingdom
- Mathematical Institute, Leiden University, Leiden, the Netherlands
| | - Lora E. Fleming
- European Centre for Environment and Human Health, University of Exeter Medical School, Truro, Cornwall, United Kingdom
| | - Nigel French
- New Zealand Food Safety Science & Research Centre, Massey University, Palmerston North, New Zealand
| | | | - Laura C. Gonzalez Villeta
- Department of Comparative Biomedical Sciences, School of Veterinary Medicine, University of Surrey, Guildford, United Kingdom
| | - Clare Heaviside
- Institute for Environmental Design and Engineering, University College London, London, United Kingdom
| | - Roberto M. La Ragione
- Department of Comparative Biomedical Sciences, School of Veterinary Medicine, University of Surrey, Guildford, United Kingdom
- School of Biosciences, University of Surrey, Guilford, United Kingdom
| | - Giovanni Leonardi
- UK Health Security Agency, Chilton, United Kingdom
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | - Sotiris Vardoulakis
- Healthy Environments And Lives (HEAL) National Research Network, Australian National University, Canberra, ACT, Australia
| | - Francis Senyah
- UK Health Security Agency, Porton Down, United Kingdom
- Médicines Sans Frontièrs, London, United Kingdom
| | - Arnoud H. M. van Vliet
- Department of Comparative Biomedical Sciences, School of Veterinary Medicine, University of Surrey, Guildford, United Kingdom
| | - Gordon Nichols
- Department of Comparative Biomedical Sciences, School of Veterinary Medicine, University of Surrey, Guildford, United Kingdom
- European Centre for Environment and Human Health, University of Exeter Medical School, Truro, Cornwall, United Kingdom
- UK Health Security Agency, Chilton, United Kingdom
- University of East Anglia, Norwich, United Kingdom
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Iacobucci G. Drug deaths in England and Wales rise to highest number on record. BMJ 2023; 383:2970. [PMID: 38114252 DOI: 10.1136/bmj.p2970] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2023]
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Riley RD. Effect of a doctor working during the festive period on population health: natural experiment using 60 years of Doctor Who episodes (the TARDIS study). BMJ 2023; 383:e077143. [PMID: 38110231 PMCID: PMC10726290 DOI: 10.1136/bmj-2023-077143] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/22/2023] [Indexed: 12/20/2023]
Abstract
OBJECTIVE To examine the effect of a (fictional) doctor working during the festive period on population health. DESIGN Natural experiment. SETTING England, Wales, and the UK. MAIN OUTCOME MEASURES Age standardised annual mortality rates in England, Wales, and the UK from 1963, when the BBC first broadcast Doctor Who, a fictional programme with a character called the Doctor who fights villains and intervenes to save others while travelling through space and time. Mortality rates were modelled in a time series analysis accounting for non-linear trends over time, and associations were estimated in relation to a new Doctor Who episode broadcast during the previous festive period, 24 December to 1 January. An interrupted time series analysis modelled the shift in mortality rates from 2005, when festive episodes of Doctor Who could be classed as a yearly Christmas intervention. RESULTS 31 festive periods from 1963 have featured a new Doctor Who episode, including 14 broadcast on Christmas Day. In time series analyses, an association was found between broadcasts during the festive period and subsequent lower annual mortality rates. In particular, episodes shown on Christmas Day were associated with 0.60 fewer deaths per 1000 person years (95% confidence interval 0.21 to 0.99; P=0.003) in England and Wales and 0.40 fewer deaths per 1000 person years (0.08 to 0.73; P=0.02) in the UK. The interrupted time series analysis showed a strong shift (reduction) in mortality rates from 2005 onwards in association with the Doctor Who Christmas intervention, with a mean 0.73 fewer deaths per 1000 person years (0.21 to 1.26; P=0.01) in England and Wales and a mean 0.62 fewer deaths per 1000 person years (0.16 to 1.09; P=0.01) in the UK. CONCLUSIONS A new Doctor Who episode shown every festive period, especially on Christmas Day, was associated with reduced mortality rates in England, Wales, and the UK, suggesting that a doctor working over the festive period could lower mortality rates. This finding reinforces why healthcare provision should not be taken for granted and may prompt the BBC and Disney+ to televise new episodes of Doctor Who every festive period, ideally on Christmas Day.
