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El-Osta A, Altalib S, Alaa A, Al-Ammouri M, Karki M, Riboli-Sasco E, Majeed A, Kudrna L. A scoping review of UK local government workplace health and wellbeing programmes. BMC Public Health 2025; 25:2138. [PMID: 40483433 PMCID: PMC12144689 DOI: 10.1186/s12889-025-23176-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2024] [Accepted: 05/14/2025] [Indexed: 06/11/2025] Open
Abstract
BACKGROUND Workplace settings are linked to staff health and wellbeing, affecting sickness absence, presenteeism and productivity. With the growing prevalence of health issues among employees in the UK, including stress and long-term conditions, effective workplace health and wellbeing support by local government can play a crucial role in keeping people economically active and well. OBJECTIVE Identify and characterise workplace health and wellbeing programmes offered by local authorities within the United Kingdom. METHODS A scoping review involved a comprehensive search of Local Authority Districts (LADs) and county councils' websites followed by direct communications between 1 January 2024 and 30 April 2024. Initiatives were included if they were designed to enhance workplace health and wellbeing, actively ongoing and offered at no cost to workplaces. Data were extracted on the initiative name, provider, deprivation level, health focus, workplace eligibility and accreditation processes. RESULTS The review identified 61 active local government workplace health programmes across the UK in March 2024, reflecting a 21% provision among local authorities. These initiatives were homogenous in focus, scope of coverage and implementation methods, with all focusing on general health. Geographical mapping highlighted regional disparities in the provision of workplace health and wellbeing initiatives that are free at the point of access (WHISPAs). England had a higher number (Central, Southern, and Southeastern regions specifically) while the rest of England, Wales, Scotland and North Ireland had a lower number or no WHISPAs. CONCLUSION There is a need for more coordinated efforts to increase the visibility and accessibility of local government workplace health initiatives that are free at the point of access. National workplace health accreditation could further encourage employers to adopt health and wellbeing programmes.
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Affiliation(s)
- Austen El-Osta
- Self-Care Academic Research Unit (SCARU), School of Public Health, Imperial College London, 90 Wood Lane, London, W12 0BZ, UK.
| | - Sami Altalib
- Self-Care Academic Research Unit (SCARU), School of Public Health, Imperial College London, 90 Wood Lane, London, W12 0BZ, UK
| | - Aos Alaa
- Self-Care Academic Research Unit (SCARU), School of Public Health, Imperial College London, 90 Wood Lane, London, W12 0BZ, UK
| | - Mahmoud Al-Ammouri
- Self-Care Academic Research Unit (SCARU), School of Public Health, Imperial College London, 90 Wood Lane, London, W12 0BZ, UK
| | - Manisha Karki
- Self-Care Academic Research Unit (SCARU), School of Public Health, Imperial College London, 90 Wood Lane, London, W12 0BZ, UK
| | - Eva Riboli-Sasco
- Self-Care Academic Research Unit (SCARU), School of Public Health, Imperial College London, 90 Wood Lane, London, W12 0BZ, UK
| | - Azeem Majeed
- Department of Primary Care & Public Health, School of Public Health, Imperial College London, 90 Wood Lane, London, W12 0BZ, UK
| | - Laura Kudrna
- Institute of Applied Health Research in Birmingham, Birmingham, B15 2 TT, UK
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Kent L, Lee SI, Singh M, Wambua S, Phillips K, Agrawal U, Azcoaga-Lorenzo A, McCowan C, Kennedy J, Hope H, Moss N, Plachcinski R, Nelson-Piercy C, Black M, Brophy S, Maguire A, O'Reilly D, Nirantharakumar K, Eastwood KA, MuM-PreDiCT Group. Prevalence and patterns of pre-existing multimorbidity in pregnancy in Northern Ireland: a population-based, retrospective study using linked routinely collected healthcare data. BMC Pregnancy Childbirth 2025; 25:666. [PMID: 40483396 PMCID: PMC12145590 DOI: 10.1186/s12884-025-07771-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2025] [Accepted: 05/27/2025] [Indexed: 06/11/2025] Open
Abstract
BACKGROUND Multimorbidity in pregnancy increases health risks to women and babies, and creates challenges for services. The aim of this study was to explore the prevalence and patterns of maternal multimorbidity in a UK population. METHODS This population-based, retrospective study used individual-level, linked, routinely collected health data accessed via The Health and Social Care Northern Ireland Business Service Organisation Honest Broker Service within a Trusted Research Environment following the Five Safes Framework. Pregnancy episodes were ascertained from the Northern Ireland Regional Maternity Service Database and linked via unique Health and Care Number to secondary care diagnoses and primary care medications. Yearly prevalence (2012-2020) of multimorbidity (≥ 2 physical or mental health conditions) and complex multimorbidity (involvement of ≥ 3 organ systems) were calculated for the full cohort and stratified by age, deprivation, body mass index (BMI) and gravida. Cross-sectional analyses of prevalence and exploration of unique combinations of conditions and organ system involvement across strata were performed during a period of stability in detection rates (2014-2019). RESULTS The annual number of pregnancies ranged from n = 24,403 (2012) to n = 19,504 (2020). Prevalence of maternal multimorbidity ranged from 18.2% (95%CI: 17.7-18.7%) (2012) to 22.8% (95% CI: 22.3-23.4%) (2016) and mostly involved coexistence of physical and mental health conditions (range: 13.0-17.4%). Complex multimorbidity ranged from 4.0% (2012) to 6.1% (2017). The mental health system demonstrated the highest prevalence compared to all other organ systems (range: 18.6-26.2%). Multimorbidity was higher at extremes of maternal age (< 25y:24.15%; 25-34y:21.20%; ≥ 35y:23.39%), and increased with deprivation (least deprived:19.61%; most deprived:25.78%), BMI (healthy:18.37%; obesity III:39.18%), and gravida (first pregnancy:19.18%; ≥ 5 pregnancies:30.69%). Mental health multimorbidity most impacted the youngest group (< 25y:4.60%; 25-34y:1.36%; ≥ 35y:0.85%) and those who were underweight (3.73% vs 1-2% in other categories). Mental health represented the most common organ system involved in multimorbidity (18.6% of the total study population), followed by respiratory (7.3%) and dermatology (7.2%). CONCLUSIONS Multimorbidity impacts over 1 in 5 pregnant women in NI, with complex multimorbidity affecting over 1 in 20. This may present challenges across public health, primary and community care and maternity services which offer support to women with multimorbidity throughout their reproductive journeys, from preconception through to long-term postnatal follow-up.
