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Hughes K, Bellis MA, Cresswell K, Hill R, Ford K, Hopkins JC. Examining relationships between adverse childhood experiences and coping during the cost-of-living crisis using a national cross-sectional survey in Wales, UK. BMJ Open 2024; 14:e081924. [PMID: 38692715 PMCID: PMC11086514 DOI: 10.1136/bmjopen-2023-081924] [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: 11/09/2023] [Accepted: 03/25/2024] [Indexed: 05/03/2024] Open
Abstract
OBJECTIVES Adverse childhood experiences (ACEs) can affect individuals' resilience to stressors and their vulnerability to mental, physical and social harms. This study explored associations between ACEs, financial coping during the cost-of-living crisis and perceived impacts on health and well-being. DESIGN National cross-sectional face-to-face survey. Recruitment used a random quota sample of households stratified by health region and deprivation quintile. SETTING Households in Wales, UK. PARTICIPANTS 1880 Welsh residents aged ≥18 years. MEASURES Outcome variables were perceived inability to cope financially during the cost-of-living crisis; rising costs of living causing substantial distress and anxiety; and self-reported negative impact of rising costs of living on mental health, physical health, family relationships, local levels of antisocial behaviour and violence, and community support. Nine ACEs were measured retrospectively. Socioeconomic and demographic variables included low household income, economic inactivity, residential deprivation and activity limitation. RESULTS The prevalence of all outcomes increased strongly with ACE count. Perceived inability to cope financially during the cost-of-living crisis increased from 14.0% with 0 ACEs to 51.5% with 4+ ACEs. Relationships with ACEs remained after controlling for socioeconomic and demographic factors. Those with 4+ ACEs (vs 0 ACEs) were over three times more likely to perceive they would be unable to cope financially and, correspondingly, almost three times more likely to report substantial distress and anxiety and over three times more likely to report negative impacts on mental health, physical health and family relationships. CONCLUSIONS Socioeconomically deprived populations are recognised to be disproportionately impacted by rising costs of living. Our study identifies a history of ACEs as an additional vulnerability that can affect all socioeconomic groups. Definitions of vulnerability during crises and communications with services on who is most likely to be impacted should consider childhood adversity and history of trauma.
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Affiliation(s)
- Karen Hughes
- Policy and International Health, World Health Organization Collaborating Centre on Investment for Health and Well-being, Public Health Wales, Cardiff, UK
- School of Health Sciences, College of Medicine and Health Sciences, Bangor University, Wrexham, UK
| | - Mark A Bellis
- Policy and International Health, World Health Organization Collaborating Centre on Investment for Health and Well-being, Public Health Wales, Cardiff, UK
- Faculty of Health, Liverpool John Moores University, Liverpool, UK
| | - Katie Cresswell
- School of Health Sciences, College of Medicine and Health Sciences, Bangor University, Wrexham, UK
| | - Rebecca Hill
- Policy and International Health, World Health Organization Collaborating Centre on Investment for Health and Well-being, Public Health Wales, Cardiff, UK
| | - Kat Ford
- School of Health Sciences, College of Medicine and Health Sciences, Bangor University, Wrexham, UK
| | - Joanne C Hopkins
- Policy and International Health, World Health Organization Collaborating Centre on Investment for Health and Well-being, Public Health Wales, Cardiff, UK
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Janssen H, Ford K, Gascoyne B, Hill R, Roberts M, Bellis MA, Azam S. Cold indoor temperatures and their association with health and well-being: a systematic literature review. Public Health 2023; 224:185-194. [PMID: 37820536 DOI: 10.1016/j.puhe.2023.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 08/18/2023] [Accepted: 09/07/2023] [Indexed: 10/13/2023]
Abstract
OBJECTIVE The study aimed to identify, appraise and update evidence on the association between cold temperatures (i.e. <18°C) within homes (i.e. dwellings) and health and well-being outcomes. STUDY DESIGN This study was a systematic review. METHODS Seven databases (MEDLINE, Embase, Cochrane Database of Systematic Reviews, CINAHL, APA PsycInfo, Applied Social Sciences Index and Abstracts, Coronavirus Research Database) were searched for studies published between 2014 and 2022, which explored the association between cold indoor temperatures and health and well-being outcomes. Studies were limited to those conducted in temperate and colder climates due to the increased risk of morbidity and mortality during winter in those climatic zones. Studies were independently quality assessed using the Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. RESULTS Of 1209 studies, 20 were included for review. Study outcomes included cardiovascular (blood pressure, electrocardiogram abnormalities, blood platelet count), respiratory (chronic obstructive pulmonary disease symptoms, respiratory viral infection), sleep, physical performance and general health. Seventeen studies found exposure to cold indoor temperatures was associated with negative effects on health outcomes studied. Older individuals and those with chronic health problems were found to be more vulnerable to negative health outcomes. CONCLUSION Evidence suggests that indoor temperatures <18°C are associated with negative health effects. However, the evidence is insufficient to allow clear conclusions regarding outcomes from specific temperature thresholds for different population groups. Significant gaps in the current evidence base are identified, including research on the impacts of cold indoor temperatures on mental health and well-being, studies involving young children, and the long-term health effects of cold indoor temperatures.
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Affiliation(s)
- H Janssen
- World Health Organization Collaborating Centre on Investment for Health and Well-being, Public Health Wales, Wrexham, LL13 7YP, UK.
| | - K Ford
- College of Human Sciences, Bangor University, Wrexham, LL13 7YP, UK
| | - B Gascoyne
- London Metropolitan University, London, N7 8DB, UK
| | - R Hill
- World Health Organization Collaborating Centre on Investment for Health and Well-being, Public Health Wales, Cardiff, CF10 4BZ, UK
| | - M Roberts
- World Health Organization Collaborating Centre on Investment for Health and Well-being, Public Health Wales, Cardiff, CF10 4BZ, UK
| | - M A Bellis
- World Health Organization Collaborating Centre on Investment for Health and Well-being, Public Health Wales, Wrexham, LL13 7YP, UK; Faculty of Health, Liverpool John Moores University, L2 2ER, UK
| | - S Azam
- World Health Organization Collaborating Centre on Investment for Health and Well-being, Public Health Wales, Cardiff, CF10 4BZ, UK
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Harwood R, Bethell G, Eastwood MP, Hotonu S, Allin B, Boam T, Rees CM, Hall NJ, Rhodes H, Ampirska T, Arthur F, Billington J, Bough G, Burdall O, Burnand K, Chhabra S, Driver C, Ducey J, Engall N, Folaranmi E, Gracie D, Ford K, Fox C, Green P, Green S, Jawaid W, John M, Koh C, Lam C, Lewis S, Lindley R, Macafee D, Marks I, McNickle L, O’Sullivan BJ, Peeraully R, Phillips L, Rooney A, Thompson H, Tullie L, Vecchione S, Tyraskis A, Maldonado BN, Pissaridou M, Sanchez-Thompson N, Morris L, John M, Godse A, Farrelly P, Cullis P, McHoney M, Colvin D. The Blunt Liver and Spleen Trauma (BLAST) audit: national survey and prospective audit of children with blunt liver and spleen trauma in major trauma centres. Eur J Trauma Emerg Surg 2023; 49:2249-2256. [PMID: 35727342 PMCID: PMC10520113 DOI: 10.1007/s00068-022-01990-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 04/24/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE To compare the reported and observed management of UK children with blunt liver or spleen injury (BLSI) to the American Pediatric Surgical Association (APSA) 2019 BLSI guidance. METHODS UK Paediatric Major Trauma Centres (pMTCs) undertook 1 year of prospective data collection on children admitted to or discussed with those centres with BLSI and an online questionnaire was distributed to all consultants who care for children with BLSI in those centres. RESULTS All 21/21 (100%) pMTCs participated; 131 patients were included and 100/152 (65%) consultants responded to the survey. ICU care was reported and observed to be primarily determined using haemodynamic status or concomitant injuries rather than injury grade, in accordance with APSA guidance. Bed rest was reported to be determined by grade of injury by 63% of survey respondents and observed in a similar proportion of patients. Contrary to APSA guidance, follow-up radiological assessment of the injured spleen or liver was undertaken in 44% of patients before discharge and 32% after discharge, the majority of whom were asymptomatic. CONCLUSIONS UK management of BLSI differs from many aspects of APSA guidance. A shift towards using clinical features to determine ICU admission and readiness for discharge is demonstrated, in line with a strong evidence base. However, routine bed rest and re-imaging after BLSI is common, contrary to APSA guidance. This disparity may exist due to concern that evidence around the incidence, presentation and natural history of complications after conservatively managed BLSI, particularly bleeding from pseudoaneurysms, is weak.
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Bellis MA, Hughes K, Ford K, Lowey H. Measuring changes in adult health and well-being during the COVID-19 pandemic and their relationship with adverse childhood experiences and current social assets: a cross-sectional survey. BMC Public Health 2023; 23:1618. [PMID: 37620866 PMCID: PMC10463476 DOI: 10.1186/s12889-023-16549-z] [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: 09/26/2022] [Accepted: 08/17/2023] [Indexed: 08/26/2023] Open
Abstract
BACKGROUND Adverse childhood experiences (ACEs) can impact mental and physical health, leaving people with less resilience to health challenges across the life-course. This study examines whether individuals' levels and changes in levels of mental health, physical health and sleep quality reported across the first year of the COVID-19 pandemic are associated with ACEs and moderated by social assets such as having trusted family and friends. METHODS A cross-sectional household telephone survey in England (a North West local authority) and Wales (nationally) using landline and mobile numbers stratified by health areas, deprivation quintile and age group and supplemented by an online survey. Data were collected from 4,673 English and Welsh residents aged ≥ 18 years during national COVID-19 restrictions (December 2020 to March 2021). Measures included nine types of ACE; self-reported mental health, physical health and sleep quality at time of survey (in pandemic) and one-year earlier (pre-pandemic); numbers of trusted family members and friends, knowledge of community help; and COVID-19 infection. RESULTS ACEs were strongly related to moving into poorer mental health, physical health, and sleep categories during the pandemic, with likelihoods more than doubling in those with ≥ 4 ACEs (vs. 0). ACEs were also associated with increased likelihood of moving out of poorer health and sleep categories although this was for a much smaller proportion of individuals. Individuals with more trusted family members were less likely to move into poorer health categories regardless of ACE counts. CONCLUSIONS ACEs are experienced by large proportions of populations and are associated with poorer health even in non-pandemic situations. However, they also appear associated with greater vulnerability to developing poorer health and well-being in pandemic situations. There is a minority of those with ACEs who may have benefited from the changes in lifestyles associated with pandemic restrictions. Connectedness especially with family, appears an important factor in maintaining health during pandemic restrictions.
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Affiliation(s)
- Mark A Bellis
- Faculty of Health, Liverpool John Moores University, Liverpool, L2 2ER, UK.
- World Health Organization Collaborating Centre on Investment for Health and Well-Being, Policy and International Health, Public Health Wales, Wrexham, LL13 7YP, UK.
- Public Health Collaborating Unit, School of Medical and Health Sciences, College of Human Sciences, Bangor University, Wrexham, LL13 7YP, UK.
| | - Karen Hughes
- World Health Organization Collaborating Centre on Investment for Health and Well-Being, Policy and International Health, Public Health Wales, Wrexham, LL13 7YP, UK
- Public Health Collaborating Unit, School of Medical and Health Sciences, College of Human Sciences, Bangor University, Wrexham, LL13 7YP, UK
| | - Kat Ford
- Public Health Collaborating Unit, School of Medical and Health Sciences, College of Human Sciences, Bangor University, Wrexham, LL13 7YP, UK
| | - Helen Lowey
- Helen Lowey Consultancy Ltd, Lathom, L40 4BQ, UK
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Bellis MA, Hughes K, Cresswell K, Ford K. Comparing relationships between single types of adverse childhood experiences and health-related outcomes: a combined primary data study of eight cross-sectional surveys in England and Wales. BMJ Open 2023; 13:e072916. [PMID: 37068903 PMCID: PMC10111913 DOI: 10.1136/bmjopen-2023-072916] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 02/17/2023] [Accepted: 03/29/2023] [Indexed: 04/19/2023] Open
Abstract
OBJECTIVES Adverse childhood experiences (ACEs) show strong cumulative associations with ill-health across the life course. Harms can arise even in those exposed to a single ACE type but few studies examine such exposure. For individuals experiencing a single ACE type, we examine which ACEs are most strongly related to different health harms. DESIGN Secondary analysis of combined data from eight cross-sectional general population ACE surveys. SETTING Households in England and Wales. PARTICIPANTS 20 556 residents aged 18-69 years. MEASURES Ten self-reported outcomes were examined: smoking, cannabis use, binge drinking, obesity, sexually transmitted infection, teenage pregnancy, mental well-being, violence perpetration, violence victimisation and incarceration. Adjusted ORs and percentage changes in outcomes were calculated for each type of ACE exposure. RESULTS Significance and magnitude of associations between each ACE and outcome varied. Binge drinking was associated with childhood verbal abuse (VA), parental separation (PS) and household alcohol problem (AP), while obesity was linked to sexual abuse (SA) and household mental illness. SA also showed the biggest increase in cannabis use (25.5% vs 10.8%, no ACEs). Household AP was the ACE most strongly associated with violence and incarceration. PS was associated with teenage pregnancy (9.1% vs 3.7%, no ACEs) and 5 other outcomes. VA was associated with 7 of the 10 outcomes examined. CONCLUSION Exposure to a single ACE increases risks of poorer outcomes across health-harming behaviours, sexual health, mental well-being and criminal domains. Toxic stress can arise from ACEs such as physical and SA but other more prevalent ACEs (eg, VA, PS) may also contribute substantively to poorer life course health.
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Affiliation(s)
- Mark A Bellis
- Faculty of Health, Liverpool John Moores University, Liverpool, UK
- WHO Collaborating Centre for Investment in Health & Well-being, Public Health Wales, Wrexham, UK
| | - Karen Hughes
- WHO Collaborating Centre for Investment in Health & Well-being, Public Health Wales, Wrexham, UK
- Public Health Collaborating Unit, School of Medical and Health Sciences, Bangor University, Bangor, UK
| | - Katie Cresswell
- Public Health Collaborating Unit, School of Medical and Health Sciences, Bangor University, Bangor, UK
| | - Kat Ford
- Public Health Collaborating Unit, School of Medical and Health Sciences, Bangor University, Bangor, UK
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Ford K, Hughes K, Cresswell K, Griffith N, Bellis MA. Associations between Adverse Childhood Experiences (ACEs) and Lifetime Experience of Car Crashes and Burns: A Cross-Sectional Study. Int J Environ Res Public Health 2022; 19:16036. [PMID: 36498109 PMCID: PMC9735663 DOI: 10.3390/ijerph192316036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 11/18/2022] [Accepted: 11/29/2022] [Indexed: 06/17/2023]
Abstract
Unintentional injury is a significant cause of disease burden and death. There are known inequalities in the experience of unintentional injuries; however, to date only a limited body of re-search has explored the relationship between exposure to adverse childhood experiences (ACEs) and unintentional injury. Using a cross-sectional sample of the adult general public (n = 4783) in Wales (national) and England (Bolton Local Authority), we identify relationships between ACE exposure and experience of car crashes and burns requiring medical attention across the life course. Individuals who had experienced 4+ ACEs were at significantly increased odds of having ever had each outcome measured. Furthermore, compared to those with no ACEs, those with 4+ were around two times more likely to report having had multiple (i.e., 2+) car crashes and over four times more likely to report having had burns multiple times. Findings expand the evidence base for the association between ACEs and negative health consequences and emphasise the need for effective interventions to prevent ACEs and their impact on life course health and well-being. Such knowledge can also be used to develop a multifaceted approach to injury prevention.
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Affiliation(s)
- Kat Ford
- Public Health Collaborating Unit, School of Medical and Health Sciences, College of Human Sciences, Bangor University, Wrexham LL13 7YP, UK
| | - Karen Hughes
- Public Health Collaborating Unit, School of Medical and Health Sciences, College of Human Sciences, Bangor University, Wrexham LL13 7YP, UK
- World Health Organization Collaborating Centre on Investment for Health and Well-Being, Policy and International Health, Public Health Wales, Wrexham LL13 7YP, UK
| | - Katie Cresswell
- Public Health Collaborating Unit, School of Medical and Health Sciences, College of Human Sciences, Bangor University, Wrexham LL13 7YP, UK
| | - Nel Griffith
- Public Health Collaborating Unit, School of Medical and Health Sciences, College of Human Sciences, Bangor University, Wrexham LL13 7YP, UK
| | - Mark A. Bellis
- Public Health Collaborating Unit, School of Medical and Health Sciences, College of Human Sciences, Bangor University, Wrexham LL13 7YP, UK
- World Health Organization Collaborating Centre on Investment for Health and Well-Being, Policy and International Health, Public Health Wales, Wrexham LL13 7YP, UK
- Faculty of Health, Liverpool John Moores University, Liverpool L2 2ER, UK
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Hughes K, Ford K, Bellis MA, Amos R. Parental Adverse Childhood Experiences and Perpetration of Child Physical Punishment in Wales. Int J Environ Res Public Health 2022; 19:12702. [PMID: 36232002 PMCID: PMC9564530 DOI: 10.3390/ijerph191912702] [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] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 09/21/2022] [Accepted: 09/29/2022] [Indexed: 06/16/2023]
Abstract
Child physical punishment is harmful to children and, as such, is being prohibited by a growing number of countries, including Wales. Parents' own childhood histories may affect their risks of using child physical punishment. We conducted a national cross-sectional survey of Welsh adults and measured relationships between the number of adverse childhood experiences (ACEs) parents (n = 720 with children aged < 18) had suffered during childhood and their use of physical punishment towards children. Overall, 28.2% of parents reported having ever physically punished a child, and 5.8% reported having done so recently (in the last year). Child physical punishment use increased with the number of ACEs parents reported. Parents with 4+ ACEs were almost three times more likely to have ever physically punished a child and eleven times more likely to have done so recently (vs. those with 0 ACEs). The majority (88.1%) of parents that reported recent child physical punishment had a personal history of ACEs, while over half reported recently having been hit themselves by a child. Child physical punishment is strongly associated with parents' own ACE exposure and can occur within the context of broader conflict. Prohibiting physical punishment can protect children and, with appropriate family support, may help break intergenerational cycles of violence.
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Affiliation(s)
- Karen Hughes
- World Health Organization Collaborating Centre on Investment for Health and Well-Being, Public Health Wales, Wrexham LL13 7YP, UK
- College of Human Sciences, Bangor University, Wrexham LL13 7YP, UK
| | - Kat Ford
- College of Human Sciences, Bangor University, Wrexham LL13 7YP, UK
| | - Mark A. Bellis
- World Health Organization Collaborating Centre on Investment for Health and Well-Being, Public Health Wales, Wrexham LL13 7YP, UK
- College of Human Sciences, Bangor University, Wrexham LL13 7YP, UK
| | - Rebekah Amos
- College of Human Sciences, Bangor University, Wrexham LL13 7YP, UK
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Ford K, Sharp C, Hughes K, Bellis MA. O4-3 An evaluation of the Time to Move workplace physical activity intervention. Eur J Public Health 2022. [PMCID: PMC9421818 DOI: 10.1093/eurpub/ckac094.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background Workplace physical activity interventions have shown positive outcomes for employee health, productivity and absenteeism (1,2). However, the majority prescribe the duration and/or type of activity to be undertaken. In response to strong public opinion that employers should do more to improve the health of their workforce, Public Health Wales, the public health agency for Wales, developed a 12-month pilot physical activity initiative - Time to Move (TTM). TTM allowed participants to use one hour/week (pro rata) of paid work time for any physical activity. We evaluated TTM to understand its impact and identify learning. Methods Using pre-experimental time series design, data were collected from participating employees: baseline (June-August 2018), mid-initiative (December 2018) and at 12-months (June-August 2019). Using validated scales where possible, questionnaires recorded: physical activity (MET-minutes/week), general health (0, poor-100, good), mental well-being (SWEMWBS), job satisfaction (1, very dissatisfied-5, very satisfied) and demographics. Biometric measures (baseline, 12-months) included Body Mass Index (BMI) and blood pressure. Analyses used descriptive statistics, bivariate analysis and generalized linear modelling. Focus groups explored participants' perceptions of TTM, analysed thematically. Results 542 participants completed all measures (63.1% of baseline). Compared to baseline, at 12-months 57.7% reported increased physical activity (30.6% decreased; 11.6% no change) with 75.3% meeting UK activity guidelines (58.8% baseline). Those with the lowest levels of physical activity at baseline (n = 223) increased their weekly moderate activity by > 2.5 hours, whilst those with moderate activity (n = 269) increased by 58 minutes/week. A small improvement was reported in mental well-being (mean scores; 22.4 baseline, 23.2 12-months), with participants with low mental well-being at baseline improving the most. Self-reported health and job satisfaction also improved. However, BMI and blood pressure changes were non-meaningful. Employee attitudes to TTM were positive. Organisational support was a motivating factor for participation, with competing demands a barrier. Conclusions The provision of paid time to engage in physical activity can improve employee health and well-being. TTM provides an example of how organisations can promote physical activity and change workplace culture. However, further research should explore the long-term impact of the intervention, including the potential impact of COVID-19-related restrictions.