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Affiliation(s)
- Richard D Riley
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
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Barry SM, Davies G, Barry TD, Evans J, Backx M, Brouns M, Mughal A, Kelly S, Collier G, Ambalavanan S, Davies C, Sharp H, Lloyd P, Hester Y, Murray N, Goddard K, Johnstone L, Parry J, Davies O, Williams R, Ahern G, Smith J. Outcomes from a national screening program for Ukrainian refugees at risk of drug resistant tuberculosis in Wales. Thorax 2023; 79:86-89. [PMID: 37344177 PMCID: PMC10804008 DOI: 10.1136/thorax-2023-220161] [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: 06/23/2023]
Abstract
High rates of drug-resistant tuberculosis in Ukraine suggest screening is necessary to mitigate public health hazards for host populations. A pathway was implemented in Wales and data prospectively collected Between 8 April and 21 December 2022. Of 5425 Ukrainian arrivals, notifications were received by TB teams on 2395 (44%) of whom 1955 (82%) were screened. The refugees were young (median age 30, IQR 14-41), and predominantly female (66.1%). Interferon- gamma release assay (IGRA) tests were positive in 112 (6.5%). One Case of active tuberculosis was identified (0.05%). Our data supports European guidelines that routine screening of this population is not recommended, but we remain uncertain as to the risks of this population going forwards.
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Affiliation(s)
- Simon M Barry
- Respiratory Medicine, Cardiff and Vale UHB, Cardiff, UK
- Respiratory Health Implementation Group, Cardiff, UK
| | - Gareth Davies
- Institute for Clinical Science and Technology, Cardiff, UK
| | - Tamas D Barry
- Division of infection and immunity, Cardiff University, Cardiff, UK
| | - Jennifer Evans
- Child Health, Cardiff and Vale University Health Board, Cardiff, UK
| | - Matthijs Backx
- Infectious Disease, Cardiff and Vale University Health Board, Cardiff, UK
| | - Mattheus Brouns
- Department of Respiratory Medicine, Aneurin Bevan University Health Board, Abergavenny, UK
| | - Ahsan Mughal
- Respiratory Medicine, Swansea Bay University Health Board, Swansea, UK
| | - Stephen Kelly
- Respiratory Medicine, Betsi Cadwaladr University Health Board, Wrexham, UK
| | | | | | - Chris Davies
- Institute for Clinical Science and Technology, Cardiff, UK
| | - Hannah Sharp
- Institute for Clinical Science and Technology, Cardiff, UK
| | - Pam Lloyd
- Respiratory Medicine, Betsi Cadwaladr University Health Board, Wrexham, UK
| | - Yvonne Hester
- Respiratory Medicine, Cardiff and Vale University Health Board, Cardiff, UK
| | - Natalie Murray
- Respiratory Medicine, Cwm Taf Morgannwg University Health Board, Llantrisant, UK
| | - Kelly Goddard
- Respiratory Medicine, Hywel Dda University Health Board, Carmarthen, UK
| | - Linzi Johnstone
- Respiratory Medicine, Swansea Bay University Health Board, Swansea, UK
| | - Jane Parry
- Respiratory Medicine, Betsi Cadwaladr University Health Board, Bangor, UK
| | - Olwen Davies
- Respiratory Medicine, Betsi Cadwaladr University Health Board, Bangor, UK
| | - Rhian Williams
- Respiratory Medicine, Cwm Taf Morgannwg University Health Board, Llantrisant, UK
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Bandyopadhyay A, Marchant E, Jones H, Parker M, Evans J, Brophy S. Factors associated with low school readiness, a linked health and education data study in Wales, UK. PLoS One 2023; 18:e0273596. [PMID: 38079428 PMCID: PMC10712842 DOI: 10.1371/journal.pone.0273596] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 11/20/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND School readiness is a measure of a child's cognitive, social, and emotional readiness to begin formal schooling. Children with low school readiness need additional support from schools for learning, developing required social and academic skills, and catching-up with their school-ready peers. This study aims to identify the most significant risk factors associated with low school readiness using linked routine data for children in Wales. METHOD This was a longitudinal cohort study using linked data. The cohort comprises of children who completed the Foundation Phase assessment between 2012 and 2018. Individuals were identified by linking Welsh Demographic Service and Pre16 Education