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Affiliation(s)
- Lisa Kent
- Centre for Public Health, Queen's University Belfast, Belfast, UK.
- Centre for Public Health, Administrative Data Research Centre Northern Ireland, Queen's University Belfast, Belfast, UK.
| | - Siang Ing Lee
- Department of Applied Health Sciences, College of Medicine and Health, University of Birmingham, Edgbaston, Birmingham, UK
| | - Megha Singh
- Department of Applied Health Sciences, College of Medicine and Health, University of Birmingham, Edgbaston, Birmingham, UK
| | - Steven Wambua
- Department of Applied Health Sciences, College of Medicine and Health, University of Birmingham, Edgbaston, Birmingham, UK
| | - Katherine Phillips
- Department of Applied Health Sciences, College of Medicine and Health, University of Birmingham, Edgbaston, Birmingham, UK
| | - Utkarsh Agrawal
- Division of Population and Behavioural Sciences, School of Medicine, University of St Andrews, St Andrews, UK
| | - Amaya Azcoaga-Lorenzo
- Division of Population and Behavioural Sciences, School of Medicine, University of St Andrews, St Andrews, UK
- Centro de Salud Los Pintores, Instituto de Investigación Sanitaria Fundación Jiménez Diaz, Madrid, Spain
| | - Colin McCowan
- Division of Population and Behavioural Sciences, School of Medicine, University of St Andrews, St Andrews, UK
| | - Jonathon Kennedy
- Centre for Population Health and Wellbeing, Swansea University, Swansea, UK
| | - Holly Hope
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology Medicine & Health, Centre for Women's Mental Health, The University of Manchester, Manchester, UK
| | - Ngawai Moss
- Patient and Public Representative, Birmingham, UK
| | | | | | - Mairead Black
- School of Medicine, Medical Science and Nutrition, Aberdeen Centre for Women's Health Research, University of Aberdeen, Aberdeen, UK
| | - Sinead Brophy
- Centre for Population Health and Wellbeing, Swansea University, Swansea, UK
| | - Aideen Maguire
- Centre for Public Health, Administrative Data Research Centre Northern Ireland, Queen's University Belfast, Belfast, UK
| | - Dermot O'Reilly
- Centre for Public Health, Administrative Data Research Centre Northern Ireland, Queen's University Belfast, Belfast, UK
| | - Krishnarajah Nirantharakumar
- Department of Applied Health Sciences, College of Medicine and Health, University of Birmingham, Edgbaston, Birmingham, UK
| | - Kelly-Ann Eastwood
- Centre for Public Health, Queen's University Belfast, Belfast, UK
- Fetal Medicine Unit, St Michael's Hospital, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
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3
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Lyons HC, Selman LE, Ben-Shlomo Y, Caskey FJ, Inward CD, Hamilton A. Peritoneal Dialysis in Young Adults: A Mixed-Methods Study. Kidney Med 2025; 7:100983. [PMID: 40201399 PMCID: PMC11978335 DOI: 10.1016/j.xkme.2025.100983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/10/2025] Open
Abstract
Background Peritoneal dialysis (PD) preserves kidney function and offers flexibility; however, few young adults have it compared with hemodialysis (HD). This study aimed to understand factors influencing the change from PD to HD. Study Design This was a sequential explanatory mixed-methods study. Setting & Participants Quantitative data were collected from 470 participants (50% male participants, 85% White, mean age: 16 years) who received dialysis between 1987 and 2015. Cox proportional hazards analysis was used to examine psychosocial factors associated with transitions from PD to HD. Qualitative data were gathered from 13 young adults (aged 14-29 years) who received dialysis between 2013 and 2015, with retrospective interviews conducted in 2020. Results 25% of participants experienced multiple episodes of PD. Survival rates for PD at 1 and 5 years were 71% and 37%, respectively. Risk factors for transitioning to HD included young adulthood (age: 15-30 years), with higher transition risks in older age groups (age: 15-19 years, HR: 2.41; age: 20-24 years, HR: 3.39; age: 25-30 years, HR: 3.14; P < 0.005). Other factors included primary kidney disease type (systemic diseases vs tubulointerstitial diseases). Leading causes for transition were infection (50%), noncompliance (21%), and mechanical issues (18%). Qualitative analysis revealed the key themes around communicating treatment options, life impact, and support structures. Resilience was an additional theme among those who continued PD. Limitations The study was based on cross-sectional psychosocial data, lacked detailed parental involvement, and may have suffered recall bias. Conclusions Young adults are at higher risk of transitioning to HD owing to both transplant failure and complications with PD. Challenges of PD have been underestimated, and there is a need to educate young adults well on all dialysis options. Additional support including mental health support, peer support, and support during life changes, such as moving out of their family home, is recommended.