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Affiliation(s)
- Kat Ford
- Medical and Health Sciences, Bangor University , Wrexham, United Kingdom
| | - Catherine Sharp
- Welsh Institute of Physical Activity, Health and Sport, Swansea University , Swansea, United Kingdom
| | - Karen Hughes
- Medical and Health Sciences, Bangor University , Wrexham, United Kingdom
| | - Mark A Bellis
- Medical and Health Sciences, Bangor University , Wrexham, United Kingdom
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Ford K, Bellis MA, Judd N, Griffith N, Hughes K. The use of mobile phone applications to enhance personal safety from interpersonal violence - an overview of available smartphone applications in the United Kingdom. BMC Public Health 2022; 22:1158. [PMID: 35681167 PMCID: PMC9185885 DOI: 10.1186/s12889-022-13551-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 05/27/2022] [Indexed: 11/13/2022] Open
Abstract
Background Interpersonal violence has devastating implications for individuals, families, and communities across the globe, placing a significant burden on health, justice, and social welfare systems. Smartphone technology may provide a platform for violence prevention interventions. However, evidence on the availability and user experience of smartphone applications aimed to prevent violence is underexplored. Methods Systematic searches of available smartphone applications marketed for personal safety and violence prevention on the Apple Store (IOS) and Google Play (Android) in the United Kingdom were run in May 2021. Relevant applications were downloaded, with data on user reviews and ratings extracted. Included applications were categorised according to their features and functions. Online user reviews were rated according to their sentiment (positive, negative, neutral) and thematically analysed. Results Of 503 applications, 86 apps met review criteria. Only 52 (61%) apps offered full functionality free of charge. Over half (52%) of apps were targeted towards the general population, with 16% targeting women and 13% targeting families. App functionality varied with 22% providing an alarm, 71% sending alerts to pre-designated contacts, 34% providing evidence capture and 26% offering educational information. Overall, 71% of applications had a user rating of four or above. For 61 apps a total of 3,820 user reviews were extracted. Over half (52.4%) of reviews were rated as having a positive sentiment, with 8.8% neutral and 38.8% negative. Key themes across user reviews included positive consequences of app use, technical and usage issues including app reliability, dissatisfaction with the financial cost of some app features and personal data and ethical issues. Conclusions Reviews suggest that users find apps for personal safety and violence prevention useful. However, individuals also report them being unreliable, not working as described and having features that others may exploit. Findings have implications for the development of policy on apps to improve personal safety, especially given recent national policy (e.g. UK) discussions about their utility. Without the regulation or accreditation of such technology for quality assurance and reliability, emphasis needs to be placed on ensuring user safety; otherwise vulnerable individuals may continue to place reliance on untested technology in potentially dangerous circumstances. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-13551-9.
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Affiliation(s)
- Kat Ford
- Public Health Collaborating Unit, School of Medical and Health Sciences, College of Human Sciences, Bangor University, Wrexham, LL13 7YP, UK.
| | - Mark A Bellis
- Public Health Collaborating Unit, School of Medical and Health Sciences, College of Human Sciences, Bangor University, Wrexham, LL13 7YP, UK.,World Health Organization Collaborating Centre on Investment for Health and Well-being, Policy and International Health, Public Health Wales, Wrexham, LL13 7YP, UK
| | - Natasha Judd
- Public Health Collaborating Unit, School of Medical and Health Sciences, College of Human Sciences, Bangor University, Wrexham, LL13 7YP, UK
| | - Nel Griffith
- Public Health Collaborating Unit, School of Medical and Health Sciences, College of Human Sciences, Bangor University, Wrexham, LL13 7YP, UK
| | - Karen Hughes
- Public Health Collaborating Unit, School of Medical and Health Sciences, College of Human Sciences, Bangor University, Wrexham, LL13 7YP, UK.,World Health Organization Collaborating Centre on Investment for Health and Well-being, Policy and International Health, Public Health Wales, Wrexham, LL13 7YP, UK
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Ford K, Bellis MA, Hill R, Hughes K. An evaluation of a short film promoting kindness in Wales during COVID-19 restrictions #TimeToBeKind. BMC Public Health 2022; 22:583. [PMID: 35331188 PMCID: PMC8944183 DOI: 10.1186/s12889-022-12876-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 02/25/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In response to successive COVID-19 restrictions in Wales, the Welsh ACE Support Hub launched the #TimeToBeKind campaign in March 2021. The campaign used a short film broadcast on national television and promoted on social media to encourage behaviour change for kindness. We evaluated the #TimeToBeKind campaign film to identify whether watching the film would result in increased intention to act in ways that promote kindness to others and if intentions were associated with being emotionally affected by the film. METHODS A mixed methods evaluation was employed, using a short online survey and interaction with the film on the Twitter social media platform. The online survey measured public (n = 390) attitudes towards the film including feelings invoked, and behavioural intentions for acts of kindness as a result of viewing the film. Tweets which interacted with the film (n = 59; likes, re-tweets or comments), and tweet sentiment (positive, negative, or neutral) towards the film were also explored. RESULTS The majority of participants reported positive attitudes to the film and agreed that they understood the campaign message (91.8%). 67.9% reported that the film made them feel upset or sad and for 22.6% the film resonated with their lockdown experience. As a result of seeing the film, 63.6% reported intentions to be kinder to others, 65.6% intended to try and help other members of their community, and 70.5% were more likely to check in on friends, family and neighbours. A higher proportion of individuals who were emotionally affected by the film (e.g. upset or sad, hopeful or encouraged, gained something positive) and those for whom the film resonated with their lockdown experience reported increased kindness behavioural intentions as a result of seeing the film. CONCLUSIONS Film can be an effective tool to promote behaviour change for kindness. Films that provoke strong emotional reactions can still be perceived positively and lead to behaviour change. With the COVID-19 pandemic accelerating a move online for many, the findings of the present evaluation are relevant to how public health messaging can adapt and utilise this space to target individuals and promote behaviour change.
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Affiliation(s)
- Kat Ford
- Public Health Collaborating Unit, College of Human Sciences, Bangor University, LL13 7YP, Wrexham, UK.
| | - Mark A Bellis
- Public Health Collaborating Unit, College of Human Sciences, Bangor University, LL13 7YP, Wrexham, UK
- World Health Organization Collaborating Centre on Investment for Health and Well-being, Policy and International Health, Public Health Wales, LL13 7YP, Wrexham, UK
| | - Rebecca Hill
- World Health Organization Collaborating Centre on Investment for Health and Well-being, Policy and International Health, Public Health Wales, CF10 4BZ, Cardiff, UK
| | - Karen Hughes
- Public Health Collaborating Unit, College of Human Sciences, Bangor University, LL13 7YP, Wrexham, UK
- World Health Organization Collaborating Centre on Investment for Health and Well-being, Policy and International Health, Public Health Wales, LL13 7YP, Wrexham, UK
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Ford K, Hughes K, Bellis MA, Sharp C. Impacts of a workplace physical activity intervention on employee physical activity & mental health for NHS staff in Wales: an evaluation of the pilot Time to Move initiative. Int J Popul Data Sci 2022. [PMCID: PMC8902510 DOI: 10.23889/ijpds.v7i2.1737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
BackgroundEstimates show that only half of adults in Wales meet the UK recommend guidelines for physical activity. In 2015, the financial burden of physical inactivity to the Welsh NHS was estimated to be £35 million. Workplace interventions promoting physical activity can result in positive outcomes for employee health, wellbeing, productivity, job satisfaction and reduced absenteeism. However, the majority of such interventions are prescriptive in the type/duration of physical activity to be completed. In response to Welsh public opinion that employers should do more to help improve the health of their workforce, Public Health Wales (PHW) developed the Time to Move initiative - a 12-month pilot providing employees the opportunity to use one hour (pro rata) of paid work time per week for physical activity of their choice.
MethodsThe Time to Move initiative was evaluated using a pre-experimental time series design. Data were collected using online questionnaires at baseline (June-August 2018), mid-initiative (Dec 2018) and 12-months post-initiative (June–Aug 2019). All measures were self-reported and included physical activity (MET-minutes/week), general health (0, poor – 100, good) and mental well-being (SWEMWBS), job satisfaction (1, very dissatisfied – 5, very satisfied) and participant demographics (e.g. age, gender, pay band).
Findings625 participants completed measures at 12-months post-initiative (72.8% of baseline sample), representing just over a third of all PHW employees. Of those completing all relevant measures, 57.7% reported increased physical activity levels at 12-months compared to baseline (30.6% decreased; 11.6% no change). 75.3% of the sample met UK physical activity guidelines at 12-months compared to 58.8% at baseline. Individuals with the lowest reported levels of physical activity at baseline (n=223) made the greatest improvements - increasing their weekly moderate physical activity by >2.5 hours. Those with moderate activity (n=269) increased by 58 minutes/week and those with high activity levels (n=50) decreased by >4 hours/week. Overall, a small but statistically significant improvement was seen in mental well-being over the study period (mean scores, 22.4 baseline, 23.2 12-months), with participants with categorised as having low mental well-being at baseline benefitting the most. For self-reported health, 34.7% increased their rating (change of at least 10 points), 54.6% had no change and 10.7% declined. The proportion very/quite satisfied with their job increased from 64.4% to 72.0%, with 33.4% of individuals reporting increased job satisfaction (19.6% decreased).
ConclusionsThe Time to Move initiative demonstrates how organisations can encourage and enable their employees to improve their health. Evaluation findings indicate that the provision of paid time to engage in physical activity resulted in positive outcomes for many employees. However, understanding of the impact of the intervention over a longer-period of time is required, including how continued participation may have been impacted by COVID-19-related restrictions.
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Hardcastle K, Ford K, Bellis MA. Maternal adverse childhood experiences and their association with preterm birth: secondary analysis of data from universal health visiting. BMC Pregnancy Childbirth 2022; 22:129. [PMID: 35172776 PMCID: PMC8848970 DOI: 10.1186/s12884-022-04454-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 02/02/2022] [Indexed: 11/29/2022] Open
Abstract
Background Being born before full gestation can have short-term and life-long health implications, yet it remains difficult to determine the risk of preterm birth among expectant mothers. Across different health settings, increasing attention is given to the health and behavioural consequences of adverse childhood experiences (ACEs) such as child abuse or neglect, or exposure to harmful household environments (e.g. in which caregivers abuse alcohol), and the potential value of understanding these hidden harms when supporting individuals and families. A large international evidence base describes the association between childhood adversity and early years outcomes for mothers and children. However, the relationship between maternal ACEs and preterm birth has received far less attention. Methods Secondary analysis was carried out on anonymised cross-sectional data from health visiting services in south and west Wales that had previously captured information on mothers’ ACEs during routine contacts. Demographic data and information on mothers’ health were extracted from the Healthy Child Wales Programme. Results Half of all mothers sampled had experienced at least one ACE, with a history of ACEs more common among younger, white British mothers and those residing in deprived areas. Preterm birth was significantly independently associated with retrospective reports of childhood sexual abuse (adjusted odds ratio [AOR] = 3.83, 95% confidence interval [CI] = 1.19–12.32, p = 0.025), neglect (AOR = 7.60, 95%CI = 1.81–31.97, p = 0.006) and overall ACE exposure (AOR = 2.67, 95%CI = 1.14–6.23, p = 0.024), with one in ten mothers (10.0%) who experienced ≥4 ACEs having preterm birth. Sub-analyses revealed a more pronounced relationship among mothers with no known chronic health conditions, with those with ≥4 ACEs and no known chronic condition four times more likely to give birth preterm (AOR = 3.89, 95%CI = 1.40–10.80, p = 0.009). Conclusions Findings highlight the importance of the entire maternal experience. The experience of childhood adversity can have a lasting impact into and beyond the prenatal period, potentially increasing the risk of preterm birth, even among otherwise healthy women. Increasing our understanding of the potential perinatal outcomes associated with ACEs can help to inform how maternity services and partners offer trauma-sensitive support to mitigate some of the risks of early parturition, as well as target intergenerational cycles of adversity and poor health. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-022-04454-z.
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Affiliation(s)
- Katie Hardcastle
- Policy and International Health, World Health Organization Collaborating Centre on Investment for Health and Well-being, Public Health Wales, Wrexham Technology Park, Wrexham, LL13 7YP, UK
| | - Kat Ford
- Public Health Collaborating Unit, School of Medical and Health Sciences, Bangor University, Wrexham Technology Park, Wrexham, LL13 7YP, UK.
| | - Mark A Bellis
- Policy and International Health, World Health Organization Collaborating Centre on Investment for Health and Well-being, Public Health Wales, Wrexham Technology Park, Wrexham, LL13 7YP, UK.,Public Health Collaborating Unit, School of Medical and Health Sciences, Bangor University, Wrexham Technology Park, Wrexham, LL13 7YP, UK
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13
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Bellis MA, Hughes K, Ford K, Madden HCE, Glendinning F, Wood S. Associations between adverse childhood experiences, attitudes towards COVID-19 restrictions and vaccine hesitancy: a cross-sectional study. BMJ Open 2022; 12:e053915. [PMID: 35105582 PMCID: PMC8829847 DOI: 10.1136/bmjopen-2021-053915] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES Adverse childhood experiences (ACEs) can affect life-course health and well-being, including risk-taking behaviour and trust. This study explored associations between ACEs and trust in health information on COVID-19, attitudes towards and compliance with COVID-19 restrictions and vaccine hesitancy. DESIGN National cross-sectional telephone survey using a sample of landline and mobile numbers stratified by Health Board, deprivation quintile and age group. SETTING Households in Wales during national COVID-19 restrictions (December 2020 to March 2021). PARTICIPANTS 2285 Welsh residents aged ≥18 years. MEASURES Nine ACEs; low trust in National Health Service (NHS) COVID-19 information; supporting removal of social distancing and mandatory face coverings; breaking COVID-19 restrictions; and vaccine hesitancy (rejection or uncertainty of vaccination). RESULTS Increasing ACE counts were independently related to low trust in NHS COVID-19 information, feeling unfairly restricted by government and ending mandatory face coverings. High ACE counts (4+ vs 0 ACEs) were also associated with supporting removal of social distancing. Breaking COVID-19 restrictions increased with ACE count with likelihood doubling from no ACEs to 4+ ACEs. Vaccine hesitancy was threefold higher with 4+ ACEs (vs 0 ACEs) and higher in younger age groups. Thus, modelled estimates of vaccine hesitancy ranged from 3.42% with no ACEs, aged ≥70 years, to 38.06% with 4+ ACEs, aged 18-29 years. CONCLUSIONS ACEs are common across populations of many countries. Understanding how they impact trust in health advice and uptake of medical interventions could play a critical role in the continuing response to COVID-19 and controlling future pandemics. Individuals with ACEs suffer greater health risks throughout life and may also be excluded from interventions that reduce infection risks. While pandemic responses should consider how best to reach those suffering from ACEs, longer term, better compliance with public health advice is another reason to invest in safe and secure childhoods for all children.
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Affiliation(s)
- Mark A Bellis
- College of Human Sciences, Bangor University, Bangor, UK
- World Health Organization Collaborating Centre on Investment for Health and Well-being, Public Health Wales, Wrexham, UK
| | - Karen Hughes
- College of Human Sciences, Bangor University, Bangor, UK
- World Health Organization Collaborating Centre on Investment for Health and Well-being, Public Health Wales, Wrexham, UK
| | - Kat Ford
- College of Human Sciences, Bangor University, Bangor, UK
| | - Hannah C E Madden
- College of Human Sciences, Bangor University, Bangor, UK
- School of Social Sciences, Liverpool Hope University, Liverpool, UK
| | | | - Sara Wood
- World Health Organization Collaborating Centre on Investment for Health and Well-being, Public Health Wales, Wrexham, UK
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14
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Hughes K, Ford K, Bellis MA, Glendinning F, Harrison E, Passmore J. Health and financial costs of adverse childhood experiences in 28 European countries: a systematic review and meta-analysis. Lancet Public Health 2021; 6:e848-e857. [PMID: 34756168 PMCID: PMC8573710 DOI: 10.1016/s2468-2667(21)00232-2] [Citation(s) in RCA: 64] [Impact Index Per Article: 21.3] [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: 06/15/2021] [Revised: 09/16/2021] [Accepted: 09/20/2021] [Indexed: 01/26/2023]
Abstract
BACKGROUND Adverse childhood experiences (ACEs) are associated with increased health risks across the life course. We aimed to estimate the annual health and financial burden of ACEs for 28 European countries. METHODS In this systematic review and meta-analysis, we searched MEDLINE, CINAHL, PsycINFO, Applied Social Sciences Index and Abstracts, Criminal Justice Databases, and Education Resources Information Center for quantitative studies (published Jan 1, 1990, to Sept 8, 2020) that reported prevalence of ACEs and risks of health outcomes associated with ACEs. Pooled relative risks were calculated for associations between ACEs and harmful alcohol use, smoking, illicit drug use, high body-mass index, depression, anxiety, interpersonal violence, cancer, type 2 diabetes, cardiovascular disease, stroke, and respiratory disease. Country-level ACE prevalence was calculated using available data. Country-level population attributable fractions (PAFs) due to ACEs were generated and applied to 2019 estimates of disability-adjusted life-years. Financial costs (US$ in 2019) were estimated using an adapted human capital approach. FINDINGS In most countries, interpersonal violence had the largest PAFs due to ACEs (range 14·7-53·5%), followed by harmful alcohol use (15·7-45·0%), illicit drug use (15·2-44·9%), and anxiety (13·9%-44·8%). Harmful alcohol use, smoking, and cancer had the highest ACE-attributable costs in many countries. Total ACE-attributable costs ranged from $0·1 billion (Montenegro) to $129·4 billion (Germany) and were equivalent to between 1·1% (Sweden and Turkey) and 6·0% (Ukraine) of nations' gross domestic products. INTERPRETATION Availability of ACE data varies widely between countries and country-level estimates cannot be directly compared. However, findings suggest ACEs are associated with major health and financial costs across European countries. The cost of not investing to prevent ACEs must be recognised, particularly as countries look to recover from the COVID-19 pandemic, which interrupted services and education, and potentially increased risk factors for ACEs. FUNDING WHO Regional Office for Europe.
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Affiliation(s)
- Karen Hughes
- WHO Collaborating Centre on Investment for Health and Well-being, Public Health Wales, Wrexham, UK
| | - Kat Ford
- College of Human Sciences, Bangor University, Wrexham, UK
| | - Mark A Bellis
- WHO Collaborating Centre on Investment for Health and Well-being, Public Health Wales, Wrexham, UK.
| | | | - Emma Harrison
- College of Human Sciences, Bangor University, Wrexham, UK; Psychology Department, Glyndwr University, Wrexham, UK
| | - Jonathon Passmore
- WHO Regional Office for Europe, United Nations Campus, Bonn, Germany
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Abstract
OBJECTIVES An evaluation of a short animated film on adverse childhood experiences (ACEs) to explore attitudes and sentiment towards the film including, for a subsample of professionals, associations between attitudes and personal experience of ACEs. DESIGN Mixed-method exploratory design. SETTING Professionals and the general public. PARTICIPANTS A short online survey with 239 professionals. Interaction and user sentiment towards with the film on social media (Twitter, YouTube). PRIMARY AND SECONDARY OUTCOME MEASURES Survey: participants' attitudes towards the film including feelings invoked, learning gained and ACE count prevalence. Twitter user and YouTube viewer sentiment (positive, negative or neutral) and interaction (likes, retweets or comments) with the film. RESULTS Attitudes to the film were positive: 94.1% and 93.7%, respectively, agreed that it provided a helpful explanation of ACEs and trusted that the film was credible. Of those who reported ACE exposure, 88.9% agreed that those with ACEs would benefit from watching the film. Despite 50.6% reporting that the film had made them feel sad or upset, the majority (66.4%) reported they found the film hopeful or encouraging. Across 358 publicly available tweets from 313 users, 39.1% of tweets expressed positive sentiment, with only 1.4% negative (59.5% neutral). However, there was no association between tweet sentiment and interaction. Thirteen YouTube versions of the film received 171 812 views, 97.3% (n=889/914) ratings were positive (ie, 'thumbs up'). CONCLUSIONS Despite being emotionally arousing, many professionals reflected positive impacts of the film including a perceived increased ability to discuss ACEs. Public sentiment demonstrated a positive reaction to and acceptability of the film. Understanding the professional and public response to materials developed to increase ACE awareness, such as the film explored here, is important given the growing number of international movements which seek to increase ACE awareness, prevent ACEs and mitigate their lifelong negative effects.