Attainment datasets. School readiness was assessed via the binary outcome of the Foundation Phase assessment (achieved/not achieved). This study used multivariable logistic regression model and a decision tree to identify and weight the most important risk factors associated with low school readiness. RESULTS In order of importance, logistic regression identified maternal learning difficulties (adjusted odds ratio 5.35(95% confidence interval 3.97-7.22)), childhood epilepsy (2.95(2.39-3.66)), very low birth weight (2.24(1.86-2.70), being a boy (2.11(2.04-2.19)), being on free school meals (1.85(1.78-1.93)), living in the most deprived areas (1.67(1.57-1.77)), maternal death (1.47(1.09-1.98)), and maternal diabetes (1.46(1.23-1.78)) as factors associated with low school readiness. Using a decision tree, eligibility for free school meals, being a boy, absence/low attendance at school, being born late in the academic year, being a low birthweight child, and not being breastfed were factors which were associated with low school readiness. CONCLUSION This work suggests that public health interventions focusing on children who are: boys, living in deprived areas, have poor early years attendance, have parents with learning difficulties, have parents with an illness or have illnesses themselves, would make the most difference to school readiness in the population.
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Affiliation(s)
- Amrita Bandyopadhyay
- National Centre for Population Health and Wellbeing Research, Swansea University Medical School, Wales, United Kingdom
| | - Emily Marchant
- National Centre for Population Health and Wellbeing Research, Swansea University Medical School, Wales, United Kingdom
| | - Hope Jones
- National Centre for Population Health and Wellbeing Research, Swansea University Medical School, Wales, United Kingdom
| | - Michael Parker
- National Centre for Population Health and Wellbeing Research, Swansea University Medical School, Wales, United Kingdom
| | - Julie Evans
- Public Health Wales, Keir Hardie University Health Park, Wales, United Kingdom
| | - Sinead Brophy
- National Centre for Population Health and Wellbeing Research, Swansea University Medical School, Wales, United Kingdom
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Mohammad HR, Barker K, Judge A, Murray DW. A Comparison of the Periprosthetic Fracture Rate of Unicompartmental and Total Knee Replacements: An Analysis of Data of >100,000 Knee Replacements from the National Joint Registry for England, Wales, Northern Ireland and the Isle of Man and Hospital Episode Statistics. J Bone Joint Surg Am 2023; 105:1857-1866. [PMID: 37733918 DOI: 10.2106/jbjs.22.01302] [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: 09/23/2023]
Abstract
BACKGROUND Periprosthetic fractures are rare but devastating complications of knee replacement, often requiring complex surgery with substantial morbidity and mortality. It is not known how the fracture rates after total knee replacement (TKR) and unicompartmental knee replacement (UKR) compare. We performed the first matched study comparing TKR and UKR periprosthetic fracture rates. METHODS This study involved 54,215 UKRs and 54,215 TKRs, identified in the National Joint Registry and Hospital Episodes Statistics database, which were propensity score-matched on patient and surgical factors. The International Classification of Diseases, Tenth Revision, (ICD-10) code M96.6 was used to identify periprosthetic fractures at ≤3 and >3 months postoperatively, as well as estimate rates at up to 10 years. Subgroup analyses were performed in different age groups (<55, 55 to 64, 65 to 74, and ≥75 years), body mass index (BMI) categories (normal, 18.5 to <25 kg/m 2 ; overweight, 25 to <30 kg/m 2 ; obese, 30 to <40 kg/m 2 ; and morbidly obese, ≥40 kg/m 2 ), and sexes. RESULTS The 3-month fracture rate was 0.09% (n = 50) in the UKR group and 0.05% (n = 25) in the TKR group, with this difference being significant (odds ratio [OR], 2.0; p = 0.004). The rate of fractures occurring at >3 months was 0.32% (n = 171) in the UKR group and 0.61% (n = 329) in the TKR group (OR, 0.51; p < 0.001). At 10 years, the cumulative incidence of fractures was 0.6% after UKR versus 1% after TKR (OR, 0.68; p < 0.001). Fracture rates increased with increasing age, decreasing BMI, and female sex for both UKRs and TKRs. CONCLUSIONS The fracture risk was small after both UKR and TKR, with small absolute differences between implant types. During the first 3 postoperative months, the fracture rate after UKR was 0.1% and was about twice as high as that after TKR. However, over the first 10 years, the cumulative fracture rate after TKR was 1% and was almost twice as high as that after UKR. Fracture rates after both UKR and TKR were higher in women, patients ≥75 years of age, and patients with normal weight. LEVEL OF EVIDENCE Therapeutic Level III . See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Hasan R Mohammad