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Affiliation(s)
- Hannah C. Lyons
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol
| | - Lucy E. Selman
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol
| | - Yoav Ben-Shlomo
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol
| | - Fergus J. Caskey
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol
| | - Carol D. Inward
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol
| | - Alexander Hamilton
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol
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4
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Murtagh E, Mason U. Northern Ireland needs a practitioner health service. BMJ 2025; 388:r599. [PMID: 40169185 DOI: 10.1136/bmj.r599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/03/2025]
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Mohammed S, Bailey GA, Farr IW, Jones C, Rawlings A, Rees S, Scully S, Wang T, Evans HT. Using the Welsh Index of Multiple Deprivation in research: estimating the effect of excluding domains on a routine health data study. BMC Public Health 2025; 25:1178. [PMID: 40155908 PMCID: PMC11951554 DOI: 10.1186/s12889-025-22369-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 03/18/2025] [Indexed: 04/01/2025] Open
Abstract
BACKGROUND The Welsh Index of Multiple Deprivation (WIMD) is an area-based deprivation measure comprising eight domains, produced by the Welsh Government to rank Lower Layer Super Output Areas (LSOAs) in Wales. Researchers use the WIMD to account for deprivation, however, as one domain contains health indicators, there is a risk of endogeneity bias when using the WIMD in research on health outcomes. This study evaluated the effect on study results of removing the health domain from the overall WIMD or using only the income domain as deprivation measures. METHODS WIMD 2019 scores were linked to 2,760,731 individuals in the SAIL Databank. Original WIMD scores including decile and quintile rankings for each LSOA 2011 were obtained from Welsh Government. The first alternative method removed the health domain from the original WIMD scores. In the second alternative method, WIMD scores were based on only the income domain. Spearman's correlation and Cohen's kappa were used to assess the agreement of ranks, deciles, and quintiles between each method. To quantify the change in association between WIMD quintile and diabetes mellitus prevalence for each alternative method, binary logistic regression obtained age-adjusted odds ratios and 95% confidence intervals. RESULTS Removing the health domain from the original WIMD scores resulted in 17.28% of LSOAs changing decile (8.64% to a more deprived group and 8.64% to a less deprived group) and 9.00% changing quintile (4.50% more deprived, 4.50% less deprived). The income-domain-only method caused 50.49% of LSOAs to change decile (26.87% more deprived, 23.62% less deprived) as compared with the original WIMD, and 29.65% changed quintile (15.14% more deprived, 14.51% less deprived). There was a significant association between each of the three methods and diabetes prevalence, with odds ratios increasing with more deprived quintiles, but the 95% confidence intervals for each method showed little or no overlap with each other. CONCLUSION To avoid biased estimates, researchers using WIMD in studies on health, education, housing, physical environment, income, employment, community safety, and access to services should consider how these domains are related to their outcomes. We describe a methodology for researchers to quantify any bias in their own studies.
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Affiliation(s)
- Shamsudeen Mohammed
- SAIL Databank, Population Data Science, Swansea University Medical School, Swansea University, Swansea, Wales
| | - Grace A Bailey
- SAIL Databank, Population Data Science, Swansea University Medical School, Swansea University, Swansea, Wales
| | - Ian W Farr
- SAIL Databank, Population Data Science, Swansea University Medical School, Swansea University, Swansea, Wales
| | - Carys Jones
- SAIL Databank, Population Data Science, Swansea University Medical School, Swansea University, Swansea, Wales
| | - Anna Rawlings
- SAIL Databank, Population Data Science, Swansea University Medical School, Swansea University, Swansea, Wales
| | - Sarah Rees
- SAIL Databank, Population Data Science, Swansea University Medical School, Swansea University, Swansea, Wales
| | - Sean Scully
- SAIL Databank, Population Data Science, Swansea University Medical School, Swansea University, Swansea, Wales
| | - Ting Wang
- SAIL Databank, Population Data Science, Swansea University Medical School, Swansea University, Swansea, Wales
| | - Hywel T Evans
- SAIL Databank, Population Data Science, Swansea University Medical School, Swansea University, Swansea, Wales.
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6
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Clark SD, Newing A. Assessing spatial accessibility of community pharmacies in England and Wales using floating catchment area techniques. J Pharm Policy Pract 2025; 18:2466203. [PMID: 40012587 PMCID: PMC11864020 DOI: 10.1080/20523211.2025.2466203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2024] [Accepted: 02/07/2025] [Indexed: 02/28/2025] Open
Abstract
Background Community pharmacies in England and Wales are taking on a broader range of primary care responsibilities in order to ease pressure on other health services. 'Pharmacy First', launched in 2024, allows patients to access treatment for a range of common conditions directly from a pharmacy without the need to consult a GP. However, funding and workforce pressures have resulted in a number of pharmacy closures in recent years. This study assesses the geographical accessibility of community pharmacies in England and Wales and identifies the impact of these recent closures. Methods Using open data on pharmacy locations and opening hours this study calculates a Spatial Accessibility Index (SPAI) for access to pharmacies by car in 2022 and 2024. We use a Modified Huff Variable Three Step Floating Catchment Area (MHV3SFCA), a variant of the Floating Catchment Area (FCA) technique. Results Suburban and rural neighbourhoods tend to have poorer access to community pharmacies, whilst more deprived neighbourhoods generally have comparatively better access. We identify neighbourhoods which could be classed as 'pharmacy deserts', which are primarily located in rural areas. We identify that all neighbourhood area types witness a reduction in overall accessibility to community pharmacies between 2022 and 2024. In total these result in a 10% reduction in the SPAI. Conclusion The MHV3SFCA applied here is novel in its application to community pharmacy accessibility in a UK context. We demonstrate its utility as a tool to identify the impact of changes to the community pharmacy network on accessibility as experienced by different neighbourhoods. We find evidence of a 'positive pharmacy care law' and also the existence of some 'pharmacy deserts'.
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Affiliation(s)
- Stephen D. Clark
- School of Geography and Consumer Data Research Centre, University of Leeds, Leeds, UK
| | - Andy Newing
- School of Geography, University of Leeds, Leeds, UK
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7
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Waite AAC, Cherry MG, Brown SL, Williams K, Boyle AJ, Johnston BW, Jones C, Fisher P, Welters ID, TRIC Network, PIM-COVID Investigators. Psychological impact of an intensive care admission for COVID-19 on patients in the United Kingdom. J Intensive Care Soc 2025; 26:11-20. [PMID: 39801629 PMCID: PMC11724402 DOI: 10.1177/17511437241312113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2025] Open
Abstract
Background The psychological impact of surviving an admission to an intensive care unit (ICU) with COVID-19 is uncertain. The objective of the study was to assess the prevalence of anxiety, depression and post-traumatic stress disorder (PTSD) symptoms in ICU survivors treated for COVID-19 infection, and identify risk factors for psychological distress. Methods This observational study was conducted at 52 ICUs in the United Kingdom. Participants, treated for COVID-19 infection during an ICU admission of ⩾24 h, were recruited post-ICU discharge. Self-report questionnaires were completed at 3, 6 and/or 12 months. Symptoms of anxiety and depression were identified using the Hospital Anxiety and Depression Scale. PTSD was assessed using the Impact of Events Scale-6. Demographic, clinical, physical and psychosocial factors were considered as putative predictors of psychological distress. Results 1620 patients provided consent and 1258 (77.7%) responded to at least one questionnaire, with responses at 3 months (N = 426), 6 months (N = 656) and 12 months (N = 1050) following ICU admission. The following prevalence rates were found at 3, 6 and 12 months, respectively: anxiety in 28.8% (95% CI 24.6-33.1), 30.4% (95% CI 27.0-33.8) and 29.3% (95% CI 26.5-32.1); depression in 25.1% (21.0-29.3), 25.9% (22.7-29.3) and 24.0% (21.5-26.6); and PTSD in 43.5% (38.8-48.2), 44.3% (40.6-48.0) and 43.2% (40.2-46.1) of patients. Risk factors for psychological distress included a previous mental health diagnosis, unemployment or being on sick leave, and a history of asthma or COPD. Conclusion Clinically significant symptoms of anxiety, depression and PTSD were common and persisted up to 12 months post-ICU discharge.