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Affiliation(s)
- Kat Ford
- Public Health Collaborating Unit, School of Health Sciences, College of Human Sciences, Bangor University, Wrexham, UK
| | - Mark A Bellis
- Public Health Collaborating Unit, School of Health Sciences, College of Human Sciences, Bangor University, Wrexham, UK
- World Health Organization Collaborating Centre on Investment for Health and Well-being, Policy and International Health, Public Health Wales NHS Trust, Wrexham, UK
| | - Kate R Isherwood
- Research and Evaluation Division, Public Health Wales NHS Trust, Cardiff, UK
| | - Karen E Hughes
- Public Health Collaborating Unit, School of Health Sciences, College of Human Sciences, Bangor University, Wrexham, UK
- World Health Organization Collaborating Centre on Investment for Health and Well-being, Policy and International Health, Public Health Wales NHS Trust, Wrexham, UK
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Nancarrow L, Tempest N, Drakeley A, Hombury R, Ford K, Hapangama D, Russell R. O-181 4D ultrasound guided embryo transfers statistically improve live birth rates - A randomised controlled trial. Hum Reprod 2021. [DOI: 10.1093/humrep/deab127.082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Study question
Does the use of 4D ultrasound to guide embryo transfers improve live birth rates in comparison to the clinical touch technique?
Summary answer
4D ultrasound guided embryo transfers (4DUS) result in significantly higher live birth rates (LBR) in comparison to those performed using the clinical touch technique (CTT)(41%vs28%).
What is known already
A previous Cochrane review showed ultrasound guided embryo transfers (ET) improve pregnancy outcomes in comparison to CTT; however there was a large degree of heterogeneity between the studies and the largest study in the review showed no difference between ultrasound guidance and CTT. A further study demonstrated no difference in ongoing pregnancy rates between 2D vs 3D ultrasound guided embryo transfers, however this study did not use LBR as an endpoint and did not report on procedure duration/difficultly, both of which are known to impact ET success rates.
Study design, size, duration
This was a prospective, open labelled randomised controlled trial comparing superiority between two techniques for ET (4DUS vs CTT). A total of 320 (n = 160/group) patients were recruited using computer generated randomisation that were centrally distributed in consecutive sealed opaque envelopes between July 2018 to December 2019. Main outcomes were clinical pregnancy rate (CPR) and LBR. Following the procedure, participants completed a survey based on their comfort and satisfaction.
Participants/materials, setting, methods
Inclusion criteria included single blastocyst transfer and a normal uterine cavity. Participants were recruited and randomized on the day of ET. Those allocated to the CTT group, had their embryo transferred without ultrasound, depositing the embryo 6cm from the external os. Those in the 4DUS group had their ET using transvaginal 4D ultrasonography and had their embryos deposited at the maximal implantation point (MIP).
Main results and the role of chance
Results were available from a total of 295 women (8% attrition rate, CTT n = 153; 4DUS n = 142)).
No demographic differences between the two groups (CTT and 4DUS) were noted including age (p = 0.05), BMI (p = 0.29), duration of infertility (p = 0.94), type of infertility (p = 0.68) or embryo quality (p = 0.89). All the 4DUS and 95% of the CTT group were performed by the same practitioner.
The 4DUS resulted in significantly higher CPR (50% vs 36% p = 0.015, OR 1.78 (1.12-2.84)) and LBR (41%vs 28%, p = 0.021, OR 1.77 (1.09-2.87)).
There were no statistically significant differences between miscarriage (p = 0.494), pregnancy of unknown location (p = 0.141) or ectopic pregnancy rates (p = 0.958) between the two groups. The 4DUS process took significantly longer time compared with the CTT procedure (15.7 vs 10.2 minutes respectively, p < 0.01). The results of the survey showed no statistical difference between patient comfort (p = 0.17) or satisfaction (p = 0.08) between the groups however there were significantly more positive comments in the 4DUS (p < 0.01). In the 4DUS group there was no difference in mean endometrial thickness (P = 0.186) or endometrial volume (p = 0.836) between pregnant and non-pregnant patients.
Limitations, reasons for caution
Due to the nature of this trial we were unable to blind the participants due to the obvious differences between the methods. Wallace catheters were used for the CTT and Kitazato catheters for the 4DUS, whilst a methodological weakness; previous meta-analysis has not shown any difference between different soft catheters.
Wider implications of the findings
LBRs, when utilizing 4DUS, are significantly higher than the current UK average (41%vs22-23%) and significantly higher than CTT. 4DUS allows for superior imaging of the uterine cavity, tailoring the embryo deposition point specifically to the patient. Further RCTs are required to confirm that 4DUS is the superior technique for ET.
Trial registration number
ISRCTN79955797 ,IRAS 202857
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Affiliation(s)
- L Nancarrow
- Liverpool Women’s Hospital, Hewitt Fertility Centre, Liverpool, United Kingdom
| | - N Tempest
- University of Liverpool, Insitute of Translational Medicine, Liverpool, United Kingdom
| | - A Drakeley
- Liverpool Women’s Hospital, Hewitt Fertility Centre, Liverpool, United Kingdom
| | - R Hombury
- Homerton University Hospital, Homerton Fertility Centre, London, United Kingdom
| | - K Ford
- Liverpool Women’s Hospital, Hewitt Fertility Centre, Liverpool, United Kingdom
| | - D Hapangama
- University of Liverpool, Centre for Women’s Health Research, Liverpool, United Kingdom
| | - R Russell
- Liverpool Women’s Hospital, Hewitt Fertility Centre, Liverpool, United Kingdom
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Wright NJ, Leather AJ, Ade-Ajayi N, Sevdalis N, Davies J, Poenaru D, Ameh E, Ademuyiwa A, Lakhoo K, Smith ER, Douiri A, Elstad M, Sim M, Riboni C, Martinez-Leo B, Akhbari M, Tabiri S, Mitul A, Aziz DAA, Fachin C, Niyukuri A, Arshad M, Ibrahim F, Moitt N, Doheim MF, Thompson H, Ubhi H, Williams I, Hashim S, Philipo GS, Herrera L, Yunus A, Vervoort D, Parker S, Benaskeur YI, Alser OH, Adofo-Ansong N, Alhamid A, Salem HK, Saleh M, Elrais SA, Abukhalaf S, Shinondo P, Nour I, Aydin E, Vaitkiene A, Naranjo K, Dube AM, Ngwenya S, Yacoub MA, Kwasau H, Hyman G, Elghazaly SM, Al-Slaibi I, Hisham I, Franco H, Arbab H, Samad L, Soomro A, Chaudhry MA, Karim S, Khattak MAK, Nah SA, Dimatatac DM, Choo CSC, Maistry N, Mitul AR, Hasan S, Karim S, Yousuf H, Qureshi T, Nour IR, Al-Taher RN, Sarhan OAK, Garcia-Aparicio L, Prat J, Blazquez-Gomez E, Tarrado X, Iriondo M, Bragagnini P, Rite S, Hagander L, Svensson E, Owusu S, Abdul-Mumin A, Bagbio D, Ismavel VA, Miriam A, T S, Anaya Dominguez M, Ivanov M, Serban AM, Derbew M, Elfiky M, Olivos Perez M, Abrunhosa Matias M, Arnaud AP, Negida A, King S, Fazli MR, Hamidi N, Touabti S, Chipalavela RF, Lobos P, Jones B, Ljuhar D, Singer G, Hasan S, Cordonnier A, Jáuregui L, Zvizdic Z, Wong J, St-Louis E, Shu Q, Lui Y, Correa C, Pos L, Alcántara E, Féliz E, Zea-Salazar LE, Ali L, Peycelon M, Anatole NK, Jallow CS, Lindert J, Ghosh D, Adhiwidjaja CF, Tabari AK, Lotfollahzadeh S, Mussein HM, Vatta F, Pasqua N, Kihiko D, Gohil H, Nour IR, Elhadi M, Almada SA, Verkauskas G, Risteski T, Peñarrieta Daher A, Outani O, Hamill J, Lawal T, Mulu J, Yapo B, Saldaña L, Espineda B, Toczewski K, Tuyishime E, Ndayishimiye I, Raboe E, Hammond P, Walker G, Djordjevic I, Chitnis M, Son J, Lee S, Hussien M, Malik S, Ismail EM, Boonthai A, Dahman NBH, Hall N, Castedo Camacho FR, Sobrero H, Butler M, Makhmud A, Novotny N, Hammouri AG, Al-Rayyes M, Bvulani B, Muraveji Q, Murzaie MY, Sherzad A, Haidari SA, Monawar AB, Samadi DAZ, Thiessen J, Venant N, Hospital SI, Jérémie N, Mbonicura JC, Vianney BJM, Tadesse A, Negash S, Roberts CA, Jabang JN, Bah A, Camamra K, Correa A, Sowe B, Gai A, Jaiteh M, Raymond KJ, Mvukiyehe JP, Itangishaka I, Kayibanda E, Manirambona E, Lule J, Costas-Chavarri A, Shyaka Gashugi I, Ndata A, Gasana G, Nezerwa YC, Simeon T, Muragijimana JDD, Rashid S, Msuya D, Elisante J, Solanki M, Manjira E, Lodhia J, Jusabani M, Tarmohamed M, Koipapi S, Souhem T, Sara N, Sihem B, Dania B, Toufik IA, Mounira BNEI, Habiba A, Aragão L, Gonçalves V, Lino Urquizo MM, Varela MF, Mercado P, Horacio B, Damiani A, Mac C, Putruele D, Liljesthrom K, Bernaus M, Jauri C, Cripovich A, Bianchin E, Puig MG, Andreussi L, Iracelay S, Marcos D, Herrera C, Palacios N, Avile R, Serezo B, Montoya D, Cepeda R, Vaquila J, Veronica S, Pardo L, Valeria P, Julio L, Martin AD, Lucio P, Gabriel C, Marianella D, Calderón Arancibia JA, Huespe E, Losa GN, Arancibia Gutiérrez E, Scherl H, Gonzalez DE, Baistrocchi V, Silva Y, Galdeano M, Medard P, Sueiras I, Romero Manteola E, Defago VH, Mieres C, Alberto C, Cornelli F, Molina M, Ravetta P, Patiño Gonzalez CC, Dallegre MB, Szklarz MT, Leyba MF, Rivarola NI, Charras MD, Morales A, Caseb P, Toselli L, Millán C, Junes MDC, Di Siervi O, Gilardi J, Simon S, Contreras CS, Rojas N, Arnoletto LB, Blain OE, Bravo MN, Sanchez N, Herrera Pesara LM, Moreno ME, Sferco CA, Huq U, Ferdousi T, Al-Mamun A, Sultana S, Mahmud R, Mahmud K, Sayeed F, Svirsky A, Sempertegui D, Negrete A, Teran A, Sadagurschi M, Popovic N, Karavdic K, Milisic E, Jonuzi A, Mesic A, Terzic S, Dendusic N, Biber E, Sehic A, Zvizdic N, Letic E, Saracevic A, Hamidovic A, Selak N, Horozic D, Hukic L, Muhic A, Vanis N, Sokolovic E, Sabic A, Becker K, Novochadlo Klüppel E, dos Santos Dias AIB, Agulham MA, Bischoff C, Sabbatini S, Fernandes de Souza R, Souza Machado AB, Werneck Raposo J, da Silva Augusto ML, Martins BM, de Souza Santos Ferreira M, Fernandes de Oliveira D, Silva dos Santos C, Ribeiro de Fernández y Alcázar F, Alves Dutra da Silva É, Furtado M, Tamada H, Silva Ferreira dos Santos M, Lopes de Almeida T, Oliveira de Andrade S, Gurgel do Amaral AC, Sartori Giovanoni L, de Deus Passos Leles K, Corrêa Costa E, Feldens L, Ferraz Schopf L, Soares de Fraga JC, Colombo de Holanda F, Brolin Santis Isolan PM, Loyola Ferreira J, Bruxel CL, Lopes Teixeira Ferdinando D, Zottis Barcelos F, Baseggio N, Knorr Brenner N, Trindade Deyl R, Dure C, Nunes Kist I, Bueno Mazzuca R, Bueno Motter S, Ramos Y, Suzana Trein C, Rezende Rosa B, de Assis Silva M, Menin FA, Semensato Carloni IC, Norberto da Silva JA, Gomes AL, Girão Tauffer M, Bassan Gonçalves PC, Nogueira Marques GM, Moriya E, Labonia C, Carrasco AL, Furtado Meyer K, Farion-Aguiar L, Amado F, Antunes A, Silva E, Telles L, Almeida G, Belmino Gadelha AA, de Azevedo Belesa F, Gonçalves da Cunha, Jr A, Souza Barros B, Zanellato JB, Guimarães P, Silva KID, Ribas B, Reuter C, Casado FT, Correa Leite MT, Testoni D, Guinsburg R, de Campos Vieira Abib S, Khodor Cury E, Dornellas do Nascimento S, Almeida Aguiar A, Melo Gallindo R, Gonçalves Borges C, Liu Y, Duote C, Wang J, Gao Z, Liang L, Luo W, Zhao X, Chen R, Wang P, Han Y, Huang T, Donglai H, Xiaodong G, Junjie C, Zhu L, Wu G, Bao X, Li H, Lv J, Li Z, Yong F, Gao ZC, Bai Q, Tang W, Xie H, Motee J, Zhu J, Wen G, Ruan W, Li S, Chen L, Huang S, Lv Z, Lu J, Huang L, Yu M, Dajia W, Bai YZ, Rincon LC, Mancera J, Alzate Gallego E, Torres-Canchala L, Silva Beltrán N, Osorio Fory G, Castaño Avila D, Forero Ladino AM, Gomez J, Jaramillo M, Morales O, Sanchez B, Tinoco Guzmán NJ, Castañeda Espinosa S, Prieto Vargas O, Pardo LM, Toral E, Cáceres Aucatoma F, Hinostroza D, Valencia S, Salinas V, Landivar Cino E, Ponce Fajardo GY, Astudillo M, Garcia V, Muñoz G, Verduga L, Verduga I, Murillo E, Bucaram E, Guayelema M, Marmol M, Sanchez J, Vergara C, Mena A, Velaña J, Salazar K, Lara S, Chiriboga E, Silva J, Gad D, Samy D, Elsadek MA, Mohammed HM, Abouheba M, Ali KO, Rashwan H, Fawzy OM, Kamel TM, Nemer R, Hassan MA, Falah EH, Abdelhady DS, Zain M, Ibrahim EAA, Elsiraffy OO, Aboelela A, Farag EM, Oshiba AM, Emam OS, Attia AM, Laymouna MA, Ghorab IA, Mohammed MM, Soliman NA, Ghaly KAE, Sadek K, Elsherbiny M, Saleh A, Sheir H, Wafa T, Elmenam MA, Abdelmaksoud S, Reda A, Mansour I, Elzohiri M, Waseem B, Elewaily M, El-Ghazaly M, Elhattab A, Shalaby A, Elsaied A, Adawy A, Sadek M, Ahmed MA, Herdan MO, Elassall GMH, Mohammed AA, Takrouney MH, Essa TM, Mahmoud AM, Saad AM, Fouly MAN, Ibrahim MA, Nageh M, Saad MM, Badr H, Fouda MF, Nofal AH, Almohamady H, Arafa MA, Amad M, Mansour MA, O'Connor J, O'Connor Z, Anatole N, Nkunzimana E, Machemedze S, Dieudonné L, Appeadu-Mensah W, Anyomih TTK, Alhassan P, Abantanga FA, Michael V, Mary Koshy R, Raj A, Kumar V, PT S, Prabhu PS, Vosoughi A, Al-Mayoof AF, Fadhle MJ, Joda AE, Algabri HNO, Al-Taher RN, Abdelhamid SS, Al-Momani HM, Amarin M, Zaghlol LY, Alsaadi NN, Qwaider YZ, Qutishat H, Aliwisat AH, Arabiat E, Bsisu I, Murshidi RM, Jabaiti MS, Bataineh ZA, Abuhayyeh HA, 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Ugwu JO, Ugwunne CA, Akhter N, Gondal MF, Raza R, Chaudary AR, Ali H, Nisar MU, Jamal MU, Pandit GS, Mumtaz U, Amjad MB, Talat N, Rehman WU, Saleem M, Mirza MB, Hashim I, Haider N, Hameed S, Saleem A, Dogar S, Sharif M, Bashir MK, Naumeri F, Rani Z, Baniowda MA, Ba'baa' B, Hassan MYM, Darwish A, Sehwiel AS, Shehada M, Balousha AG, Ajrami Y, Alzamari AAM, Yaghi B, Al-saleem HSHA, Farha MSA, Abdelhafez MOM, Anaya F, Qadomi AB, Odi AANB, Assi MAF, Sharabati F, Abueideh A, Beshtawi DMS, Arafat H, Khatatba LZA, Abatli SJ, Al-Tammam H, Jaber D, Kayed YIO, Abumunshar AA, Misk RA, Alzeer AMS, Sharabati M, Ghazzawi I, Darras OM, M.Qabaja M, Hajajreh MS, Samarah YA, Yaghi DH, Qunaibi MAF, Mayaleh AA, Joubeh S, Ebeido A, Adawi S, Adawi I, Alqor MOI, Arar AS, Awad H, Abu-Nejmah F, Shabana OS, Alqarajeh F, Alzughayyar TZ, Madieh J, Sbaih MF, Alkareem RMA, Lahlooh RA, Halabi YA, Baker W, Almusleh TFH, Tahyneh AAA, Atatri YYM, Jamie NA, Massry NAA, Lubbad W, A.Nemer A, Alser M, Salha AAS, Alnahhal K, Elmzyyen AM, Ghabayen ATS, Alamrain AAA, Al-Shwaikh SH, Elshaer OA, Shaheen N, Fares J, Dalloul H, Qawwash A, Jayyab MA, Ashour DA, Shaheen AA, Naim SRR, Shiha EA, Dammagh NMA, Almadhoun W, Al-Salhi AA, Hammato AY, Salim JM, Hasanain DK, Alwadia SMS, Nassar I, Al-Attar HM, Alshaikhkhalil HAA, Jamie YMKA, Ashour YS, Alijla SS, Tallaa MAE, Abuattaya AA, Wishah BD, ALDIRAWI MOHAMMEDA, Darwish AS, Alzerei ST, Wishah N, Alijla S, Garcia I, Diaz Echegaray M, Cañapataña Sahuanay VR, Trigoso Mori F, Alvarado Zelada J, Salinas Barreto JJ, Rivera Altamirano P, Torres Miranda C, Anicama Elias R, Rivera Alvarez J, Vasquez Matos JP, Ayque Rosas F, Ledesma Peraza J, Gutarra Palomino A, Vega Centen S, Casquero V, Ortiz Argomedo MR, Lapouble F, Llap Unchón G, Delgado Malaga FP, Ortega Sotelo L, Gamboa Kcomt S, Villalba Villalba A, Mendoza Leon NR, Cardenas Alva LR, Loo Neyra MS, Alanguia Chipana CL, Torres Picón CMDJ, Huaytalla Quiroz N, Dominguez D, Segura Calle C, Arauco J, Ormeño Calderón L, Ghilardi Silva X, Fernandez Wilson MD, Gutierrez Maldonado JE, Diaz Leon C, Berrocal Anaya W, Chavez Galvez P, Aguilar Gargurevich PP, Diaz Castañeda FDM, Guisse C, Ramos Paredes E, Apaza Leon JL, Aguilar Aguilar F, Ramirez De La Cruz R, Flores Carbajal L, Mendoza Chiroque C, Sulca Cruzado GJ, Tovar Gutierrez N, Sotelo Sanchez J, Paz Soldan C, Hernández Córdova K, Delgado Quinteros EF, Brito Quevedo LM, Mendoza Oviedo JJ, Samanez Obeso A, Paredes Espinoza P, de Guzman J, Yu R, Cosoreanu V, Ionescu S, Mironescu A, Vida L, Papa A, Verdeata R, Gavrila B, Muntean L, Lukac M, Stojanovic M, Toplicic D, Slavkovic M, Slavkovi A, Zivanovic D, Kostic A, Raicevic M, Nkuliza D, Sidler D, Vos CD, Merwe EV, Tasker D, Khamag O, Rengura C, Siyotula T, Jooma U, Delft DV, Arnold M, Mangray