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Nuffield Orthopaedic Centre, University of Oxford, Oxford, United Kingdom
- Barts Bone & Joint Health, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Karen Barker
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Nuffield Orthopaedic Centre, University of Oxford, Oxford, United Kingdom
| | - Andrew Judge
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Nuffield Orthopaedic Centre, University of Oxford, Oxford, United Kingdom
- Musculoskeletal Research Unit, Southmead Hospital, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - David W Murray
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Nuffield Orthopaedic Centre, University of Oxford, Oxford, United Kingdom
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Disease surveillance in England and Wales, November 2023. Vet Rec 2023; 193:439-43. [PMID: 38038291 DOI: 10.1002/vetr.3736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2023]
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Mikolai J, Dorey P, Keenan K, Kulu H. Spatial patterns of COVID-19 and non-COVID-19 mortality across waves of infection in England, Wales, and Scotland. Soc Sci Med 2023; 338:116330. [PMID: 37907058 DOI: 10.1016/j.socscimed.2023.116330] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 09/12/2023] [Accepted: 10/10/2023] [Indexed: 11/02/2023]
Abstract
Recent studies have established the key individual-level risk factors of COVID-19 mortality such as age, gender, ethnicity, and socio-economic status. However, the spread of infectious diseases is a spatial and temporal process implying that COVID-19 mortality and its determinants may vary sub-nationally and over time. We investigate the spatial patterns of age-standardised death rates due to COVID-19 and their correlates across local authority districts in England, Wales, and Scotland across three waves of infection. Using a Spatial Durbin model, we explore within- and between-country variation and account for spatial dependency. Areas with a higher share of ethnic minorities and higher levels of deprivation had higher rates of COVID-19 mortality. However, the share of ethnic minorities and population density in an area were more important predictors of COVID-19 mortality in earlier waves of the pandemic than in later waves, whereas area-level deprivation has become a more important predictor over time. Second, during the first wave of the pandemic, population density had a significant spillover effect on COVID-19 mortality, indicating that the pandemic spread from big cities to neighbouring areas. Third, after accounting for differences in ethnic composition, deprivation, and population density, initial cross-country differences in COVID-19 mortality almost disappeared. COVID-19 mortality remained higher in Scotland than in England and Wales in the third wave when COVID-19 mortality was relatively low in all three countries. Interpreting these results in the context of higher overall (long-term) non-COVID-19 mortality in Scotland suggests that Scotland may have performed better than expected during the first two waves. Our study highlights that accounting for both spatial and temporal factors is essential for understanding social and demographic risk factors of mortality during pandemics.
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Affiliation(s)
- Júlia Mikolai
- ESRC Centre for Population Change, United Kingdom; University of St Andrews, United Kingdom.
| | | | - Katherine Keenan
- ESRC Centre for Population Change, United Kingdom; University of St Andrews, United Kingdom
| | - Hill Kulu
- ESRC Centre for Population Change, United Kingdom; University of St Andrews, United Kingdom
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