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Affiliation(s)
- Alicia AC Waite
- Intensive Care Unit, Royal Liverpool University Hospital, Liverpool, UK
- Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | - Mary Gemma Cherry
- Department of Primary Care and Mental Health, Institute of Population Health, University of Liverpool, Liverpool, UK
- Clinical Health Psychology Service, Liverpool University Hospitals NHS Trust, Liverpool, UK
| | - Stephen L Brown
- Department of Primary Care and Mental Health, Institute of Population Health, University of Liverpool, Liverpool, UK
- School of Psychology, University of New England, Armidale, NSW, Australia
| | - Karen Williams
- Intensive Care Unit, Royal Liverpool University Hospital, Liverpool, UK
| | - Andrew J Boyle
- Regional Intensive Care Unit, Royal Victoria Hospital, Belfast, UK
- Wellcome-Wolfson Institute for Experimental Medicine, Queen’s University Belfast, Belfast, UK
| | - Brian W Johnston
- Intensive Care Unit, Royal Liverpool University Hospital, Liverpool, UK
- Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
- Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool, UK
| | | | - Peter Fisher
- Department of Primary Care and Mental Health, Institute of Population Health, University of Liverpool, Liverpool, UK
| | - Ingeborg D Welters
- Intensive Care Unit, Royal Liverpool University Hospital, Liverpool, UK
- Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
- Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool, UK
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Alarcón-Yaquetto DE, Stewart R, Perera G, Pinto da Costa M. Impact of loneliness and living alone on negative symptoms in severe mental illness: An electronic health record data analysis. Schizophr Res 2025; 276:196-201. [PMID: 39919689 DOI: 10.1016/j.schres.2025.01.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2024] [Revised: 01/24/2025] [Accepted: 01/27/2025] [Indexed: 02/09/2025]
Abstract
Important changes in symptom profiles occur early in the course of severe mental illness (SMI) after its clinical presentation. The emergence of negative symptoms is of particular concern for later function, and these may well have strong links with loneliness and poor social support which are also recognised to be common. However, the impact of loneliness and social isolation on symptoms and treatment outcomes remains unclear. To explore this, we conducted a retrospective observational analysis using data from electronic health records of a large mental health provider in London. Loneliness, living alone and symptoms of SMI were extracted using bespoke natural language processing algorithms. Symptoms were grouped into five domains: positive, negative, disorganised, manic, and catatonic, and were measured at diagnosis and 12 months following the initial SMI diagnosis. Loneliness and living alone were operationalised as binary variables, based on any recording during the follow-up period. A total of 8237 records were analysed. The prevalence of loneliness was 20.4 % and living alone 19.9 %, with only 6.8 % recorded with both. Recorded loneliness was associated with an increase in negative symptoms over the follow-up period, in models adjusted by sociodemographic variables and pharmacological treatment [OR 1.28 (1.11-1.48), p = 0.001], as was living alone to a weaker extent [OR 1.18 (1.02-1.36), p = 0.030]. No associations were found between either exposure variable and changes in symptoms from other domains. Given that negative symptoms are disabling and challenging to treat, these results highlight the importance of effective interventions to enhance social support in SMI over the early post-diagnostic period.
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Affiliation(s)
- Dulce E Alarcón-Yaquetto
- Health Service and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King's College London, United Kingdom.
| | - Robert Stewart
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, United Kingdom; South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Gayan Perera
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, United Kingdom
| | - Mariana Pinto da Costa
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, United Kingdom; South London and Maudsley NHS Foundation Trust, London, United Kingdom
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Wilson LB, Angus C, Brennan A, Gillespie D, Shortt NK, Tunstall H, Valiente R, Pearce J. Quantile regression of tobacco tax pass-through in the UK 2017-2021: how have manufacturers passed through tax changes for different tobacco products in small retailers? Analysis at the national level and by neighbourhood of deprivation. Tob Control 2025:tc-2024-058958. [PMID: 39848682 DOI: 10.1136/tc-2024-058958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2024] [Accepted: 01/09/2025] [Indexed: 01/25/2025]
Abstract
BACKGROUND The effectiveness of tax increases in reducing tobacco consumption relies on the tobacco retailers and producers passing on increases to consumers (tax pass-through). Previous UK research on supermarkets found heterogeneous levels of tax pass-through across the market segments and price distribution of tobacco products. This study uses data from small retailers across the UK to assess whether recent tax changes have been passed on to consumers and if this varies across the price distribution, between countries of the UK and by neighbourhood deprivation. METHODS We use panel data quantile regression analysis of tobacco sales in small retailers in the UK from March 2017 to December 2021 combined with UK tax rates and store-level index of multiple deprivation (IMD). We calculated the rate of tax pass-through for factory-made cigarettes (FM) and roll-your-own tobacco (RYO). RESULTS Following increases in the duty payable on tobacco, we find evidence of overshifting across the entire price distribution for FM and RYO. For England, Scotland and Wales, the rate of the overshift in tax increased with product price. For Scotland, we find that stores in the least deprived IMD pass-through taxes at a higher rate. CONCLUSIONS Our evidence shows heterogeneous levels of tax pass-through by price, region and level of deprivation. The findings emphasise the importance of understanding the pricing strategies of the tobacco industry (TI) and how these vary across the UK to develop robust approaches to mitigate the pricing strategies of the TI.