H, Harilal S, Madziba S, Wijekoon N, Gamage T, Bright BP, Abdulrahman A, Mohammed OAA, Salah M, Ajwa AEA, Morjan M, Batal MM, Faks V, Mouti MB, Assi A, Al-Mouakeh A, Tarabishi AS, Aljarad Z, Alhamid A, Khorana J, Poocharoen W, Liukitithara S, Sriniworn A, Nuntasunti W, Ngerncham M, Phannua R, Thaiwatcharamas K, Tanming P, Sahnoun L, Kchiche N, Abdelmoumen R, Eroğlu E, Ozen MA, Cömert HSY, İmamoğlu M, Sarıhan H, Kader Ş, Mutlu M, Aslan Y, Beşir A, Geze Ş, Çekiç B, Yalcinkaya A, Sönmez K, Karabulut R, Türkyılmaz Z, Şeref K, Altın M, Aykut M, Akan M, Erdem M, Ergenekon E, Türkyılmaz C, Keleş E, Canözer A, Yeniay AÖ, Eren E, Cesur İB, Özçelik Z, Kurt G, Mert MK, Kaya H, Çelik M, Karakus SC, Erturk N, Suzen A, Hakan N, Akova F, Pasaoglu M, Eshkabilov S, Yuldashev RZ, Abdunomonovich DA, Muslimovich AM, Patel A, Kapihya C, Ensar N, Nataraja RM, Sivasubramaniam M, Jones M, Teague W, Tanny ST, Thomas G, Roberts K, Venkatraman SS, Till H, Pigeolet M, Dassonville M, Shikha A, Win WSP, Ahmad ZAH, Meloche-Dumas L, Caouette-Laberge L, St-Vil D, Aspirot A, Piché N, Joharifard S, Safa N, Laberge JM, Emil S, Puligandla P, Shaw K, Wissanji H, Duggan E, Guadagno E, Puentes MC, Leal PO, Mendez Benavente C, Rygl M, Trojanová B, Berková K, Racková T, Planka L, Škvařil J, Štichhauer R, Sabti S, Macdonald A, Bouhadiba N, Kufeji D, Pardy C, Mccluney S, Keshtgar A, Roberts R, Rhodes H, Burns K, Garrett-Cox R, Ford K, Cornwall H, Ravi K, Arthur F, Losty P, Lander T, Jester I, Arul S, Gee O, Soccorso G, Singh M, Pachl M, Martin B, Alzubair A, Kelay A, Sutcliffe J, Middleton T, Thomas AH, Kurian M, Cameron F, Sivaraj J, Thomas MC, Rex D, Jones C, Bradshaw K, Bonnard A, Delforge X, Duchesne C, Gall CL, Defert C, Laraqui Hossini S, Guerin F, Hery G, Fouquet-Languillat V, Kohaut J, Broch A, Blanc T, Harper L, Delefortrie T, Ballouhey Q, Fourcade L, Grosos C, Parmentier B, Levard G, Grella MG, Renaux Petel M, Grynberg L, Abbo O, Mouttalib S, Juricic M, Scalabre A, Haraux E, Rissmann A, Krause H, Goebel P, Patzer L, Rolle U, Schmedding A, Antunez-Mora A, Tillig B, Bismarck SV, Barbosa PR, Knorr C, Stark D, Brunero M, Avolio L, Manni F, Molinelli M, Guazzotti M, Raffaele A, Romano PG, Cavaiuolo S, Parigi GB, Juhasz L, Rieth A, Strumila A, Dagilytė R, Liubsys A, Gurskas P, Malcius D, Mikneviciute A, Vinskaite A, Barauskas V, Vierboom L, Hall T, Beasley S, Goddard L, Stringer M, Weeratunga N, Adams S, Cama J, Wong M, Jayaratnam S, Kukkady A, Samarakkody U, Gerus S, Patkowski D, Wolny A, Koszutski T, Tobor S, Osowicka M, Czauderna P, Wyrzykowski D, Garnier H, Anzelewicz S, Marta O, Knurowska A, Weiszewsk A, Grabowski A, Korlacki W, Pasierbek M, Wolak P, Piotrowska A, Roszkiewicz A, Kalicińsk P, Trypens A, Kowalewsk G, Sigalet D, Alsaied A, Ali M, Alsaggaf A, Ghallab A, Owiwi Y, Zeinelabdeen A, Fayez M, Atta A, Zidan M, Radwan AS, Shalaby H, Abdelbaqi R, Alattas K, Kano Y, Sindi O, Alshehri A, Altokhais T, Alturki F, Almosaibli M, Krisanova D, Abbas W, Yang HB, Kim HY, Youn JK, Chung JH, Cho SH, Hwang IJ, Lee JY, Song ES, Arboleda J, Ruiz de Temiño Bravo M, Siles Hinojosa A, García M, Casal Beloy I, Oliu San Miguel D, Molina Vazquez ME, Alonso V, Sanchez A, Gomez O, Carrillo I, Wester T, Mesas Burgos C, Hagander L, Salö M, Omling E, Rudolfson N, Granéli C, Arnadóttir H, Grottling E, Abrahamsson K, Gatzinsky V, Dellenmark Blom M, Borbonet D, Puglia P, Jimenez Morejon V, Acuna G, Moraes M, Chan J, Brahmamdam P, Tom A, Sherer K, Gonzales B, Cunningham A, Krishnaswami S, Baertschiger R, Leech M, Williams R, Camp L, Gosain A, Mora M, Lyttle BD, Chang J, McColl Makepeace L, Fowler KL, Mansfield S, Hodgman E, Amaechi C, Beres A, Pernik MN, Dosselman LJ, Almasri M, Jain S, Modi V, Fernandez Ferrer M, Coon J, Gonzalez J, Honhar M, Ruzgar N, Coghill G, Ullrich S, Cheung M, Løfberg K, Greenberg J, Davenport K, Gadepalli S, Fox S, Johnson S, Pilkington M, Hamilton A, Lin N, Sola J, Yao Y, Davis JK, Langer M, Vacek J, Abdullah F, Khlevner J, Middlesworth W, Levitt M, Ahmad H, Siddiqui SM, Bowder A, Derks T, Amoabin AA, Pinar B, Owusu-Sekyere F, Saousen B, Naidoo R, Karamustafic A, Oliveira DPD, Motter SB, Andrade J, Šafus A, Langley J, Wilke A, Deya C, Murtadi HM, Berzanskis M, Calistus N, Ajiboye OS, Felix M, Olabisi OO, Erçin S, Muradi T, Burks SS, Lerma S, Jacobson J, Calancea C, Valerio-Vazquez R, Sikwete G, Sekyere O, Mbonisweni A, Syed S, Hyeon CS, Pajouhandeh F, Kunfah SMP. Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study. Lancet 2021; 398:325-339. [PMID: 34270932 PMCID: PMC8314066 DOI: 10.1016/s0140-6736(21)00767-4] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 03/10/2021] [Accepted: 03/25/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. METHODS We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung's disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. FINDINGS We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung's disease) from 264 hospitals (89 in high-income countries, 166 in middle-income countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36-39) and median bodyweight at presentation was 2·8 kg (2·3-3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in low-income countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88-4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59-2·79], p<0·0001), sepsis at presentation (1·20 [1·04-1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4-5 vs ASA 1-2, 1·82 [1·40-2·35], p<0·0001; ASA 3 vs ASA 1-2, 1·58, [1·30-1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02-1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41-2·71], p=0·0001; parenteral nutrition 1·35, [1·05-1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47-0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50-0·86], p=0·0024) or percutaneous central line (0·69 [0·48-1·00], p=0·049) were associated with lower mortality. INTERPRETATION Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between low-income, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030. FUNDING Wellcome Trust.
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Ashton K, Davies AR, Hughes K, Ford K, Cotter-Roberts A, Bellis MA. Adult support during childhood: a retrospective study of trusted adult relationships, sources of personal adult support and their association with childhood resilience resources. BMC Psychol 2021; 9:101. [PMID: 34176519 PMCID: PMC8237477 DOI: 10.1186/s40359-021-00601-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 06/09/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Adverse childhood experiences (ACEs) can affect health and well-being across the life course. Resilience is an individual characteristic that is known to help negate the effect of adversities and potentially transform toxic stress into tolerable stress. Having access to a trusted adult during childhood is critical to helping children build resiliency. Here, we aim to understand the relationship between always having access to trusted adult support and childhood resilience resources, and examine which sources of personal adult support and the number of sources of adult support, best foster childhood resilience. METHODS A Welsh national cross-sectional retrospective survey (n = 2497), using a stratified random probability sample. Data were collected via face-to-face interviews at participants' places of residence by trained interviewers. Analyses use chi-square and binary logistic regression methods. Outcome measures were childhood resilience resources, access to an always-available trusted adult, and sources of personal adult support. RESULTS Prevalence of access to an always-available trusted adult decreased with increasing number of ACEs from 86.6% of individuals with no ACEs, to 44.4% of those with four or more ACEs (≥ 4). In addition, for those experiencing ≥ 4 ACEs, individuals with no access to a trusted adult were substantially less likely than those with access, to report childhood resilience resources. For example, for individuals with ≥ 4 ACEs, those with access to an always-available trusted adult were 5.6 times more likely to have had supportive friends and 5.7 times more likely to have been given opportunities to develop skills to succeed in life, compared to those with no access to a trusted adult. When looking at sources of personal adult support, resilience levels increased dramatically for those individuals who had either one parent only or two parents as sources of support, in comparison to those without parental support. CONCLUSIONS Analyses here suggest strong relationships between elements of childhood resilience, constant access to trusted adults and different sources of personal adult support. While the eradication of ACEs remains unlikely, actions to strengthen childhood access to trusted adults may partially ease immediate harms and protect future generations.
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Affiliation(s)
- Kathryn Ashton
- Policy and International Development Directorate, a World Health Organization Collaboration Centre on Investment for Health and Well-Being, Cardiff, CF10 4BZ UK
| | - Alisha R. Davies
- Knowledge Directorate, Public Health Wales, Cardiff, CF10 4BZ UK
| | - Karen Hughes
- Policy and International Development Directorate, a World Health Organization Collaboration Centre on Investment for Health and Well-Being, Wrexham, LL13 7YP UK
- Public Health Collaborating Unit, School of Health Sciences, Bangor University, Wrexham, LL13 7YP UK
| | - Kat Ford
- Public Health Collaborating Unit, School of Health Sciences, Bangor University, Wrexham, LL13 7YP UK
| | - Andrew Cotter-Roberts
- Policy and International Development Directorate, a World Health Organization Collaboration Centre on Investment for Health and Well-Being, Cardiff, CF10 4BZ UK
| | - Mark A. Bellis
- Policy and International Development Directorate, a World Health Organization Collaboration Centre on Investment for Health and Well-Being, Wrexham, LL13 7YP UK
- Public Health Collaborating Unit, School of Health Sciences, Bangor University, Wrexham, LL13 7YP UK
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Dua A, Ford K, Fiore S, Pappas DA, Janak J, Blachley T, Roberts-Toler C, Emeanuru K, Kremer J, Kivitz A. POS0606 DISEASE ACTIVITY AND PATIENTS-REPORTED OUTCOMES AFTER SWITCHING BETWEEN IL-6 RECEPTOR INHIBITORS AND JAK INHIBITORS: AN ANALYSIS FROM THE CORRONA REGISTRY. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.1298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Rheumatoid arthritis (RA) patients who fail therapy may be switched to any of the five classes of biological disease-modifying antirheumatic drugs (DMARDs) and targeted synthetic DMARDs, to meet treatment goals. Physicians may hesitate to switch between Janus Kinase inhibitors (JAKi) and interleukin-6 receptor inhibitors (IL-6Ri) since they both impact IL-6 signalling and due to limited data on switching between the two classes.Objectives:This retrospective, observational study based on the real-world Corrona RA registry aimed to describe the response in RA patients switching between IL-6Ri and JAKi.Methods:Adult RA patients who initiated either IL-6Ri or JAKi after November 2012 and had a six-month post-initiation follow-up visit were eligible. Patients in ‘Cohort A’ initiated an IL-6Ri following discontinuation of a JAKi and those in ‘Cohort B’ initiated a JAKi following discontinuation of an IL-6Ri. Disease activity measures and patient-reported outcomes (PROs) were evaluated at baseline and at six-month follow-up. Within each group, change from baseline was assessed for Clinical Disease Activity Index (CDAI), Health Assessment Questionnaire (HAQ), pain, fatigue, tender joint count (TJC), swollen joint count (SJC), physician global assessment (MDGA), patient global assessment (PtGA) and morning stiffness duration. Proportion of patients achieving CDAI low disease activity (LDA), CDAI remission and minimal clinically important difference (MCID) for HAQ, pain, fatigue, MDGA, PtGA were assessed. Adjusted linear and logistic regression models were performed for between-group comparisons (Cohort A vs Cohort B) excluding initiators who switched therapy prior to six-month visit.Results:Cohorts A and B included 122 and 144 initiators, respectively. Patients who switched toIL-6Ri (vs JAKi) were younger (mean [SD] age, 56.2 [11.3] vs 58.9 [12.6] years), had higher baseline CDAI (23.2 [12.9] vs 20.2 [12.8]), had higher prior use of ≥2 csDMARDs (75% vs 65%), and were less likely to initiate therapy as monotherapy (44% vs 50%).In Cohort A, significant changes from baseline were observed for all continuous outcomes except HAQ and fatigue. In Cohort B, a significant improvement was observed only for patient-reported pain (Table 1).Table 1.Unadjusted Within-Group Change from Baseline to Six Months, Mean (95% CI), nOutcomesCohort A, N = 122Cohort B, N = 144CDAI-4.7 (-7.6, -1.9), 109-2.4 (-5.2, 0.4), 116HAQ-0.0 (-0.1, 0.1), 105-0.1 (-0.1, 0.0), 118Patient-reported pain-8.2 (-13.4, -3.0), 109-5.9 (-11.5, -0.2), 120Patient-reported fatigue-4.4 (-9.0, 0.2), 109-1.7 (-6.6, 3.3), 117TJC-1.6 (-3.0, -0.1), 112-1.2 (-2.6, 0.3), 117SJC-1.5 (-2.5, -0.4), 112-0.4 (-1.3, 0.6),117MDGA-10.9 (-15.6, -6.3), 112-4.3 (-8.7, 0.2), 117PtGA-6.0 (-11.2, -0.8), 109-4.8 (-10.5, 0.8), 120Morning stiffness durationa-1.3 (-2.2, -0.5), 109-0.1 (-1.1, 0.8), 118aAmong those reporting morning stiffness at baseline.In the adjusted between-group comparison (data not shown) of change from baseline, there were no significant differences in clinical outcomes between Cohorts A and B.In both cohorts, patients achieved CDAI LDA, CDAI remission, and MCIDs across other PROs (Figure 1). In the adjusted between-group comparison (data not shown), the results were similar with the exception of achievement of CDAI LDA among patients with moderate to high disease activity at baseline.Figure 1.Rates of CDAI LDA, CDAI Remission, and MCID for PROsa at Six MonthsConclusion:In general, in both cohorts a substantial proportion of patients achieved CDAI LDA and MCID across PROs. Despite some overlap of JAKi and IL-6Ri therapies’ on the IL-6 pathway, there are some distinct mechanisms of action which may result in meaningful improvements for a subset of patients.Acknowledgements:Amy Praestgaard (Sanofi) contributed to the interpretation of the statistical analysis for this abstract. Medical writing support for this abstract was provided by Nupur Chaubey (Sanofi).Disclosure of Interests:Anisha Dua Speakers bureau: AbbVie, Consultant of: Consulting/advisory board for AbbVie, Novartis, and Chemocentryx, Employee of: Board member of Vasculitis foundation and Chicago Rheumatism Society, Kerri Ford Shareholder of: Sanofi, Employee of: Sanofi, Stefano Fiore Shareholder of: Sanofi, Employee of: Sanofi. In addition, Stefano Fiore has a patent EP 19306553.9; USPTO #s 62/799,698; 62/851,474; 62/935,395 issued, Dimitrios A Pappas Shareholder of: Corrona LLC, Consultant of: Sanofi, AbbVie, Gtech, Roche Hellas, and Novartis, Employee of: Corrona LLC. Board of directors, Corrona Research Foundation, Judson Janak: None declared, Taylor Blachley: None declared, Carla Roberts-Toler: None declared, Kelechi Emeanuru: None declared, Joel Kremer Consultant of: AbbVie, Lilly, Novartis, Pfizer, BMS, Genentech, Regeneron, Sanofi, and Corrona, Grant/research support from: AbbVie, Lilly, Novartis, and Pfizer, Alan Kivitz Shareholder of: Pfizer, Sanofi, GlaxoSmithKline, Gilead Sciences, Inc., and Novartis, Speakers bureau: Celgene, Merck, Lilly, Novartis, Pfizer, Sanofi, Flexion, and AbbVie, Consultant of: AbbVie, Boehringer Ingelheim, Flexion, Janssen, Pfizer, Sanofi, Regeneron, SUN Pharma Advanced Research, Gilead Sciences, Inc. In addition, Alan Kivitz reports other from Altoona Center for Clinical Research, PC, during the conduct of the study.