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Affiliation(s)
- Luke B Wilson
- School of Medicine and Population Health, The University of Sheffield, Sheffield, UK
| | - Colin Angus
- School of Medicine and Population Health, The University of Sheffield, Sheffield, UK
- SPECTRUM Consortium, UK
| | - Alan Brennan
- School of Medicine and Population Health, The University of Sheffield, Sheffield, UK
- SPECTRUM Consortium, UK
| | - Duncan Gillespie
- School of Medicine and Population Health, The University of Sheffield, Sheffield, UK
- SPECTRUM Consortium, UK
| | - Niamh K Shortt
- SPECTRUM Consortium, UK
- Centre for Research on Environment, Society and Health (CRESH), School of GeoSciences, University of Edinburgh, Edinburgh, UK
| | - Helena Tunstall
- SPECTRUM Consortium, UK
- Centre for Research on Environment, Society and Health (CRESH), School of GeoSciences, University of Edinburgh, Edinburgh, UK
| | - Roberto Valiente
- SPECTRUM Consortium, UK
- Centre for Research on Environment, Society and Health (CRESH), School of GeoSciences, University of Edinburgh, Edinburgh, UK
| | - Jamie Pearce
- SPECTRUM Consortium, UK
- Centre for Research on Environment, Society and Health (CRESH), School of GeoSciences, University of Edinburgh, Edinburgh, UK
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10
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Griffiths MJS, Cookson R, Avanceña ALV, Espinoza MA, Jacobsen CM, Sussell J, Kowal S. Primer on Health Equity Research in Health Economics and Outcomes Research: An ISPOR Special Interest Group Report. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2025; 28:16-24. [PMID: 39779065 DOI: 10.1016/j.jval.2024.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 08/12/2024] [Accepted: 09/25/2024] [Indexed: 01/11/2025]
Abstract
OBJECTIVES Disparities in health and healthcare between more and less socially advantaged groups are pervasive, multidimensional, and far-reaching. The material and social conditions in which people are born, grow, work, live, and age are systematically associated with their health and with the volume, quality, and outcomes of care received by the vast majority of the general population, as well as by specific marginalized populations. The field of health economics and outcomes research (HEOR) has an important role in supporting health equity goals. This publication aimed to act as a "primer" for conducting health equity research within the field of HEOR, establishing foundational understanding of key concepts. METHODS The ISPOR Special Interest Group on Health Equity Research was established in 2021 to advance equity-informative methods and data to better enable researchers to empirically investigate-and ultimately reduce-unfair social differences in health. This publication was developed by the ISPOR Special Interest Group leadership team with input from the group membership. RESULTS The resultant publication provides an overview of health equity research methods and data considerations as they relate to HEOR-relevant topics including clinical trials, real-world evidence and economic evaluation. Reflecting the current body of research on health equity in HEOR, particular focus is given to the latter. It also brings together a list of core reference material to support future learning. CONCLUSIONS This report provides the HEOR community with a tailored "state of play" overview of health equity, to support development of foundational understanding and inspire increased engagement.
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Affiliation(s)
| | - Richard Cookson
- Centre for Health Economics, University of York, York, England, UK
| | - Anton L V Avanceña
- Health Outcomes Division, College of Pharmacy, The University of Texas at Austin, Austin, TX, USA; Department of Internal Medicine, Dell Medical School, The University of Texas at Austin, Austin, TX, USA
| | - Manuel A Espinoza
- Departamento de Salud Pública, Pontificia Universidad Catolica de Chile, Santiago, Chile; Centro para la Prevención y Control del Cancer, Santiago, Chile
| | - Caroline M Jacobsen
- Health Economics Center of Excellence, Boston Scientific, Marlborough, MA, USA
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11
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Black M, Yuill C, Harkness M, Ahmed S, Williams L, Boyd KA, Reid M, Bhide A, Heera N, Huddleston J, Modi N, Norrie J, Pasupathy D, Sanders J, Smith GCS, Townsend R, Cheyne H, McCourt C, Stock S. Cervical ripening at home or in hospital during induction of labour: the CHOICE prospective cohort study, process evaluation and economic analysis. Health Technol Assess 2024; 28:1-142. [PMID: 39707888 DOI: 10.3310/lpyt7894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2024] Open
Abstract
Background Around one in three pregnant women undergoes induction of labour in the United Kingdom, usually preceded by in-hospital cervical ripening to soften and open the cervix. Objectives This study set out to determine whether cervical ripening at home is within an acceptable safety margin of cervical ripening in hospital, is effective, acceptable and cost-effective from both National Health Service and service user perspectives. Design The CHOICE study comprised a prospective multicentre observational cohort study using routinely collected data (CHOICE cohort), a process evaluation comprising a survey and nested case studies (qCHOICE) and a cost-effectiveness analysis. The CHOICE cohort set out to compare outcomes of cervical ripening using dinoprostone (a prostaglandin) at home with in-hospital cervical ripening from 39 weeks of gestation. Electronic maternity record data were collected from 26 maternity units. Following pilot analysis, the primary comparison was changed to ensure feasibility and to reflect current practice, comparing home cervical ripening using a balloon catheter with in-hospital cervical ripening using any prostaglandin from 37 weeks of gestation. Analysis involved multiple logistic regression for the primary outcome and descriptive statistics for all other outcomes. The qCHOICE study reported descriptive statistics of quantitative survey data and thematic analysis of focus group and interview data. The economic analysis involved a decision-analytic model from a National Health Service and Personal Social Services perspective, populated with CHOICE cohort and published data. Secondary analysis explored the patient perspective utilising cost estimates from qCHOICE data. Setting Twenty-six United Kingdom maternity units. Participants Women with singleton pregnancies at or beyond 37 weeks of gestation having induction with details of cervical ripening method and location recorded. Main outcome measures Neonatal unit admission within 48 hours of birth for 48 hours or more. qCHOICE Maternal and staff experience of cervical ripening. Economic analysis Incremental cost per neonatal unit admission within 48 hours of birth avoided. Data sources Electronic maternity records from 26 maternity units; survey and interviews with service users/maternity staff; focus groups with maternity staff; published literature on economic aspects. Results CHOICE cohort: A total of 515 women underwent balloon cervical ripening at home and 4332 underwent in-hospital cervical ripening using prostaglandin in hospitals that did not offer home cervical ripening. Neonatal unit admission within 48 hours of birth for 48 hours or more following home cervical ripening with balloon was not increased compared with in-hospital cervical ripening with prostaglandin. However, there was substantial uncertainty with the adjusted analysis consistent with a 74% decrease in the risk through to an 81% increase. qCHOICE Important aspects of service users' experience of home cervical ripening were quality of information provided, support and perception of genuine choice. Economic analysis Home cervical ripening with balloon led to cost savings of £993 (-£1198, -£783) per woman and can be considered the dominant strategy. Limitations Circumstances relating to the COVID-19 pandemic limited the number of participating maternity units and the duration for which units participated. Low numbers of women having at-home cervical ripening limited the power to detect differences in safety, effectiveness, cost and acceptability between study groups. Conclusions Home cervical ripening using balloon catheter may be as safe for babies as using prostaglandins in hospital in low and moderate-risk groups, but there is substantial uncertainty. Home cervical ripening with balloon is likely to be cost saving. Impacts on workload, service user and staff experiences were complex. Future work Future research should focus on optimising experience and logistics of home cervical ripening within busy maternity services. Study registration Current Controlled Trials ISRCTN32652461. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: NIHR127569) and is published in full in Health Technology Assessment; Vol. 28, No. 81. See the NIHR Funding and Awards website for further award information.