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Curtis J, Fiore S, Ford K, Janak J, Chang H, Pappas DA, Blachley T, Emeanuru K, Bykerk V. POS0594 MEANINGFUL IMPROVEMENT AND WORSENING IN PATIENTS WHO DO NOT ACHIEVE LDA AND SWITCH THERAPY TO A NEW BIOLOGIC OR TARGETED THERAPY: RESULTS FROM THE CORRONA REGISTRY. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Guidelines recommend adjusting therapy in patients with rheumatoid arthritis (RA) who fail to reach and sustain low disease activity (LDA) or remission (disease control). Many factors can affect the decision to change therapy, including the potential for improvement as well as the fear of potential worsening or loss of improvement already achieved. Although data exist on response to treatment in patients who switch therapy, data addressing the likelihood of worsening are limited.Objectives:The aim of this analysis was to describe the demographic, clinical characteristics, and change in clinical outcomes in patients on biologic/targeted synthetic disease-modifying anti-rheumatic drugs (b/tsDMARDs) who had some improvement in clinical disease activity index (CDAI) but did not achieve LDA after ~ 6-12 months of treatment and then switched to a different b/tsDMARD.Methods:This study included adult inadequately responding RA patients from the CORRONA registry who: (1) started a biologic or Janus kinase inhibitor (JAKi) between January 2010 to November 2020 (V1), (2) had any CDAI improvement (i.e., decrease ≥1 unit) but were not in LDA or remission at a subsequent visit (baseline [BL]) occurring 3 to 15 months after V1; (3) had a third visit (follow-up [F/U]) 6 (±3) months after BL with a valid CDAI measure; (4) switched therapy at the BL or between BL and F/U, with the switch occurring at least 3 months prior to the F/U. CDAI >10 and ≤22 was defined as moderate disease activity (MDA) and CDAI >22 was defined as high disease activity (HDA). Two thresholds of change in CDAI (≥6 and ≥12 units) were used to define meaningful improvement and meaningful worsening after the switch. If there was no meaningful improvement or meaningful worsening, this was considered as no meaningful change (-5 to +5 for 6 units change and -11 to +11 for 12 units change). These thresholds for meaningful change were set for all switchers regardless of their pre-switch CDAI value. Descriptive statistics were generated for demographic and clinical characteristics for the switchers at BL, and the change of clinical outcomes was evaluated from BL to F/U.Results:Of the 1,224 patients fulfilling the inclusion criteria, 93 (7.6%) switched therapy and 1,131 (92.4%) did not switch therampy after not achieving an adequate response on the initial b/tsDMARD. At BL, 42.5% and 70.0% of patients had no meaningful improvement to their prior therapy based on ≥6 and ≥12-unit change, respectively; mean (SD) age was 53.1 (14.0) years; duration of RA 10.7 (10.4) years; CDAI 22.2 (10.8); 81.7% were female; 64.5% had MDA, 35.5% had HDA; 21.5 % reported being disabled, 24.7% were current smokers, and 50% were obese. In terms of prior biologic use 57.0%, 22.6%, and 20.4% had been on 1, 2, and 3+, respectively. From BL to F/U, meaningful worsening occurred in 30.1% and 12.9% using a threshold of 6 and 12, respectively, with the remaining patients experiencing meaningful improvement or no meaningful change (Figure 1).Figure 1.Meaningful Worsening, Meaningful Improvement, and No Meaningful Change Based on CDAI Change Thresholds of ≥6 and ≥12 From BL to F/U (N=93)Conclusion:In our analysis, a large proportion of patients who initiated a biologic/JAKi and experienced some improvement but failed to attain LDA or remission, did not switch therapy within approximately a year. This analysis consisted of many patients who did not have a meaningful response to their prior biologic/JAKi, patients who had received multiple prior biologics, and a large portion of patients with poor prognostic factors. Despite this, the proportion of patients with meaningful worsening was low compared with most patients who had either meaningful improvement or no meaningful change. Additional research is warranted to understand the reasons for not switching and whether the likelihood of a meaningful change correlates with prior response, poor prognosis, or other factors.Acknowledgements:Amy Praestgaard (Sanofi) contributed to the statistical analysis for this abstract. Medical writing support for this abstract was provided by Krishna Kammari (Sanofi).Disclosure of Interests:Jeffrey Curtis Grant/research support from: and personal fees from AbbVie, Amgen, BMS, CORRONA, Eli Lily, Janssen, Myriad, Pfizer, Roche, Regeneron, Radius, UCB, outside the submitted work, Stefano Fiore Shareholder of: Sanofi, Employee of: Sanofi. In addition, he has a patent EP 19306553.9; USPTO #s 62/799,698; 62/851,474; 62/935,395 issued, Kerri Ford Shareholder of: Sanofi, Employee of: Sanofi, Judson Janak: None declared, Hong Chang: None declared, Dimitrios A Pappas Employee of: CORRONA LLC. He has previously acted as a consultant for Sanofi, Abbvie, Gtech Roche Hellas, and Novartis. He has an equity interest in CORRONA LLC. and is on the Board of directors of the CORRONA research foundation, Taylor Blachley: None declared, Kelechi Emeanuru: None declared, Vivian Bykerk Grant/research support from: reports grants from Amgen, BMS, UCB, and Novartis were given to institution, that grants from the NIH, PCORI, and CIHR were given to institutions which whom she is affiliated, and that she has received personal fees from Amgen, Gilead, BMS, Pfizer, Sanofi Aventis, Roche, UCB and Regeneron, outside the submitted work.
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Fiore S, Chen L, Clinton C, Yun H, Praestgaard A, Ford K, Curtis J. POS0638 DISEASE SEVERITY AND OUTCOMES AMONG PATIENTS WITH RHEUMATOID ARTHRITIS WHO RECEIVE A NEWLY APPROVED BIOLOGIC: REAL-WORLD US EXPERIENCE WITH SARILUMAB FROM THE ACR RISE REGISTRY. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.3655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Patients with rheumatoid arthritis (RA) who have received multiple biologics or targeted therapies over time tend to have more refractory and more severe disease, which may lead to worse clinical response to treatment.Objectives:We used data from the ACR RISE registry to assess whether disease severity was greater in those who received sarilumab shortly after its FDA approval (May 2017) than in subsequent time periods and to evaluate the effectiveness of sarilumab in populations with various degrees of disease severity.Methods:Patients with RA who initiated sarilumab treatment in the period 2017-2020 were identified in the ACR RISE registry and divided into Cohort 1 (2017, year of the FDA approval) and the calendar year-based Cohorts 2-4 (2018-2020). Patient demographics, RA-related features, and comorbidities were determined using data prior to sarilumab initiation. The cohorts were compared using chi-square test (categorical variables) and a nonparametric test (continuous variables). Sarilumab effectiveness was assessed using 3 cohorts assembled based on progressively restrictive criteria: Active Disease cohort (Clinical Disease Activity Index [CDAI] >10 or Routine Assessment of Patient Index Data 3 [RAPID3] >6, and C-reactive protein, if measured, ≥8 mg/L), TARGET Eligibility cohort (patients who satisfied enrolment criteria for TARGET,1 a Phase 3 sarilumab trial in patients with RA and an inadequate response to TNF inhibitors), and TARGET Baseline cohort (patients from TARGET Eligibility cohort with characteristics weighted to match those from the TARGET trial baseline,1 using the matching-adjusted indirect comparison method2). In all 3 effectiveness cohorts, mean changes in CDAI and RAPID3 at 6 and 12 months post-initiation of sarilumab were evaluated using a model adjusted for baseline score, age, sex, race, calendar year, and seropositivity.Results:A total of 2949 patients, treated by 585 rheumatologists, initiated sarilumab treatment in the period 2017–2020. The 4 yearly cohorts were relatively similar in terms of patients’ age, sex, race, and most clinical characteristics. However, patients receiving sarilumab shortly after FDA approval (Cohort 1) had more ambulatory visits, a greater number of previously used non-TNFi biologics (particularly tocilizumab), and a higher comorbidity burden, and were more likely to be current users of glucocorticoids or opioids than sarilumab initiators in the subsequent 3 years. In the 3 cohorts used to assess sarilumab effectiveness, the greatest improvement was observed in the TARGET Baseline cohort, which also had the greatest mean baseline CDAI score (43), compared with the other two (24 both).Conclusion:In this real-world cohort, we observed modest evidence for channeling of patients with greater RA severity and greater prior exposure to non-TNFi biologics to sarilumab shortly after its FDA approval. This cohort effect did not diminish the effectiveness of sarilumab. All cohorts showed improvement, with the greatest clinical improvement observed in the cohort with the highest baseline CDAI score who most closely resembled those enrolled in a phase 3 trial of patients with an inadequate response to TNF inhibitors.References:[1]Fleischmann R, et al. Arthritis Rheumatol 2017;69:277-290.[2]Signorovitch JE et al. Value Health 2012;15:940-7.Figure 1.Adjusted improvements in CDAI and RAPID3Acknowledgements:This study was sponsored by Sanofi. Medical writing support was provided by Vojislav Pejović, PhD (Eloquent Medical Affairs, division of Envision Pharma Group) and funded by Sanofi.Disclosure of Interests:Stefano Fiore Employee of: Sanofi, Lang Chen: None declared, Cassie Clinton Consultant of: Information available in profile, Huifeng Yun Grant/research support from: Research support for Pfizer, Amy Praestgaard Employee of: Sanofi, Kerri Ford Employee of: Sanofi, Jeffrey Curtis Consultant of: Received consulting and research grants from AbbVie, Amgen, BMS, Lilly, Gilead, GSK, Janssen, Myriad, Pfizer, Roche, Samsung, Sandoz, Sanofi, UCB, Grant/research support from: Received consulting and research grants from AbbVie, Amgen, BMS, Lilly, Gilead, GSK, Janssen, Myriad, Pfizer, Roche, Samsung, Sandoz, Sanofi, UCB
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Ford K, Gunawardana S, Manirambona E, Philipoh GS, Mukama B, Kanyamuhunga A, Cartledge P, Nyoni MJ, Mwaipaya D, Mpwaga J, Bokhary Z, Scanlan T, Heinsohn T, Hathaway H, Mansfield R, Wilson S, Lakhoo K. Investigating Wilms' Tumours Worldwide: A Report of the OxPLORE Collaboration-A Cross-Sectional Observational Study. World J Surg 2020; 44:295-302. [PMID: 31605179 DOI: 10.1007/s00268-019-05213-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Childhood cancer is neglected within global health. Oxford Pediatrics Linking Oncology Research with Electives describes early outcomes following collaboration between low- and high-income paediatric surgery and oncology centres. The aim of this paper is twofold: to describe the development of a medical student-led research collaboration; and to report on the experience of Wilms' tumour (WT). METHODS This cross-sectional observational study is reported as per STROBE guidelines. Collaborating centres included three tertiary hospitals in Tanzania, Rwanda and the UK. Data were submitted by medical students following retrospective patient note review of 2 years using a standardised data collection tool. Primary outcome was survival (point of discharge/death). RESULTS There were 104 patients with WT reported across all centres over the study period (Tanzania n = 71, Rwanda n = 26, UK n = 7). Survival was higher in the high-income institution [87% in Tanzania, 92% in Rwanda, 100% in the UK (X2 36.19, p < 0.0001)]. Given the short-term follow-up and retrospective study design, this likely underestimates the true discrepancy. Age at presentation was comparable at the two African sites but lower in the UK (one-way ANOVA, F = 0.2997, p = 0.74). Disease was more advanced in Tanzania at presentation (84% stage III-IV cf. 60% and 57% in Rwanda and UK, respectively, X2 7.57, p = 0.02). All patients had pre-operative chemotherapy, and a majority had nephrectomy. Post-operative morbidity was higher in lower resourced settings (X2 33.72, p < 0.0001). Methodology involving medical students and junior doctors proved time- and cost-effective. This collaboration was a valuable learning experience for students about global research networks. CONCLUSIONS This study demonstrates novel research methodology involving medical students collaborating across the global south and global north. The comparison of outcomes advocates, on an institutional level, for development in access to services and multidisciplinary treatment of WT.
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Affiliation(s)
- K Ford
- Department of Pediatric Surgery, Oxford University Hospital, Headley Way, Headington, Oxford, OX3 9DU, UK
| | | | - E Manirambona
- University of Rwanda, Centre Hospitalier Universitaire de Kigali, Kigali, Rwanda
| | - G S Philipoh
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - B Mukama
- University of Rwanda, Centre Hospitalier Universitaire de Kigali, Kigali, Rwanda
| | - A Kanyamuhunga
- Department of Pediatric Oncology, Centre Hospitalier Universitaire de Kigali, Kigali, Rwanda
| | - P Cartledge
- University of Rwanda, Centre Hospitalier Universitaire de Kigali, Kigali, Rwanda.,Yale University, New Haven, USA
| | - M J Nyoni
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - D Mwaipaya
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - J Mpwaga
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Z Bokhary
- Department of Pediatric Surgery, Muhimbili National Hospital, Dar es Salaam, Tanzania
| | - T Scanlan
- Department of Pediatric Oncology, Muhimbili National Hospital, Dar es Salaam, Tanzania
| | | | | | | | - S Wilson
- Department of Paediatric Oncology, Oxford University Hospitals, Oxford, UK
| | - K Lakhoo
- Department of Pediatric Surgery, Oxford University Hospital, Headley Way, Headington, Oxford, OX3 9DU, UK. .,Oxford University, Oxford, UK. .,Department of Pediatric Surgery, Muhimbili National Hospital, Dar es Salaam, Tanzania. .,Department of Paediatric Oncology, Oxford University Hospitals, Oxford, UK.
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Hughes K, Bellis MA, Sethi D, Andrew R, Yon Y, Wood S, Ford K, Baban A, Boderscova L, Kachaeva M, Makaruk K, Markovic M, Povilaitis R, Raleva M, Terzic N, Veleminsky M, Włodarczyk J, Zakhozha V. Adverse childhood experiences, childhood relationships and associated substance use and mental health in young Europeans. Eur J Public Health 2020; 29:741-747. [PMID: 30897194 PMCID: PMC6660110 DOI: 10.1093/eurpub/ckz037] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background Adverse childhood experiences (ACEs) can increase risks of health-harming behaviours and poor health throughout life. While increases in risk may be affected by resilience resources such as supportive childhood relationships, to date few studies have explored these effects. Methods We combined data from cross-sectional ACE studies among young adults (n = 14 661) in educational institutions in 10 European countries. Nine ACE types, childhood relationships and six health outcomes (early alcohol initiation, problem alcohol use, smoking, drug use, therapy, suicide attempt) were explored. Multivariate modelling estimated relationships between ACE counts, supportive childhood relationships and health outcomes. Results Almost half (46.2%) of participants reported ≥1 ACE and 5.6% reported ≥4 ACEs. Risks of all outcomes increased with ACE count. In individuals with ≥4 ACEs (vs. 0 ACEs), adjusted odds ratios ranged from 2.01 (95% CIs: 1.70–2.38) for smoking to 17.68 (95% CIs: 12.93–24.17) for suicide attempt. Supportive childhood relationships were independently associated with moderating risks of smoking, problem alcohol use, therapy and suicide attempt. In those with ≥4 ACEs, adjusted proportions reporting suicide attempt reduced from 23% with low supportive childhood relationships to 13% with higher support. Equivalent reductions were 25% to 20% for therapy, 23% to 17% for problem drinking and 34% to 32% for smoking. Conclusions ACEs are strongly associated with substance use and mental illness. Harmful relationships are moderated by resilience factors such as supportive childhood relationships. Whilst ACEs continue to affect many children, better prevention measures and interventions that enhance resilience to the life-long impacts of toxic childhood stress are required.
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Affiliation(s)
- Karen Hughes
- Public Health Wales, WHO Collaborating Centre on Investment for Health and Well-being, Wrexham, UK.,College of Human Sciences, Bangor University, Wrexham, UK
| | - Mark A Bellis
- Public Health Wales, WHO Collaborating Centre on Investment for Health and Well-being, Wrexham, UK.,College of Human Sciences, Bangor University, Wrexham, UK
| | - Dinesh Sethi
- Division of Non-Communicable Diseases and Promoting Health through the Life-Course, World Health Organization Regional Office for Europe, Copenhagen, Denmark
| | - Rachel Andrew
- Public Health Wales, WHO Collaborating Centre on Investment for Health and Well-being, Wrexham, UK
| | - Yongjie Yon
- Division of Non-Communicable Diseases and Promoting Health through the Life-Course, World Health Organization Regional Office for Europe, Copenhagen, Denmark
| | - Sara Wood
- Public Health Wales, WHO Collaborating Centre on Investment for Health and Well-being, Wrexham, UK
| | - Kat Ford
- College of Human Sciences, Bangor University, Wrexham, UK
| | - Adriana Baban
- Department of Psychology, Babes-Bolyai University, Cluj-Napoca, Romania
| | | | - Margarita Kachaeva
- Forensic Psychiatric Department, V. Serbsky Federal Medical Research Centre for Psychiatry and Narcology, Ministry of Health, Moscow, Russian Federation
| | | | - Marija Markovic
- Centre for Promotion of Health, Institute of Public Health of Belgrade, Belgrade, Serbia
| | | | - Marija Raleva
- University Clinic of Psychiatry, School of Medicine-Skopje, Skopje, Republic of Macedonia
| | - Natasa Terzic
- Center for Health System Development, Institute of Public Health of Montenegro, Podgorica, Montenegro
| | - Milos Veleminsky
- Faculty of Health and Social Sciences, University of South Bohemia in Ceske Budejovice, České Budějovice, Czech Republic
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Sharp CA, Bellis MA, Hughes K, Ford K, Di Lemma LCG. Public acceptability of public health policy to improve population health: A population-based survey. Health Expect 2020; 23:802-812. [PMID: 32329938 PMCID: PMC7495082 DOI: 10.1111/hex.13041] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 02/06/2020] [Accepted: 02/07/2020] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND For public health policies to be effective, it is critical that they are acceptable to the public as acceptance levels impact success rate. OBJECTIVE To explore public acceptance of public health statements and examine differences in acceptability across socio-demographics, health behaviours (physical activity, diet, binge drinking and smoking), health status and well-being. METHOD A cross-sectional survey was conducted with a nationally representative sample (N = 1001) using a random stratified sampling method. Face-to-face interviews were conducted at homes of residents in Wales aged 16+ years. Individuals reported whether they agreed, had no opinion, or disagreed with 12 public health statements. RESULTS More than half of the sample were supportive of 10 out of 12 statements. The three statements with the greatest support (>80% agreement) reflected the importance of: a safe and loving childhood to becoming a healthy adult, schools teaching about health, and healthier foods costing less. Individuals who engaged in unhealthy behaviours were less likely to agree with some of the statements (eg 39.8% of binge drinkers agreed alcohol adverts should be banned compared to 57.6% of those who never binge drink; P < .001). CONCLUSIONS Findings show an appetite for public health policies among the majority of the public. The relationship between supporting policies and engaging in healthy behaviours suggests a feedback loop that is potentially capable of shifting both public opinion and the opportunities for policy intervention. If a nation becomes healthier, this could illicit greater support for stronger policies which could encourage more people to move in a healthier direction.
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Affiliation(s)
- Catherine A. Sharp
- Public Health Collaborating UnitSchool of Health SciencesBangor UniversityWrexhamUK
| | - Mark A. Bellis
- Public Health Collaborating UnitSchool of Health SciencesBangor UniversityWrexhamUK
- Policy and International Health DirectorateWorld Health Organization Collaborating Centre on Investment for Health and Well‐beingPublic Health WalesWrexhamUK
| | - Karen Hughes
- Public Health Collaborating UnitSchool of Health SciencesBangor UniversityWrexhamUK
- Policy and International Health DirectorateWorld Health Organization Collaborating Centre on Investment for Health and Well‐beingPublic Health WalesWrexhamUK
| | - Kat Ford
- Public Health Collaborating UnitSchool of Health SciencesBangor UniversityWrexhamUK
| | - Lisa C. G. Di Lemma
- Policy and International Health DirectorateWorld Health Organization Collaborating Centre on Investment for Health and Well‐beingPublic Health WalesWrexhamUK
- Faculty of Health and Social CareUniversity of ChesterChesterUK
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Ford K, Bellis MA, Hughes K, Barton ER, Newbury A. Adverse childhood experiences: a retrospective study to understand their associations with lifetime mental health diagnosis, self-harm or suicide attempt, and current low mental wellbeing in a male Welsh prison population. Health Justice 2020; 8:13. [PMID: 32533348 PMCID: PMC7291757 DOI: 10.1186/s40352-020-00115-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 05/31/2020] [Indexed: 06/03/2023]
Abstract
BACKGROUND Prisoners are at increased risk of poor mental health and self-harming behaviours, with suicide being the leading cause of death in custody. Adverse childhood experiences (ACEs) such as child maltreatment are strong predictors of poor mental health and wellbeing yet despite high levels of ACEs in offender populations, relatively few studies have explored the relationships between ACEs and prisoners' mental health and wellbeing. We conducted an ACE survey with 468 male adult prisoners in a Welsh prison who were not currently considered to be at risk of self-harm and suicide and explored relationships between ACEs, lifetime mental illness diagnosis, self-harm (lifetime and lifetime in prison) or suicide attempt (lifetime and lifetime in prison), and current low mental wellbeing. RESULTS Most participants (84.2%) had suffered at least one ACE and 45.5% had suffered ≥4 ACEs. Prevalence of lifetime mental illness diagnosis, self-harm (lifetime and lifetime in prison) or suicide attempt (lifetime and lifetime in prison), and current low mental wellbeing increased with exposure to ACEs. For example, 2.7% of those with no ACEs reported lifetime self-harm or suicide attempt in prison compared with 31.0% (self-harm in prison) and 18.3% (suicide attempt in prison) of those with ≥4 ACEs. Compared with participants with no ACEs, those with ≥4 ACEs were four times more likely to report lifetime mental illness diagnosis and suicide attempt, and over 10 times more likely to report lifetime self-harm than those with no ACEs. Independent of lifetime mental illness diagnosis, self-harm or suicide attempt, participants with ≥4 ACEs were almost three times more likely to have current low mental wellbeing than those with no ACEs. CONCLUSIONS Male prisoners that have suffered multiple ACEs are substantially more likely to have lifetime mental illness diagnosis, self-harm or suicide attempt, and to have current low mental wellbeing whilst in prison. Findings suggest that trauma-informed approaches are needed in prisons to support prisoner mental health and wellbeing.