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Affiliation(s)
- Mairead Black
- Aberdeen Centre for Women's Health Research, Aberdeen Maternity Hospital, Aberdeen, UK
| | - Cassandra Yuill
- Centre for Maternal and Child Health Research, School of Health and Psychological Sciences University of London, London, UK
| | - Mairi Harkness
- Nursing, Maternity and Allied Health Professions Research Unit, University of Stirling, Stirling, UK
| | - Sayem Ahmed
- Health Economics and Health Technology Assessment, School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Linda Williams
- Edinburgh Clinical Trials Unit, University of Edinburgh, Edinburgh, UK
| | - Kathleen A Boyd
- Health Economics and Health Technology Assessment, School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | | | - Amar Bhide
- Fetal Medicine Unit, St George's Hospital, London, UK
| | | | | | - Neena Modi
- Imperial College London, Chelsea and Westminster NHS Foundation Trust, London, UK
| | - John Norrie
- Edinburgh Clinical Trials Unit, University of Edinburgh, Edinburgh, UK
| | - Dharmintra Pasupathy
- Reproduction and Perinatal Centre, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Julia Sanders
- School of Healthcare Sciences, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - Gordon C S Smith
- Obstetrics and Gynaecology, University of Cambridge, Cambridge, UK
| | | | - Helen Cheyne
- Nursing, Maternity and Allied Health Professions Research Unit, University of Stirling, Stirling, UK
| | - Christine McCourt
- Centre for Maternal and Child Health Research, School of Health and Psychological Sciences University of London, London, UK
| | - Sarah Stock
- Usher Institute, University of Edinburgh, Edinburgh, UK
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12
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Butler D, O'Donovan D, Johnston J, Hart N. 'Challenging but ultimately rewarding' - lived experiences of Deep End Northern Ireland GPs: a qualitative study. Br J Gen Pract 2024; 74:e797-e804. [PMID: 39164029 PMCID: PMC11539923 DOI: 10.3399/bjgp.2024.0167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Accepted: 08/16/2024] [Indexed: 08/22/2024] Open
Abstract
BACKGROUND Living in socioeconomically deprived areas is associated with shorter lives and worse health. GPs working in these areas face additional challenges compared with those in more affluent locations. AIM To establish GPs' motivation for working in these areas, to discover the challenges that GPs face, and to gain insights from GPs on potential improvements and changes. DESIGN AND SETTING An interpretative phenomenological analysis was undertaken of GPs' lived experiences of working in the most socioeconomically deprived practices in Northern Ireland (NI), which is the most deprived country within the UK. METHOD Interviews were carried out with nine GPs to find out the challenges facing them, why they work in a Deep End area, and what suggestions, ideas, and solutions they have to improve patient care and GP experience at NI's Deep End. RESULTS The challenges related to wider health service failures including the increased demand on GPs and feelings of powerlessness. Patient population challenges included 'missingness', late or crisis presentations, alongside the clinical difficulties of a highly 'medicalised' patient population, as well as the high prevalence of mental health problems. However, GPs choose to work in Deep End areas because the environments were seen as clinically stimulating and rewarding, as well as giving them feelings of belonging and fulfilling a duty to 'their' area. Improvements focused on providing more flexible access, increased mental health provision, and future training and recruitment, particularly around widening participation in medical school. CONCLUSION Improving the environmental conditions, empowering individuals, and investing in communities are essential factors to achieving health. The current model of providing reactionary acute care is leading to GPs experiencing powerlessness and feelings of helplessness at the Deep End.