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Affiliation(s)
- Kat Ford
- Public Health Collaborating Unit, School of Health Sciences, College of Human Sciences, Bangor University, Wrexham, LL13 7YP UK
| | - Mark A. Bellis
- Public Health Collaborating Unit, School of Health Sciences, College of Human Sciences, Bangor University, Wrexham, LL13 7YP UK
- World Health Organization Collaborating Centre on Investment for Health and Wellbeing, Policy and International Health Directorate, Public Health Wales, Wrexham, LL13 7YP UK
| | - Karen Hughes
- Public Health Collaborating Unit, School of Health Sciences, College of Human Sciences, Bangor University, Wrexham, LL13 7YP UK
- World Health Organization Collaborating Centre on Investment for Health and Wellbeing, Policy and International Health Directorate, Public Health Wales, Wrexham, LL13 7YP UK
| | - Emma R. Barton
- World Health Organization Collaborating Centre on Investment for Health and Wellbeing, Policy and International Health Directorate, Public Health Wales, Wrexham, LL13 7YP UK
| | - Annemarie Newbury
- World Health Organization Collaborating Centre on Investment for Health and Wellbeing, Policy and International Health Directorate, Public Health Wales, Wrexham, LL13 7YP UK
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Abstract
OBJECTIVE To estimate the health and financial burden of adverse childhood experiences (ACEs) in England and Wales. DESIGN The study combined data from five randomly stratified cross-sectional ACE studies. Population attributable fractions (PAFs) were calculated for major health risks and causes of ill health and applied to disability adjusted life years (DALYs), with financial costs estimated using a modified human capital method. SETTING Households in England and Wales. PARTICIPANTS 15 285 residents aged 18-69. OUTCOME MEASURES The outcome measures were PAFs for single (1 ACE) and multiple (2-3 and ≥4 ACEs) ACE exposure categories for four health risks (smoking, alcohol use, drug use, high body mass index) and nine causes of ill health (cancer, type 2 diabetes, heart disease, respiratory disease, stroke, violence, anxiety, depression, other mental illness); and annual estimated DALYs and financial costs attributable to ACEs. RESULTS Cumulative relationships were found between ACEs and risks of all outcomes. For health risks, PAFs for ACEs were highest for drug use (Wales 58.8%, England 52.6%), although ACE-attributable smoking had the highest estimated costs (England and Wales, £7.8 billion). For causes of ill health, PAFs for ACEs were highest for violence (Wales 48.9%, England 43.4%) and mental illness (ranging from 29.1% for anxiety in England to 49.7% for other mental illness in Wales). The greatest ACE-attributable costs were for mental illness (anxiety, depression and other mental illness; England and Wales, £11.2 billion) and cancer (£7.9 billion). Across all outcomes, the total annual ACE-attributable cost was estimated at £42.8 billion. The majority of costs related to exposures to multiple rather than a single ACE (ranging from 71.9% for high body mass index to 98.3% for cancer). CONCLUSIONS ACEs impose a substantial societal burden in England and Wales. Policies and practices that prevent ACEs, build resilience and develop trauma-informed services are needed to reduce burden of disease and avoidable service use and financial costs across health and other sectors.
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Affiliation(s)
- Karen Hughes
- 1World Health Organization Collaborating Centre on Investment for Health and Well-being, Policy and International Health, Public Health Wales, Wrexham, UK
- School of Human Sciences, Bangor University, Wrexham, UK
| | - Kat Ford
- Public Health Collaborating Unit, College of Human Sciences, Bangor University, Wrexham, UK
| | - Rajendra Kadel
- 1World Health Organization Collaborating Centre on Investment for Health and Well-being, Policy and International Health, Public Health Wales, Wrexham, UK
| | - Catherine A Sharp
- Public Health Collaborating Unit, College of Human Sciences, Bangor University, Wrexham, UK
| | - Mark A Bellis
- 1World Health Organization Collaborating Centre on Investment for Health and Well-being, Policy and International Health, Public Health Wales, Wrexham, UK
- School of Human Sciences, Bangor University, Wrexham, UK
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Choy E, Bykerk V, Lee Y, St John G, Van Hoogstraten H, Ford K, Praestgaard A, Sebba A. SAT0102 NONINFLAMMATORY PAIN IS A FREQUENT PHENOMENON IN RHEUMATOID ARTHRITIS AND RESPONDS WELL TO TREATMENT WITH SARILUMAB. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.2015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Inflammation is clearly a key driver of pain in rheumatoid arthritis (RA). However, in some patients the level of pain exceeds what would be expected based on the amount of synovitis observed, which may indicate the presence of noninflammatory pain (NIP). Interleukin-6 (IL-6) has been shown in animal models to increase sensitization to pain and may play a role in NIP.Objectives:To assess the effect of sarilumab, a human IL-6 receptor inhibitor approved for the treatment of adults with moderate to severely active RA, on NIP and disease activity, stratified by baseline (BL) NIP status.Methods:The analysis included data from three Phase 3 studies of sarilumab: MOBILITY (NCT01061736), MONARCH (NCT02332590), and TARGET (NCT01709578). Patients received double-blind placebo or sarilumab 150 mg or 200 mg subcutaneously (SC) every 2 weeks (q2w), plus weekly csDMARD (MOBILITY and TARGET), or adalimumab 40 mg or sarilumab 200 mg SC q2w as monotherapy (MONARCH).NIP was defined using an established formula: tender 28-joint count (TJC) – swollen 28-joint count (SJC) ≥7.1,2Patients were assessed for NIP at study BL and for change in NIP status at Weeks 12 and 24. The proportion of patients achieving ACR20/50/70, Clinical Disease Activity Index (CDAI) ≤10, and DAS28-CRP <3.2 at Week 24 was assessed in patients with and without BL NIP. No inferential statistics were performed.Results:Of 2112 patients in the analysis, 490 (23%) met the criteria for NIP at study BL: MOBILITY, n = 294/1197 (25%); MONARCH, n = 90/369 (24%); TARGET, n = 106/546 (19%). BL demographics were similar for patients with or without BL NIP: mean age (SD) was 52.6 (10.7) versus 51.2 (12.3) years, and 85% versus 81% were female. Patients with BL NIP had higher CDAI, DAS28-CRP, pain Visual Analog Scale (VAS), and TJC at BL versus patients without NIP (Table). Of patients with NIP at BL, those who received sarilumab were more likely to have no NIP at Weeks 12 and 24 versus patients who received placebo or adalimumab (Figure 1). The percentage of patients achieving improvements in disease activity at Week 24 was greater for sarilumab versus adalimumab among both patients with and without BL NIP, and these differences were larger among patients with BL NIP for all assessments except ACR50 (Figure 2).Table.Baseline characteristicsPatients with TJC – SCJ ≥7Mean (SD)Yes (n = 490)No (n = 1622)Duration of RA, years9.1 (8.6)9.7 (8.4)TJC, 0–2821.7 (4.7)14.3 (6.2)SJC, 0–2810.7 (4.3)13.1 (6.0)CRP, mg/L22.7 (27.0)22.9 (24.0)HAQ-DI, 0–31.8 (0.6)1.7 (0.6)DAS28-CRP6.4 (0.7)5.9 (0.9)CDAI46.0 (9.4)40.4 (13.0)Pain VAS72.3 (18.2)67.0 (20.7)Conclusion:NIP was prevalent at BL in the patient populations assessed. Among patients with BL NIP, a lower proportion continued to have NIP at Weeks 12 and 24 when treated with sarilumab versus placebo or adalimumab. Patients with and without BL NIP had greater improvements in pain when treated with sarilumab versus adalimumab. The difference in clinical improvement was greater among patients with BL NIP versus without BL NIP for most measures. These trends support the emerging concept that mechanisms other than direct inflammation may contribute to pain in RA, potentially mediated via IL-6 signaling.References:[1]Durán J et al.Rheumatology. 2015;54:2166–70[2]Pollard LC et al.Rheumatology. 2010;49:924–8Acknowledgments:Study funding and medical writing support (Joseph Hodgson, PhD, Adelphi Communications Ltd, Macclesfield, UK) provided by Sanofi Genzyme (Cambridge, MA, USA) and Regeneron Pharmaceuticals, Inc. (Tarrytown, NJ, USA) in accordance with GPP3 guidelines.Disclosure of Interests:Ernest Choy Grant/research support from: Amgen, Bio-Cancer, Chugai Pharma, Ferring Pharmaceuticals, Novimmune, Pfizer, Roche, UCB, Consultant of: AbbVie, Amgen, AstraZeneca, Biogen, Boehringer Ingelheim, Bristol-Myers Squibb, Celgene, Chelsea Therapeutics, Chugai Pharma, Daiichi Sankyo, Eli Lilly, Ferring Pharmaceuticals, GlaxoSmithKline, Hospita, Ionis, Janssen, Jazz Pharmaceuticals, MedImmune, Merck Sharp & Dohme, Merrimack Pharmaceutical, Napp, Novartis, Novimmune, ObsEva, Pfizer, R-Pharm, Regeneron Pharmaceuticals, Inc., Roche, SynAct Pharma, Sanofi Genzyme, Tonix, UCB, Speakers bureau: Amgen, Boehringer Ingelheim, Bristol-Myers Squibb, Chugai Pharma, Eli Lilly, Hospira, Merck Sharp & Dohme, Novartis, Pfizer, Regeneron Pharmaceuticals, Inc., Roche, Sanofi-Aventis, UCB, Vivian Bykerk: None declared, Yvonne Lee Shareholder of: Cigna-Express Scripts, Grant/research support from: Pfizer, Consultant of: Highland Instruments, Inc., Gregory St John Shareholder of: Regeneron Pharmaceuticals, Inc., Employee of: Regeneron Pharmaceuticals, Inc., Hubert van Hoogstraten Shareholder of: Sanofi, Employee of: Sanofi, Kerri Ford Shareholder of: Sanofi Genzyme, Employee of: Sanofi Genzyme, Amy Praestgaard Employee of: Sanofi Genzyme, Anthony Sebba Consultant of: Genentech, Gilead, Lilly, Regeneron Pharmaceuticals Inc., Sanofi, Speakers bureau: Lilly, Roche, Sanofi
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Tesser J, Wright GC, Strand V, Kaine J, Maslova K, St John G, Ford K, Praestgaard A, Choy E. FRI0108 ASSOCIATION BETWEEN CHANGES IN C-REACTIVE PROTEIN AT WEEK 12 AND PATIENT-REPORTED OUTCOMES AT WEEK 24 WITH SARILUMAB THERAPY ACROSS THREE PIVOTAL PHASE 3 STUDIES. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.2181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Evaluation of early response to rheumatoid arthritis (RA) therapy at 12 weeks after initiation is recommended in treatment guidelines. C-reactive protein (CRP) response at 12 weeks on therapy may indicate favorable longer-term patient-reported outcomes (PROs).Objectives:To describe the association between CRP response at Week 12 and PROs at Week 24 with sarilumab therapy across three pivotal studies.Methods:The analysis included patients with RA who took part in MOBILITY (NCT01061736), TARGET (NCT01709578), or MONARCH (NCT02332590) and were treated with sarilumab 200 mg every 2 weeks (q2w) or adalimumab 40 mg q2w (MONARCH only). Patients who achieved a CRP response at Week 12 (defined as serum CRP ≤3 mg/L) were evaluated for PROs at Week 24. Response for PROs was defined as change from baseline visual analog scale score ≥10 for pain, sleep, and morning stiffness and an increase of ≥4 for FACIT-Fatigue score. Odds ratios (ORs) and 95% confidence intervals (CIs) were generated for the likelihood of achieving PRO responses at Week 24.Results:The proportions of patients achieving a CRP response at Week 12 were 78% (MOBILITY), 74% (TARGET), 80% (MONARCH, sarilumab), and 36% (MONARCH, adalimumab). Of these, 71.4% (MOBILITY; OR 3.78, 95% CI 2.31–6.18), 71.5% (TARGET; OR 2.86, 95% CI 1.44–5.65), 79.7% (MONARCH, sarilumab; OR 4.40, 95% CI 2.04–9.47), and 79.7% (MONARCH, adalimumab; OR 2.76, 95% CI 1.36–5.61) reported pain score responses at Week 24. Fatigue responses at Week 24 among Week 12 CRP responders were 66.6% (MOBILITY; OR 2.74, 95% CI 1.69–4.45), 59.9% (TARGET; OR 3.18, 95% CI 1.58–6.42), 73.0% (MONARCH, sarilumab; OR 4.78, 95% CI 2.21–10.33), and 64.1% (MONARCH, adalimumab; OR 1.64, 95% CI 0.88–3.06). Sleep was evaluated in MOBILITY only, and 58.2% of those achieving Week 12 CRP responses reported sleep score responses at Week 24 (OR 3.51, 95% CI 2.10–5.87). Morning stiffness responses (evaluated in TARGET and MONARCH only) at Week 24 among patients with Week 12 CRP responses were 71.5% (TARGET; OR 3.70, 95% CI 1.86–7.39), 81.1% (MONARCH, sarilumab; OR 5.36, 95% CI 2.47–11.63), and 75.0% (MONARCH, adalimumab; OR 2.42, 95% CI 1.24–4.72).Conclusion:Achievement of a CRP response at Week 12 in patients with RA treated with sarilumab 200 mg q2w or adalimumab 40 mg q2w was associated with improvements at Week 24 in PROs for pain, fatigue, sleep, and morning stiffness. Among patients with RA, CRP responses at 12 weeks on treatment predict favorable longer-term PRO improvements.Acknowledgments:Study funding was provided by Sanofi Genzyme (Cambridge, USA) and Regeneron Pharmaceuticals, Inc. (Tarrytown, USA). Medical writing support (Tracey Lonergan, Adelphi Communications Ltd, Macclesfield, UK) was provided by Sanofi Genzyme and Regeneron Pharmaceuticals, Inc. in accordance with Good Publication Practice (GPP3) guidelines.Disclosure of Interests:John Tesser Consultant of: Sanofi/Regeneron, Speakers bureau: Sanofi/Regeneron, Grace C. Wright Consultant of: AbbVie, Amgen, Bristol-Myers Squibb, Exagen, Eli Lilly, Myriad Autoimmune, Novartis, Pfizer, Regeneron Pharmaceuticals, Inc., Sanofi Genzyme, UCB, Speakers bureau: AbbVie, Amgen, Bristol-Myers Squibb, Exagen, Eli Lilly, Myriad Autoimmune, Novartis, Regeneron Pharmaceuticals, Inc., Sanofi Genzyme, UCB, Vibeke Strand Consultant of: AbbVie, Amgen, Biogen, Celltrion, Consortium of Rheumatology Researchers of North America, Crescendo Bioscience, Eli Lilly, Genentech/Roche, GlaxoSmithKline, Hospira, Janssen, Merck, Novartis, Pfizer, Regeneron Pharmaceuticals, Inc., Sanofi, UCB, Jeff Kaine Speakers bureau: Eli Lilly, Merck, Regeneron Pharmaceuticals, Inc., Sanofi, Karina Maslova Shareholder of: Sanofi Genzyme, Employee of: Sanofi Genzyme, Gregory St John Shareholder of: Regeneron Pharmaceuticals, Inc., Employee of: Regeneron Pharmaceuticals, Inc., Kerri Ford Shareholder of: Sanofi Genzyme, Employee of: Sanofi Genzyme, Amy Praestgaard Employee of: Sanofi Genzyme, Ernest Choy Grant/research support from: Amgen, Bio-Cancer, Chugai Pharma, Ferring Pharmaceuticals, Novimmune, Pfizer, Roche, UCB, Consultant of: AbbVie, Amgen, AstraZeneca, Biogen, Boehringer Ingelheim, Bristol-Myers Squibb, Celgene, Chelsea Therapeutics, Chugai Pharma, Daiichi Sankyo, Eli Lilly, Ferring Pharmaceuticals, GlaxoSmithKline, Hospita, Ionis, Janssen, Jazz Pharmaceuticals, MedImmune, Merck Sharp & Dohme, Merrimack Pharmaceutical, Napp, Novartis, Novimmune, ObsEva, Pfizer, R-Pharm, Regeneron Pharmaceuticals, Inc., Roche, SynAct Pharma, Sanofi Genzyme, Tonix, UCB, Speakers bureau: Amgen, Boehringer Ingelheim, Bristol-Myers Squibb, Chugai Pharma, Eli Lilly, Hospira, Merck Sharp & Dohme, Novartis, Pfizer, Regeneron Pharmaceuticals, Inc., Roche, Sanofi-Aventis, UCB
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Ford K, Brocklehurst P, Hughes K, Sharp CA, Bellis MA. Understanding the association between self-reported poor oral health and exposure to adverse childhood experiences: a retrospective study. BMC Oral Health 2020; 20:51. [PMID: 32059720 PMCID: PMC7020341 DOI: 10.1186/s12903-020-1028-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 01/29/2020] [Indexed: 11/10/2022] Open
Abstract
Background Adverse childhood experiences, including physical, sexual or emotional abuse, can have detrimental impacts on child and adult health. However, little research has explored the impact that such early life experiences have on oral health. This study examines whether experiencing adverse childhood experiences before the age of 18 years is associated with self-reported poor dental health in later life. Methods Using stratified random probability sampling, a household survey (N = 5307; age range 18–69 years) was conducted in the South of England (Hertfordshire, Luton and Northamptonshire). Data were collected at participants’ homes using face-to-face interviews. Measures included exposure to nine adverse childhood experiences, and two dental outcomes: tooth loss (> 8 teeth lost due to dental caries or damage) and missing or filled teeth (direct or indirect restorations; > 12 missing or filled teeth). Results Strong associations were found between exposure to childhood adversity and poor dental health. The prevalence of tooth loss was significantly higher (8.3%) in those with 4+ adverse childhood experiences compared to those who had experienced none (5.0%; p < 0.05). A similar relationship was found for levels of missing or filled teeth (13.4%, 4+ adverse childhood experiences; 8.1%, none; p < 0.001). Exposure to 4+ adverse childhood experiences was associated with a higher level of tooth loss and restorations at any age, compared to individuals who had not experienced adversity. Demographically adjusted means for tooth loss increased with adverse childhood experience count in all age groups, rising from 1.0% (18–29 years) and 13.0% (60–69 years) in those with none, to 3.0% and 26.0%, respectively in those reporting 4+. Conclusions Exposure to childhood adversity could be an important predictive factor for poor dental health. As oral health is an important part of a child’s overall health status, approaches that seek to improve dental health across the life-course should start with safe and nurturing childhoods free from abuse and neglect. Given the growing role that dental professionals have in identifying violence and abuse, it seems appropriate to raise awareness in the field of dentistry of the potential for individuals to have suffered adverse childhood experiences, and the mechanisms linking childhood adversity to poor dental health.
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Affiliation(s)
- Kat Ford
- Public Health Collaborating Unit, School of Health Sciences, College of Human Sciences, Bangor University, Wrexham, LL13 7YP, Wales.
| | - Paul Brocklehurst
- NWORTH, School of Health Sciences, College of Human Sciences, Bangor University, Gwynedd, LL57 2UW, Wales
| | - Karen Hughes
- Public Health Collaborating Unit, School of Health Sciences, College of Human Sciences, Bangor University, Wrexham, LL13 7YP, Wales.,Policy and International Health Directorate, World Health Organization Collaborating Centre on Investment for Health and Wellbeing, Public Health Wales, Wrexham, LL13 7YP, Wales
| | - Catherine A Sharp
- Public Health Collaborating Unit, School of Health Sciences, College of Human Sciences, Bangor University, Wrexham, LL13 7YP, Wales
| | - Mark A Bellis
- Public Health Collaborating Unit, School of Health Sciences, College of Human Sciences, Bangor University, Wrexham, LL13 7YP, Wales.,Policy and International Health Directorate, World Health Organization Collaborating Centre on Investment for Health and Wellbeing, Public Health Wales, Wrexham, LL13 7YP, Wales
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Bellis MA, Hughes K, Ford K, Ramos Rodriguez G, Sethi D, Passmore J. Life course health consequences and associated annual costs of adverse childhood experiences across Europe and North America: a systematic review and meta-analysis. Lancet Public Health 2019; 4:e517-e528. [PMID: 31492648 PMCID: PMC7098477 DOI: 10.1016/s2468-2667(19)30145-8] [Citation(s) in RCA: 398] [Impact Index Per Article: 79.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 07/19/2019] [Accepted: 07/22/2019] [Indexed: 12/23/2022]
Abstract
BACKGROUND An increasing number of studies are identifying associations between adverse childhood experiences (ACEs) and ill health throughout the life course. We aimed to calculate the proportions of major risk factors for and causes of ill health that are attributable to one or multiple types of ACE and the associated financial costs. METHODS In this systematic review and meta-analysis, we searched for studies in which risk data in individuals with ACEs were compared with these data in those without ACEs. We searched six electronic databases (MEDLINE, CINAHL, PsycINFO, Applied Social Sciences Index and Abstracts, Criminal Justice Databases, and the Education Resources Information Center) for quantitative studies published between Jan 1, 1990, and July 11, 2018, that reported risks of health-related behaviours and causes of ill health in adults that were associated with cumulative measures of ACEs (ie, number of ACEs). We included studies in adults in populations that did not have a high risk of ACEs, that had sample sizes of at least 1000 people, and that provided ACE prevalence data. We calculated the pooled RR for risk factors (harmful alcohol use, illicit drug use, smoking, and obesity) and causes of ill health (cancer, diabetes, cardiovascular disease, respiratory disease, anxiety, and depression) associated with ACEs. RRs were used to estimate the population-attributable fractions (PAFs) of risk attributable to ACEs and the disability-adjusted life-years (DALYs) and financial costs associated with ACEs. This study was prospectively registered in PROSPERO (CRD42018090356). FINDINGS Of 4387 unique articles found following our initial search, after review of the titles (and abstracts, when the title was relevant), we assessed 880 (20%) full-text articles. We considered 221 (25%) full-text articles for inclusion, of which 23 (10%) articles met all selection criteria for our meta-analysis. We found a pooled prevalence of 23·5% of individuals (95% CI 18·7-28·5) with one ACE and 18·7% (14·7-23·2) with two or more ACEs in Europe (from ten studies) and of 23·4% of individuals (22·0-24·8) with one ACE and 35·0% (31·6-38·4) with two or more ACEs in north America (from nine studies). Illicit drug use had the highest PAFs associated with ACEs of all the risk factors assessed in both regions (34·1% in Europe; 41·1% in north America). In both regions, PAFs of causes of ill health were highest for mental illness outcomes: ACEs were attributed to about 30% of cases of anxiety and 40% of cases of depression in north America and more than a quarter of both conditions in Europe. Costs of cardiovascular disease attributable to ACEs were substantially higher than for most other causes of ill health because of higher DALYs for this condition. Total annual costs attributable to ACEs were estimated to be US$581 billion in Europe and $748 billion in north America. More than 75% of these costs arose in individuals with two or more ACEs. INTERPRETATION Millions of adults across Europe and north America live with a legacy of ACEs. Our findings suggest that a 10% reduction in ACE prevalence could equate to annual savings of 3 million DALYs or $105 billion. Programmes to prevent ACEs and moderate their effects are available. Rebalancing expenditure towards ensuring safe and nurturing childhoods would be economically beneficial and relieve pressures on health-care systems. FUNDING World Health Organization Regional Office for Europe.
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Affiliation(s)
- Mark A Bellis
- Policy and International Health Directorate, World Health Organization Collaborating Centre on Investment for Health and Wellbeing, Public Health Wales, Wrexham, UK; College of Human Sciences, Bangor University, Wrexham, UK.
| | - Karen Hughes
- Policy and International Health Directorate, World Health Organization Collaborating Centre on Investment for Health and Wellbeing, Public Health Wales, Wrexham, UK; College of Human Sciences, Bangor University, Wrexham, UK
| | - Kat Ford
- College of Human Sciences, Bangor University, Wrexham, UK
| | - Gabriela Ramos Rodriguez
- Policy and International Health Directorate, World Health Organization Collaborating Centre on Investment for Health and Wellbeing, Public Health Wales, Wrexham, UK
| | - Dinesh Sethi
- Violence and Injury Prevention, World Health Organization Regional Office for Europe, Copenhagen, Denmark
| | - Jonathon Passmore
- Violence and Injury Prevention, World Health Organization Regional Office for Europe, Copenhagen, Denmark
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Hazell S, Hales R, Wang K, Ford K, McNutt T, Hrinivich W, Han P, Anderson L, Ferro A, Moore J, Voong K. Applying Non-Homogeneous Dose Optimization to Improve Conventionally-fractionated IMRT Plan Quality in Patients with NSCLC. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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McClelland TJ, Ford K, Dagash H, Lander A, Lakhoo K. Low-fidelity Paediatric Surgical Simulation: Description of Models in Low-Resource Settings. World J Surg 2019; 43:1193-1197. [PMID: 30706107 DOI: 10.1007/s00268-019-04921-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Surgical simulation is an important aspect of competency-based training. Recent trends in paediatric surgical simulations have migrated towards high-fidelity simulation with advanced technology resulting in models which are expensive and largely inaccessible in low- and middle-income countries. METHODS This article describes four wet simulation models of common surgical procedures in paediatric population created with animal tissue from local abattoir. The models are designed to provide a framework for others to make the models and benefit from the training opportunity they provide especially in low-middle-income countries. RESULTS The models created in the wet laboratory are neonatal bowel anastomosis, duodenoduodenostomy for discrepancy anastomosis, gastrostomy and pyeloplasty. These models are easily reproducible in resource-challenged healthcare setting as they are low cost, utilise locally available resources and require only a basic set of surgical instruments with which to perform the procedures. CONCLUSION These models provide locally accessible material for sustainable training programmes which are fundamental in developing safe and affordable surgical care worldwide.
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Affiliation(s)
| | - K Ford
- Nuffield Department of Surgery, University of Oxford and Oxford University Hospitals, Oxford, UK
| | - H Dagash
- Department of Pediatric Surgery, Leicester Royal Infirmary, Leicester, UK.,Soba University Hospital, Khartoum, Sudan
| | - A Lander
- Department of Paediatric Surgery, Birmingham Children's Hospital, Birmingham, UK
| | - K Lakhoo
- Nuffield Department of Surgery, University of Oxford and Oxford University Hospitals, Oxford, UK. .,Muhimbili National Hospital, Dar es Salaam, Tanzania. .,Department of Paediatric Surgery, John Radcliffe Hospital, Oxford, OX3 9DU, UK.
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Ford K, Hughes K, Hardcastle K, Di Lemma LCG, Davies AR, Edwards S, Bellis MA. The evidence base for routine enquiry into adverse childhood experiences: A scoping review. Child Abuse Negl 2019; 91:131-146. [PMID: 30884399 DOI: 10.1016/j.chiabu.2019.03.007] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 02/25/2019] [Accepted: 03/04/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND Exposure to adverse childhood experiences (ACEs; e.g., maltreatment, household dysfunction) is associated with a multiplicity of negative outcomes throughout the life course. Consequently, increasing interest is being paid to the application of routine enquiry for ACEs to enable identification and direct interventions to mitigate their harms. OBJECTIVE To explore the evidence base for retrospective routine enquiry in adults for ACEs, including feasibility and acceptability amongst practitioners, service user acceptability and outcomes from implementation. METHODS A scoping review of the literature was conducted, drawing upon three databases (CINAHL, MEDLINE, PsycINFO) and manual searching and citation tracking. Searches included studies published from 1997 until end of April 2018 examining enquiry into ACEs, or the feasibility/acceptability of such enquiry across any setting. All included studies presented empirical findings, with studies focusing on screening for current adversities excluded. RESULTS Searches retrieved 380 articles, of which 15 met the eligibility criteria. A narrative approach to synthesize the data was utilized. Four studies examined practitioner feasibility and/or acceptability of enquiry, three reported service user acceptability and six studies implemented routine ACE enquiry (not mutually exclusive categories). Further, eight studies explored current practice and practitioner attitudes towards ACE enquiry. CONCLUSIONS Limited literature was found providing evidence for outcomes from enquiry. No studies examined impacts on service user health or service utilization. Few studies explored feasibility or acceptability to inform the application of routine ACE enquiry. The implementation of routine ACE enquiry therefore needs careful consideration. Focus should remain on evaluating developing models of ACE enquiry to advance understanding of its impact.
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Affiliation(s)
- Kat Ford
- Public Health Collaborating Unit, College of Human Sciences, BIHMR, Bangor University, Wrexham Technology Park, Wrexham, LL13 7YP, UK.
| | - Karen Hughes
- Public Health Collaborating Unit, College of Human Sciences, BIHMR, Bangor University, Wrexham Technology Park, Wrexham, LL13 7YP, UK; Policy and International Development Directorate, a World Health Organization Collaboration Centre on Investment for Health and Well-being, Public Health Wales, Wrexham, LL13 7YP, UK
| | - Katie Hardcastle
- Policy and International Development Directorate, a World Health Organization Collaboration Centre on Investment for Health and Well-being, Public Health Wales, Wrexham, LL13 7YP, UK
| | - Lisa C G Di Lemma
- Policy and International Development Directorate, a World Health Organization Collaboration Centre on Investment for Health and Well-being, Public Health Wales, Wrexham, LL13 7YP, UK
| | - Alisha R Davies
- Research, Evaluation and Development Directorate, Public Health Wales, Number 2 Capital Quarter, Tyndall Street, Cardiff, CF10 4BZ, UK
| | - Sara Edwards
- School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Mark A Bellis
- Public Health Collaborating Unit, College of Human Sciences, BIHMR, Bangor University, Wrexham Technology Park, Wrexham, LL13 7YP, UK; Policy and International Development Directorate, a World Health Organization Collaboration Centre on Investment for Health and Well-being, Public Health Wales, Wrexham, LL13 7YP, UK
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Hughes K, Quigg Z, Ford K, Bellis MA. Ideal, expected and perceived descriptive norm drunkenness in UK nightlife environments: a cross-sectional study. BMC Public Health 2019; 19:442. [PMID: 31029124 PMCID: PMC6486975 DOI: 10.1186/s12889-019-6802-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Accepted: 04/11/2019] [Indexed: 12/01/2022] Open
Abstract
Background Drunkenness is common in nightlife environments and studies suggest it can be considered both desirable and normal by nightlife users. We aimed to compare UK nightlife users’ ideal levels of drunkenness to their expected drunkenness on a night out and their perceptions of descriptive nightlife norms. Methods A cross-sectional survey with nightlife patrons (n = 408, aged 18–35) in three cities. Using a scale from 1 (completely sober) to 10 (very drunk), participants rated: personal drunkenness at survey; expected drunkenness on leaving nightlife; perceived descriptive drunkenness norm in the city’s nightlife; and ideal personal drunkenness. Analyses were limited to those who had or were intending to consume alcohol. Results Almost half of participants (46.8%) expected to get drunker than their reported ideal level on the night of survey, rising to four fifths of those with the highest levels of expected drunkenness. 77.9% rated typical nightlife drunkenness ≥8 but only 40.9% expected to reach this level themselves and only 23.1% reported their ideal drunkenness as ≥8. Higher expected drunkenness was associated with higher ideal drunkenness, higher perceived drunkenness norm and later expected home time. Conclusions Nightlife users’ perceptions of typical drunkenness in nightlife settings may be elevated and many of the heaviest drinkers are likely to drink beyond their ideal level of drunkenness. Findings can support emerging work to address cultures of intoxication in nightlife environments and suggest that interventions to correct misperceptions of normal levels of nightlife drunkenness may be of benefit. Electronic supplementary material The online version of this article (10.1186/s12889-019-6802-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Karen Hughes
- Policy and International Health, Public Health Wales, Clwydian House, Wrexham, LL13 7YP, UK. .,College of Human Sciences, Bangor University, Bangor, LL57 2UW, UK.
| | - Zara Quigg
- Public Health Institute, Liverpool John Moores University, Liverpool, L2 2QP, UK
| | - Kat Ford
- Bangor Institute for Health and Medical Research, School of Health Sciences, Wrexham, LL13 7YP, UK
| | - Mark A Bellis
- Policy and International Health, Public Health Wales, Clwydian House, Wrexham, LL13 7YP, UK.,College of Human Sciences, Bangor University, Bangor, LL57 2UW, UK
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Grey HR, Ford K, Bellis MA, Lowey H, Wood S. Associations between childhood deaths and adverse childhood experiences: An audit of data from a child death overview panel. Child Abuse Negl 2019; 90:22-31. [PMID: 30716652 DOI: 10.1016/j.chiabu.2019.01.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 01/18/2019] [Accepted: 01/24/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND Despite strong associations between adverse childhood experiences (ACEs) and poor health, few studies have examined the cumulative impact of ACEs on causes of childhood mortality. METHODS This study explored if data routinely collected by child death overview panels (CDOPs) could be used to measure ACE exposure and examined associations between ACEs and child death categories. Data covering four years (2012-2016) of cases from a CDOP in North West England were examined. RESULTS Of 489 cases, 20% were identified as having ≥4 ACEs. Deaths of children with ≥4 ACEs were 22.26 (5.72-86.59) times more likely (than those with 0 ACEs) to be classified as 'avoidable and non-natural' causes (e.g., injury, abuse, suicide; compared with 'genetic and medical conditions'). Such children were also 3.44 (1.75-6.73) times more likely to have their deaths classified as 'chronic and acute conditions'. CONCLUSIONS This study evidences that a history of ACEs can be compiled from CDOP records. Measurements of ACE prevalence in retrospective studies will miss individuals who died in childhood and may underestimate the impacts of ACEs on lifetime health. Strong associations between ACEs and deaths from 'chronic and acute conditions' suggest that ACEs may be important factors in child deaths in addition to those classified as 'avoidable and non-natural'. Results add to an already compelling case for ACE prevention in the general population and families affected by child health problems. Broader use of routinely collected child death records could play an important role in improving multi-agency awareness of ACEs and their negative health and mortality risks as well in the development of ACE informed responses.
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Affiliation(s)
- Hannah R Grey
- Public Health Collaborating Unit, College of Human Sciences, Bangor University, Wrexham, LL13 7YP, UK.
| | - Kat Ford
- Public Health Collaborating Unit, College of Human Sciences, Bangor University, Wrexham, LL13 7YP, UK
| | - Mark A Bellis
- Public Health Collaborating Unit, College of Human Sciences, Bangor University, Wrexham, LL13 7YP, UK; Policy, Research and International Development Directorate, Public Health Wales, Clwydian House, Wrexham, LL13 7YP, UK
| | - Helen Lowey
- Specialist Public Health Department, Blackburn with Darwen Borough Council, 10 Duke Street, Blackburn, BB2 1DH, UK
| | - Sara Wood
- Policy, Research and International Development Directorate, Public Health Wales, Clwydian House, Wrexham, LL13 7YP, UK
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Bellis MA, Hughes K, Ford K, Edwards S, Sharples O, Hardcastle K, Wood S. Does adult alcohol consumption combine with adverse childhood experiences to increase involvement in violence in men and women? A cross-sectional study in England and Wales. BMJ Open 2018; 8:e020591. [PMID: 30523131 PMCID: PMC6286488 DOI: 10.1136/bmjopen-2017-020591] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 08/10/2018] [Accepted: 10/04/2018] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES To examine if, and to what extent, a history of adverse childhood experiences (ACEs) combines with adult alcohol consumption to predict recent violence perpetration and victimisation. DESIGN Representative face-to-face survey (n=12 669) delivered using computer-assisted personal interviewing and self-interviewing. SETTING Domiciles of individuals living in England and Wales. PARTICIPANTS Individuals aged 18-69 years resident within randomly selected locations. 12 669 surveys were completed with participants within our defined age range. MAIN OUTCOME MEASURES Alcohol consumption was measured using the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) and childhood adversity using the short ACEs tool. Violence was measured using questions on perpetration and victimisation in the last 12 months. RESULTS Compliance was 55.7%. There were strong positive relationships between numbers of ACEs and recent violence perpetration and victimisation in both sexes. Recent violence was also strongly related to positive AUDIT-C (≥5) scores. In males, heavier drinking and ≥4ACEs had a strong multiplicative relationship with adjusted prevalence of recent violent perpetration rising from 1.3% (95% CIs 0.9% to 1.9%; 0 ACEs, negative AUDIT-C) to 3.6% (95% CIs 2.7% to 4.9%; 0 ACEs, positive AUDIT-C) and 8.5% (95% CI 5.6% to 12.7%; ≥4ACEs, negative AUDIT-C) to 28.3% (95% CI 22.5% to 34.8%; ≥4ACEs, positive AUDIT-C). In both sexes, violence perpetration and victimisation reduced with age independently of ACE count and AUDIT-C status. The combination of young age (18-29 years), ≥4ACEs and positive AUDIT-C resulted in the highest adjusted prevalence for both perpetration and victimisation in males (61.9%, 64.9%) and females (24.1%, 27.2%). CONCLUSIONS Those suffering multiple adverse experiences in childhood are also more likely to be heavier alcohol users. Especially for males, this combination results in substantially increased risks of violence. Addressing ACEs and heavy drinking together is rarely a feature of public health policy, but a combined approach may help reduce the vast costs associated with both.
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Affiliation(s)
- Mark A Bellis
- College of Health and Behavioural Sciences, Bangor University, Bangor, UK
- Policy, Research and International Development Directorate, Public Health Wales, Cardiff, UK
| | - Karen Hughes
- College of Health and Behavioural Sciences, Bangor University, Bangor, UK
- Policy, Research and International Development Directorate, Public Health Wales, Cardiff, UK
| | - Kat Ford
- College of Health and Behavioural Sciences, Bangor University, Bangor, UK
| | - Sara Edwards
- School of Medicine, Trinity College Dublin, Dublin, Republic of Ireland
| | | | - Katie Hardcastle
- Policy, Research and International Development Directorate, Public Health Wales, Cardiff, UK
| | - Sara Wood
- Policy, Research and International Development Directorate, Public Health Wales, Cardiff, UK
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Hardcastle K, Bellis MA, Ford K, Hughes K, Garner J, Ramos Rodriguez G. Measuring the relationships between adverse childhood experiences and educational and employment success in England and Wales: findings from a retrospective study. Public Health 2018; 165:106-116. [PMID: 30388488 DOI: 10.1016/j.puhe.2018.09.014] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 07/09/2018] [Accepted: 09/16/2018] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Educational and employment outcomes are critical elements in determining the life course of individuals, yet through health and other mechanisms, those who suffer adverse childhood experiences (ACEs) may experience barriers to achieve in these domains. This study examines the association between ACEs and poor educational outcomes, before considering the impact of ACEs and education on employment in adulthood. STUDY DESIGN Retrospective cross-sectional surveys were conducted in England and Wales using a random stratified sampling methodology. METHODS During face-to-face household interviews (n = 2881), data were collected on demographic factors, ACEs, self-rated childhood affluence, the highest qualification level attained and the current employment status. RESULTS While respondents with ≥4 ACEs were significantly more likely to have no formal qualifications (adjusted odds ratio [AOR] = 2.18; P < 0.001), among those who did achieve secondary level qualifications, the presence of ACEs did not further impact subsequent likelihood of going on to attain college or higher qualifications. However, results suggest a persisting independent impact of high (≥4) ACEs, which were found to be significantly associated with both current unemployment (AOR = 2.52, P < 0.001) and long-term sickness and disability (AOR = 3.94, P < 0.001). Modelled levels of not being in employment ranged from as little as 3% among those with 0 or 1 ACE and higher qualifications to 62% among those with no qualifications and ≥4 ACEs (adjusted for age, gender and childhood affluence effects). CONCLUSIONS Compulsory education may play a pivotal role in mitigating the effects of adversity, supporting the case for approaches within schools that build resilience and tackle educational inequalities. However, adults with ACEs should not be overlooked and efforts should be considered to support them in achieving meaningful employment.