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Affiliation(s)
- Daniel Butler
- School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast
| | - Diarmuid O'Donovan
- Queen's University Belfast; honorary consultant in public health, Public Health Agency, Belfast
| | - Jenny Johnston
- School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast
| | - Nigel Hart
- School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast
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13
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Arnold J, Carter LM, Md Yusof MY, Dutton K, Wigston Z, Dass S, Wood S, Relton S, Vital EM. ANA-associated arthritis: clinical and biomarker characterization of a population for basket trials. Rheumatology (Oxford) 2024; 63:3135-3145. [PMID: 39087598 PMCID: PMC11534109 DOI: 10.1093/rheumatology/keae269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 04/22/2024] [Accepted: 04/25/2024] [Indexed: 08/02/2024] Open
Abstract
OBJECTIVES ANA-associated rheumatic and musculoskeletal (MSK) diseases (RMDs) [SLE, primary SS (pSS), scleroderma, inflammatory myositis, MCTD and UCTD] make up a disease spectrum with overlapping clinical and immunological features. MSK inflammation is common and impactful across ANA-associated RMDs. The objectives of this study were to evaluate MSK inflammation (ANA-associated arthritis) prevalence in a multidisease ANA-associated RMD study, assess its clinical impact across ANA-associated RMD diagnoses, propose new basket groupings of patients, and evaluate immunological profiles in legacy and new basket contexts. METHODS An observational study enrolled patients with ANA-associated RMDs. Demographic variables, comorbidities, therapies, disease activity instruments [BILAG, SLEDAI, the EULAR SS disease activity index (ESSDAI), physician visual analogue scale (VAS)], patient-reported outcomes [SF36, FACIT-Fatigue, EQ5D, ICECAP-A, Work Productivity and Activity impairment (WPAI), patient VAS] and the biomarker profile (six-gene expression scores, flow cytometry, autoantibody profile) were analysed. Reclustering utilized Gaussian mixture modelling (GMM). The clinical and immune features of new and legacy clusters were compared. RESULTS Inflammatory MSK symptoms were prevalent across ANA-associated RMDs, in 213/294 patients. In ANA-associated arthritis patients, most variables did not differ between diagnoses, with the exception of the EQ5D-5L index and mobility domains (lower in MCTD/pSS, both P < 0.05). FM and OA prevalence were similar across diagnoses. Therapy use differed significantly, the use of biologics being greatest in SLE (P < 0.05). GMM yielded two multidisease clusters: High MSK disease activity (n = 89) and low MSK disease activity (n = 124). The high MSK disease activity cluster included all patients with active joint swelling, and they had significantly higher prednisolone usage, physician global assessment (PGA), Sm/RNP/SmRNP/chromatin positivity, Tetherin mean fluorescence intensity (MFI), and IFN Score-A activity, along with numerically lower FM and OA prevalence. CONCLUSION We defined ANA-associated arthritis, a more clinically and immunologically homogeneous population than existing RMD populations for trials, and a more prevalent population for therapies in the clinic.
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Affiliation(s)
- Jack Arnold
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Lucy M Carter
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Md Yuzaiful Md Yusof
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Katherine Dutton
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Zoe Wigston
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Shouvik Dass
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Samuel Wood
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Samuel Relton
- Leeds Institute of Data Analytics, University of Leeds, Leeds, UK
| | - Edward M Vital
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
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14
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Gupta S, Lam V, Jordan IK, Mariño-Ramírez L. A composite socioeconomic deprivation index from All of Us survey data: associations with health outcomes and disparities. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.10.04.24314904. [PMID: 39802760 PMCID: PMC11722465 DOI: 10.1101/2024.10.04.24314904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/21/2025]
Abstract
Socioeconomic deprivation - defined as a lack of social, economic and material resources - is associated with poor health outcomes and health disparities between population groups. The All of Us Research Program is a longitudinal cohort study of diverse participants from the United States, with demographic and social determinants of health data gleaned from participant surveys and health outcome data derived from electronic health records. We developed a composite index of socioeconomic deprivation (iSDI) using a cohort of 202,919 All of Us participants - based on education, employment, health insurance, housing, and income data - and we associated iSDI with health outcomes and disparities. iSDI is significantly associated with 970 out of 1,755 (55.3%) health conditions modeled here, with 661 positive and 309 negative associations. Mental disorders and circulatory diseases show the highest proportion of positive associations with iSDI, whereas neoplasms and congenital anomalies show the highest proportion of negative associations. Black (0.55) and Hispanic (0.52) All of Us participants show higher average iSDI values compared to White (0.29) and Asian (0.24) participants; although the majority of iSDI variation is found within (76.8%) rather than between (23.2%) groups. iSDI mediates 213 out of 399 (53.5%) Black health disparity conditions and 173 out of 297 (58.2%) Hispanic health disparity conditions. The composite socioeconomic deprivation index (iSDI) developed here is associated with a wide variety of health outcomes and disparities in the All of Us cohort, and we make participant iSDI values available on the Researcher Workbench to support future studies on social determinants of health.
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Affiliation(s)
- Sonali Gupta
- National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, Maryland, USA
- IHRC-Georgia Tech Applied Bioinformatics Laboratory, Atlanta, Georgia, USA
| | - Vincent Lam
- National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, Maryland, USA
| | - I. King Jordan
- IHRC-Georgia Tech Applied Bioinformatics Laboratory, Atlanta, Georgia, USA
- School of Biological Sciences, Georgia Institute of Technology, Atlanta, Georgia, USA
| | - Leonardo Mariño-Ramírez
- National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, Maryland, USA
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15
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Plonczak AM, Hennedige A, Kearney A, Blumenow W, Piggott K, Garvie L, Milligan C, Duncan C, Parks CJ. Multimodal Outcomes of Early Open Extended Midline Strip Craniectomy With Bilateral Microbarrel Staving for Correction of Isolated Nonsyndromic Sagittal Synostosis. J Craniofac Surg 2024:00001665-990000000-01995. [PMID: 39356245 DOI: 10.1097/scs.0000000000010642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 08/01/2024] [Indexed: 10/03/2024] Open
Abstract
AIM Sagittal synostosis is the most common craniosynostosis. The aim of surgery is to preserve cognitive function and to correct the morphologic changes. In our unit, the authors offer strip craniectomy and microbarrel staving (SMB) performed at 16 to 22 weeks. This study aims to ascertain the 7-year outcome of scaphocephaly correction by SMB. The authors investigate whether the improvement in cranial index (CI) is sustained over time, and report speech and language and neurodevelopmental outcomes. METHODS All nonsyndromic patients with sagittal synostosis who underwent SMB between 2009 and 2012 were identified from a prospectively created database that recorded anthropometric measurements, quality metrics, and neurodevelopmental outcomes. RESULTS A total of 27 patients were analyzed. The mean CI preoperatively was 67.5% (±3.5), and at 7 years 78% (±4.8). Regarding neurodevelopmental outcomes at 7 years, SDQ responses did not highlight any concerns for social, emotional, or behavioral outcomes. The vast majority of those who completed a WASI-II assessment performed within the average ranges in terms of cognitive ability. In terms of speech and language 70% of subjects demonstrated receptive language within normal level (WNL). Seventy-seven percent of subjects demonstrated expressive language WNL. CONCLUSIONS In conclusion, after 7 years of follow-up, early open extended SMB is a safe and effective method for correction of isolated nonsyndromic isolated sagittal synostosis. Across the neurodevelopmental measures and assessments, the children in the current study appeared to perform within expected ranges. Speech and language problems are more prevalent than in the general population.