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Affiliation(s)
- K Hardcastle
- Policy, Research and International Development Directorate, Public Health Wales, Clwydian House, Wrexham, LL13 7YP, UK.
| | - M A Bellis
- Policy, Research and International Development Directorate, Public Health Wales, Clwydian House, Wrexham, LL13 7YP, UK; Hot House, College of Human Sciences, BIHMR, Bangor University, Wrexham, LL13 7YP, UK
| | - K Ford
- Hot House, College of Human Sciences, BIHMR, Bangor University, Wrexham, LL13 7YP, UK
| | - K Hughes
- Policy, Research and International Development Directorate, Public Health Wales, Clwydian House, Wrexham, LL13 7YP, UK; Hot House, College of Human Sciences, BIHMR, Bangor University, Wrexham, LL13 7YP, UK
| | - J Garner
- Policy, Research and International Development Directorate, Public Health Wales, Clwydian House, Wrexham, LL13 7YP, UK
| | - G Ramos Rodriguez
- Policy, Research and International Development Directorate, Public Health Wales, Clwydian House, Wrexham, LL13 7YP, UK
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Quigg Z, Hughes K, Butler N, Ford K, Canning I, Bellis MA. Drink Less Enjoy More: effects of a multi-component intervention on improving adherence to, and knowledge of, alcohol legislation in a UK nightlife setting. Addiction 2018; 113:1420-1429. [PMID: 29575369 DOI: 10.1111/add.14223] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Revised: 12/18/2017] [Accepted: 03/19/2018] [Indexed: 11/30/2022]
Abstract
AIMS To estimate the association between implementation of a community-based multi-component intervention (Drink Less Enjoy More) and sales of alcohol to pseudo-intoxicated patrons and nightlife patron awareness of associated legislation. DESIGN Cross-sectional pre-intervention and follow-up measurements, including alcohol test purchases (using pseudo-intoxicated patrons) in licensed premises (stratified random sample; 2013, 2015) and a survey with nightlife patrons (convenience sample; 2014, 2015). SETTING One UK municipality with a large night-time economy. PARTICIPANTS Licensed premises (pre = 73; follow-up = 100); nightlife patrons (pre = 214; follow-up = 202). INTERVENTION The Drink Less Enjoy More intervention included three interacting components: community mobilization and awareness-raising; responsible bar server training; and active law enforcement of existing legislation prohibiting sales of alcohol to, and purchasing of alcohol for, a person who appears to be alcohol intoxicated: 'intoxicated', herein for economy. MEASUREMENTS The primary outcomes were alcohol service refusal to pseudo-intoxicated patrons and nightlife patron knowledge of alcohol legislation (illegal to sell alcohol to, and purchase alcohol for, intoxicated people), adjusted for potential confounders including characteristics of the area, venue, test purchase and nightlife patron. FINDINGS Pre-intervention, 16.4% of alcohol sales were refused, compared with 74.0% at follow-up (P < 0.001). In adjusted analyses, the odds of service refusal were higher at follow-up [adjusted odds ratio (aOR) = 14.63, P < 0.001]. Service refusal was also associated with server gender and patron drunkenness within the venue. Among drinkers, accurate awareness of alcohol legislation was higher at follow-up (sales: pre = 44.5%; follow-up = 66.0%; P < 0.001/purchase: pre = 32.5%; follow-up = 56.0%; P < 0.001). In adjusted analyses, knowledge of legislation was higher at follow-up (sales: aOR = 2.73, P < 0.001; purchasing: aOR = 2.73, P < 0.001). Knowledge of legislation was also associated with participant age (purchasing) and expectations of intoxication (sales). CONCLUSION A community-based multi-component intervention concerning alcohol sales legislation in the United Kingdom (UK) was associated with a reduction in sales of alcohol to pseudo-intoxicated patrons in on-licensed premises in a UK nightlife setting and an improvement in nightlife patron awareness of associated legislation.
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Affiliation(s)
- Zara Quigg
- Public Health Institute, Liverpool John Moores University, Liverpool, UK
| | - Karen Hughes
- Policy Research and International Development Directorate, Public Health Wales, Cardiff, UK.,School of Healthcare Sciences, Bangor University, Bangor, UK
| | - Nadia Butler
- Public Health Institute, Liverpool John Moores University, Liverpool, UK
| | - Kat Ford
- School of Healthcare Sciences, Bangor University, Bangor, UK
| | - Ian Canning
- Public Health Department, Liverpool City Council, Liverpool, UK
| | - Mark A Bellis
- Policy Research and International Development Directorate, Public Health Wales, Cardiff, UK.,School of Healthcare Sciences, Bangor University, Bangor, UK
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Bellis MA, Hughes K, Ford K, Hardcastle KA, Sharp CA, Wood S, Homolova L, Davies A. Adverse childhood experiences and sources of childhood resilience: a retrospective study of their combined relationships with child health and educational attendance. BMC Public Health 2018; 18:792. [PMID: 29940920 PMCID: PMC6020215 DOI: 10.1186/s12889-018-5699-8] [Citation(s) in RCA: 75] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 06/12/2018] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Adverse childhood experiences (ACEs) including maltreatment and exposure to household stressors can impact the health of children. Community factors that provide support, friendship and opportunities for development may build children's resilience and protect them against some harmful impacts of ACEs. We examine if a history of ACEs is associated with poor childhood health and school attendance and the extent to which such outcomes are counteracted by community resilience assets. METHODS A national (Wales) cross-sectional retrospective survey (n = 2452) using a stratified random probability sampling methodology and including a boost sample (n = 471) of Welsh speakers. Data collection used face-to-face interviews at participants' places of residence. Outcome measures were self-reported poor childhood health, specific conditions (asthma, allergies, headaches, digestive disorders) and school absenteeism. RESULTS Prevalence of each common childhood condition, poor childhood health and school absenteeism increased with number of ACEs reported. Childhood community resilience assets (being treated fairly, supportive childhood friends, being given opportunities to use your abilities, access to a trusted adult and having someone to look up to) were independently linked to better outcomes. In those with ≥4 ACEs the presence of all significant resilience assets (vs none) reduced adjusted prevalence of poor childhood health from 59.8 to 21.3%. CONCLUSIONS Better prevention of ACEs through the combined actions of public services may reduce levels of common childhood conditions, improve school attendance and help alleviate pressures on public services. Whilst the eradication of ACEs remains unlikely, actions to strengthen community resilience assets may partially offset their immediate harms.
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Affiliation(s)
- Mark A. Bellis
- College of Health and Behavioural Sciences, Bangor University, Bangor, LL57 2UW UK
- Policy, Research and International Development Directorate, Public Health Wales, Clwydian House, Wrexham, LL13 7YP UK
| | - Karen Hughes
- College of Health and Behavioural Sciences, Bangor University, Bangor, LL57 2UW UK
- Policy, Research and International Development Directorate, Public Health Wales, Clwydian House, Wrexham, LL13 7YP UK
| | - Kat Ford
- College of Health and Behavioural Sciences, Bangor University, Bangor, LL57 2UW UK
| | - Katie A. Hardcastle
- Policy, Research and International Development Directorate, Public Health Wales, Clwydian House, Wrexham, LL13 7YP UK
| | - Catherine A. Sharp
- College of Health and Behavioural Sciences, Bangor University, Bangor, LL57 2UW UK
| | - Sara Wood
- Policy, Research and International Development Directorate, Public Health Wales, Clwydian House, Wrexham, LL13 7YP UK
| | - Lucia Homolova
- Policy, Research and International Development Directorate, Public Health Wales, Number 2 Capital Quarter, Tyndall Street, Cardiff, CF10 4BZ UK
| | - Alisha Davies
- Policy, Research and International Development Directorate, Public Health Wales, Number 2 Capital Quarter, Tyndall Street, Cardiff, CF10 4BZ UK
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Bellis M, Hughes K, Hardcastle K, Ashton K, Ford K, Quigg Z, Davies A. The impact of adverse childhood experiences on health service use across the life course using a retrospective cohort study. J Health Serv Res Policy 2017. [PMCID: PMC5549819 DOI: 10.1177/1355819617706720] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Objectives The lifelong health impacts of adverse childhood experiences are increasingly being identified, including earlier and more frequent development of non-communicable disease. Our aim was to examine whether adverse childhood experiences are related to increased use of primary, emergency and in-patient care and at what ages such impact is apparent. Methods Household surveys were undertaken in 2015 with 7414 adults resident in Wales and England using random probability stratified sampling (age range 18–69 years). Nine adverse childhood experiences (covering childhood abuse and household stressors) and three types of health care use in the last 12 months were assessed: number of general practice (GP) visits, emergency department (ED) attendances and nights spent in hospital. Results Levels of use increased with increasing numbers of adverse childhood experiences experienced. Compared to those with no adverse childhood experiences, odds (±95% CIs) of frequent GP use (≥6 visits), any ED attendance or any overnight hospital stay were 2.34 (1.88–2.92), 2.32 (1.90–2.83) and 2.67 (2.06–3.47) in those with ≥ 4 adverse childhood experiences. Differences were independent of socio-economic measures of deprivation and other demographics. Higher health care use in those with ≥ 4 adverse childhood experiences (compared with no adverse childhood experiences) was evident at 18–29 years of age and continued through to 50–59 years. Demographically adjusted means for ED attendance rose from 12.2% of 18-29 year olds with no adverse childhood experiences to 28.8% of those with ≥ 4 adverse childhood experiences. At 60–69 years, only overnight hospital stay was significant (9.8% vs. 25.0%). Conclusions Along with the acute impacts of adverse childhood experiences on child health, a life course perspective provides a compelling case for investing in safe and nurturing childhoods. Disproportionate health expenditure in later life might be reduced through childhood interventions to prevent adverse childhood experiences.
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Affiliation(s)
- Mark Bellis
- Professor of Public Health, College of Health and Behavioural Sciences, Bangor University; Director of Policy, Research and International Development, Public Health Wales, UK
| | - Karen Hughes
- Professor of Public Health, College of Health and Behavioural Sciences, Bangor University; Research Development Manager, Directorate of Policy, Research and International Development, Public Health Wales, UK
| | - Katie Hardcastle
- Public Health Researcher, Directorate of Policy, Research and International Development, Public Health Wales, UK
| | - Kathryn Ashton
- Public Health Researcher, Directorate of Policy, Research and International Development, Public Health Wales, UK
| | - Kat Ford
- Public Health Researcher, Directorate of Policy, Research and International Development, Public Health Wales, UK
| | - Zara Quigg
- Violence and Nightlife Research Manager, Public Health Institute, Liverpool John Moores University, UK
| | - Alisha Davies
- Head of Research and Development, Directorate of Policy, Research and International Development, Public Health Wales, UK
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Bellis MA, Hardcastle K, Ford K, Hughes K, Ashton K, Quigg Z, Butler N. Erratum to: Does continuous trusted adult support in childhood impart life-course resilience against adverse childhood experiences - a retrospective study on adult health-harming behaviours and mental well-being. BMC Psychiatry 2017; 17:140. [PMID: 28407757 PMCID: PMC5391560 DOI: 10.1186/s12888-017-1305-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Accepted: 04/07/2017] [Indexed: 12/04/2022] Open
Affiliation(s)
- Mark A. Bellis
- grid.7362.0College of Health and Behavioural Sciences, Bangor University, Bangor, LL57 2PZ UK ,grid.439475.8Directorate of Policy, Research and International Development, Public Health Wales, Number 2 Capital Quarter, Tyndall Street, Cardiff, CF10 4BZ UK
| | - Katie Hardcastle
- grid.439475.8Directorate of Policy, Research and International Development, Public Health Wales, Number 2 Capital Quarter, Tyndall Street, Cardiff, CF10 4BZ UK
| | - Kat Ford
- grid.439475.8Directorate of Policy, Research and International Development, Public Health Wales, Number 2 Capital Quarter, Tyndall Street, Cardiff, CF10 4BZ UK
| | - Karen Hughes
- grid.7362.0College of Health and Behavioural Sciences, Bangor University, Bangor, LL57 2PZ UK ,grid.439475.8Directorate of Policy, Research and International Development, Public Health Wales, Number 2 Capital Quarter, Tyndall Street, Cardiff, CF10 4BZ UK
| | - Kathryn Ashton
- grid.439475.8Directorate of Policy, Research and International Development, Public Health Wales, Number 2 Capital Quarter, Tyndall Street, Cardiff, CF10 4BZ UK
| | - Zara Quigg
- grid.4425.7Public Health Institute, Liverpool John Moores University, 5-21, Webster Street, Liverpool, L3 2ET UK
| | - Nadia Butler
- grid.4425.7Public Health Institute, Liverpool John Moores University, 5-21, Webster Street, Liverpool, L3 2ET UK
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Bellis MA, Hardcastle K, Ford K, Hughes K, Ashton K, Quigg Z, Butler N. Does continuous trusted adult support in childhood impart life-course resilience against adverse childhood experiences - a retrospective study on adult health-harming behaviours and mental well-being. BMC Psychiatry 2017; 17:110. [PMID: 28335746 PMCID: PMC5364707 DOI: 10.1186/s12888-017-1260-z] [Citation(s) in RCA: 78] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Accepted: 03/09/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Adverse childhood experiences (ACEs) including child abuse and household problems (e.g. domestic violence) increase risks of poor health and mental well-being in adulthood. Factors such as having access to a trusted adult as a child may impart resilience against developing such negative outcomes. How much childhood adversity is mitigated by such resilience is poorly quantified. Here we test if access to a trusted adult in childhood is associated with reduced impacts of ACEs on adoption of health-harming behaviours and lower mental well-being in adults. METHODS Cross-sectional, face-to-face household surveys (aged 18-69 years, February-September 2015) examining ACEs suffered, always available adult (AAA) support from someone you trust in childhood and current diet, smoking, alcohol consumption and mental well-being were undertaken in four UK regions. Sampling used stratified random probability methods (n = 7,047). Analyses used chi squared, binary and multinomial logistic regression. RESULTS Adult prevalence of poor diet, daily smoking and heavier alcohol consumption increased with ACE count and decreased with AAA support in childhood. Prevalence of having any two such behaviours increased from 1.8% (0 ACEs, AAA support, most affluent quintile of residence) to 21.5% (≥4 ACEs, lacking AAA support, most deprived quintile). However, the increase was reduced to 7.1% with AAA support (≥4 ACEs, most deprived quintile). Lower mental well-being was 3.27 (95% CIs, 2.16-4.96) times more likely with ≥4 ACEs and AAA support from someone you trust in childhood (vs. 0 ACE, with AAA support) increasing to 8.32 (95% CIs, 6.53-10.61) times more likely with ≥4 ACEs but without AAA support in childhood. Multiple health-harming behaviours combined with lower mental well-being rose dramatically with ACE count and lack of AAA support in childhood (adjusted odds ratio 32.01, 95% CIs 18.31-55.98, ≥4 ACEs, without AAA support vs. 0 ACEs, with AAA support). CONCLUSIONS Adverse childhood experiences negatively impact mental and physical health across the life-course. Such impacts may be substantively mitigated by always having support from an adult you trust in childhood. Developing resilience in children as well as reducing childhood adversity are critical if low mental well-being, health-harming behaviours and their combined contribution to non-communicable disease are to be reduced.
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Affiliation(s)
- Mark A. Bellis
- College of Health and Behavioural Sciences, Normal Site, Bangor University, Bangor, LL57 2PZ UK
- Directorate of Policy, Research and International Development, Public Health Wales, Number 2 Capital Quarter, Tyndall Street, Cardiff, CF10 4BZ UK
| | - Katie Hardcastle
- Directorate of Policy, Research and International Development, Public Health Wales, Number 2 Capital Quarter, Tyndall Street, Cardiff, CF10 4BZ UK
| | - Kat Ford
- Directorate of Policy, Research and International Development, Public Health Wales, Number 2 Capital Quarter, Tyndall Street, Cardiff, CF10 4BZ UK
| | - Karen Hughes
- College of Health and Behavioural Sciences, Normal Site, Bangor University, Bangor, LL57 2PZ UK
- Directorate of Policy, Research and International Development, Public Health Wales, Number 2 Capital Quarter, Tyndall Street, Cardiff, CF10 4BZ UK
| | - Kathryn Ashton
- Directorate of Policy, Research and International Development, Public Health Wales, Number 2 Capital Quarter, Tyndall Street, Cardiff, CF10 4BZ UK
| | - Zara Quigg
- Public Health Institute, Faculty of Education, Health and Community, Liverpool John Moores University, 15-21 Webster Street, Liverpool, L3 2ET UK
| | - Nadia Butler
- Public Health Institute, Faculty of Education, Health and Community, Liverpool John Moores University, 15-21 Webster Street, Liverpool, L3 2ET UK
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Bellis MA, Ashton K, Hughes K, Ford K, Bishop J, Paranjothy S. Adverse Childhood Experiences (ACEs) in Wales and their Impact on Health in the Adult Population. Eur J Public Health 2016. [DOI: 10.1093/eurpub/ckw167.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Denman S, Ford K, Toolan J, Mistry A, Corps C, Wood P, Savic S. Home self-administration of omalizumab for chronic spontaneous urticaria. Br J Dermatol 2016; 175:1405-1407. [PMID: 27639259 DOI: 10.1111/bjd.15074] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- S Denman
- Department of Clinical Immunology and Allergy, St James's University Hospital, Beckett Street, Leeds, U.K
| | - K Ford
- Department of Clinical Immunology and Allergy, St James's University Hospital, Beckett Street, Leeds, U.K
| | - J Toolan
- Department of Clinical Immunology and Allergy, St James's University Hospital, Beckett Street, Leeds, U.K
| | - A Mistry
- Department of Clinical Immunology and Allergy, St James's University Hospital, Beckett Street, Leeds, U.K
| | - C Corps
- Department of Clinical Immunology and Allergy, St James's University Hospital, Beckett Street, Leeds, U.K
| | - P Wood
- Department of Clinical Immunology and Allergy, St James's University Hospital, Beckett Street, Leeds, U.K
| | - S Savic
- Department of Clinical Immunology and Allergy, St James's University Hospital, Beckett Street, Leeds, U.K.,National Institute for Health Research-Leeds Musculoskeletal Biomedical Research Unit (NIHR-LMBRU) and Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM), Wellcome Trust Brenner Building, St James's University Hospital, Beckett Street, Leeds, U.K
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Ford K, Quigg Z, Hughes K, Butler N, Bellis MA. 284 Understanding the impact of adverse childhood experiences on health and wellbeing in England. Inj Prev 2016. [DOI: 10.1136/injuryprev-2016-042156.284] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Quigg Z, Ford K, Butler N, Hardcastle K, Hughes K. 632 Know the score: evaluation of an intervention to reduce levels of drunkenness in a UK nightlife area. Inj Prev 2016. [DOI: 10.1136/injuryprev-2016-042156.632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Ford K, Poenaru D, Moulot O, Tavener K, Bradley S, Bankole R, Tshifularo N, Ameh E, Alema N, Borgstein E, Hickey A, Ade-Ajayi N. Gastroschisis: Bellwether for neonatal surgery capacity in low resource settings? J Pediatr Surg 2016; 51:1262-7. [PMID: 27032610 DOI: 10.1016/j.jpedsurg.2016.02.090] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Revised: 02/22/2016] [Accepted: 02/24/2016] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Economic disadvantage may adversely influence the outcomes of infants with gastroschisis (GS). Gastroschisis International (GiT) is a network of seven paediatric surgical centres, spanning two continents, evaluating GS treatment and outcomes. MATERIAL AND METHODS A 2-year retrospective review of GS infants at GiT centres. Primary outcome was mortality. Sites were classified into high, middle and low income country (HIC, MIC, and LIC). MIC and LIC were sometimes combined for analysis (LMIC). Disability adjusted life years (DALYs) were calculated and centres with the highest mortality underwent a needs assessment. RESULTS Mortality was higher in the LICs and LMICs: 100% in Uganda and Cote d'Ivoire, 75% in Nigeria and 60% in Malawi. 29% and 0% mortality was reported in South Africa and the UK, respectively. Septicaemia was the commonest cause of death. Averted and non-avertable DALYs were nil in Uganda and Cote d'Ivoire (no survivors). In the UK (100% survival) averted DALYs (met need) was highest, representing death and disability prevented by surgical intervention. Performance improvement measures were agreed: a prospectively maintained GS register; clarification of the key team members of a GS team and management pathway. CONCLUSIONS We propose the use of GS as a bellwether condition for assessing institutional capacity to deliver newborn surgical care. Early access to care, efficient multidisciplinary team working, appropriate resuscitation, avoidance of abdominal compartment syndrome, stabilization prior to formal closure and proactive nutritional interventions may reduce GS-associated burden of disease in low resource settings.
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Affiliation(s)
- Kat Ford
- King's Centre for Global Health, London, UK; King's College Hospital, London, UK
| | - Dan Poenaru
- MyungSung Christian Medical center, Addis Ababa, Ethiopia
| | - Olivier Moulot
- Centre Hospitalier Universitairee, Treichville, Cote D'Ivorie
| | | | | | - Rouma Bankole
- Centre Hospitalier Universitairee, Treichville, Cote D'Ivorie
| | | | | | | | | | | | - Niyi Ade-Ajayi
- King's Centre for Global Health, London, UK; King's College Hospital, London, UK.
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Ford K, Burner E, Terp S, Lam C, Menchine M, Arora S. 43 Describing the Evolution of Mobile Technology Usage for Latino Patients and Comparing Findings to National Mobile Health Estimates. Ann Emerg Med 2015. [DOI: 10.1016/j.annemergmed.2015.07.072] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Zhang M, Torres J, Ford K, Terp S, Arora S, Menchine M, Burner E. 193 Mobile Health Capacity Amongst Emergency Department Inner-City Patients With Risky Alcohol Use and Satisfaction With a Text Message-Based Intervention. Ann Emerg Med 2015. [DOI: 10.1016/j.annemergmed.2015.07.225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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