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Affiliation(s)
- Agata M Plonczak
- Department of Craniofacial Surgery, Alder Hey Children's Hospital NHS Trust, Eaton
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16
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Hussain Z, Bin Sahl A, Hussain A, Collins T, Pillai A. Socioeconomic and Demographic Determinants of Hip Fracture Incidence: A Comprehensive Analysis. Cureus 2024; 16:e68790. [PMID: 39376833 PMCID: PMC11456409 DOI: 10.7759/cureus.68790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/06/2024] [Indexed: 10/09/2024] Open
Abstract
INTRODUCTION Hip fracture incidence is rising globally, making it crucial to understand the demographic factors that influence their occurrence for targeted healthcare interventions. This study focuses on examining the determinants of hip fracture incidence, particularly socioeconomic status, body mass index (BMI), and gender. METHODS The study utilised data from 570 patients recorded in the 2023 National Hip Fracture Database Audit tool. Socioeconomic status was assessed through the Index of Multiple Deprivation (IMD), based on patient postcodes. The analysis aimed to explore correlations between socioeconomic status, BMI, gender, and the incidence and types of hip fractures. RESULTS The findings indicate that the majority of hip fractures occurred in individuals from the lowest socioeconomic deciles, with a statistically significant correlation (p < 0.05) between lower socioeconomic status and higher fracture incidence. Gender-specific disparities were observed, with males experiencing fractures at younger ages and presenting with different fracture types compared to females. Additionally, lower BMI was significantly associated with a higher likelihood of certain fracture types (p < 0.05). CONCLUSIONS The study highlights the substantial influence of socioeconomic status, gender, and BMI on hip fracture incidence and typology. These results indicate the need for targeted prevention strategies and health policies aimed at mitigating hip fracture risks in socioeconomically disadvantaged populations. Understanding these factors can enable healthcare providers to allocate resources and interventions more effectively, reducing the incidence and impact of hip fractures in deprived areas.
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Affiliation(s)
- Zeeshan Hussain
- Trauma and Orthopaedics, University of Manchester, Manchester, GBR
| | - Abdullah Bin Sahl
- Trauma and Orthopaedics, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, GBR
| | - Ahad Hussain
- General Practice, Carpenters Surgery, AT Medics, London, GBR
| | - Tom Collins
- Trauma and Orthopaedics, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, GBR
| | - Anand Pillai
- Trauma and Orthopaedics, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, GBR
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17
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Fahoum K, Ringel JB, Hirsch JA, Rundle A, Levitan EB, Reshetnyak E, Sterling MR, Ezeoma C, Goyal P, Safford MM. Development and validation of mortality prediction models based on the social determinants of health. J Epidemiol Community Health 2024; 78:508-514. [PMID: 38729661 PMCID: PMC11236504 DOI: 10.1136/jech-2023-221287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 05/01/2024] [Indexed: 05/12/2024]
Abstract
BACKGROUND There is no standardised approach to screening adults for social risk factors. The goal of this study was to develop mortality risk prediction models based on the social determinants of health (SDoH) for clinical risk stratification. METHODS Data were used from REasons for Geographic And Racial Differences in Stroke (REGARDS) study, a national, population-based, longitudinal cohort of black and white Americans aged ≥45 recruited between 2003 and 2007. Analysis was limited to participants with available SDoH and mortality data (n=20 843). All-cause mortality, available through 31 December 2018, was modelled using Cox proportional hazards with baseline individual, area-level and business-level SDoH as predictors. The area-level Social Vulnerability Index (SVI) was included for comparison. All models were adjusted for age, sex and sampling region and underwent internal split-sample validation. RESULTS The baseline prediction model including only age, sex and REGARDS sampling region had a c-statistic of 0.699. An individual-level SDoH model (Model 1) had a higher c-statistic than the SVI (0.723 vs 0.708, p<0.001) in the testing set. Sequentially adding area-level SDoH (c-statistic 0.723) and business-level SDoH (c-statistics 0.723) to Model 1 had minimal improvement in model discrimination. Structural racism variables were associated with all-cause mortality for black participants but did not improve model discrimination compared with Model 1 (p=0.175). CONCLUSION In conclusion, SDoH can improve mortality prediction over 10 years relative to a baseline model and have the potential to identify high-risk patients for further evaluation or intervention if validated externally.
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Affiliation(s)
- Khalid Fahoum
- Weill Cornell Medicine, New York, New York, USA
- Department of Medicine, NYU Grossman School of Medicine, New York, New York, USA
| | | | - Jana A Hirsch
- Urban Health Collaborative, Drexel University School of Public Health, Philadelphia, Pennsylvania, USA
| | | | - Emily B Levitan
- University of Alabama at Birmingham, Birmingham, Alabama, USA
| | | | | | - Chiomah Ezeoma
- Department of Population Health Sciences, Weill Cornell Medicine, New York, New York, USA
| | - Parag Goyal
- Department of Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Monika M Safford
- Department of Medicine, Weill Cornell Medicine, New York, New York, USA
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Tsimpida D, Tsakiridi A, Daras K, Corcoran R, Gabbay M. Unravelling the dynamics of mental health inequalities in England: A 12-year nationwide longitudinal spatial analysis of recorded depression prevalence. SSM Popul Health 2024; 26:101669. [PMID: 38708408 PMCID: PMC11066558 DOI: 10.1016/j.ssmph.2024.101669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 03/28/2024] [Accepted: 04/03/2024] [Indexed: 05/07/2024] Open
Abstract
Background Depression is one of the most significant public health issues, but evidence of geographic patterns and trends of depression is limited. We aimed to examine the spatio-temporal patterns and trends of depression prevalence among adults in a nationwide longitudinal spatial study in England and evaluate the influence of neighbourhood socioeconomic deprivation in explaining patterns. Methods Information on recorded depression prevalence was obtained from the indicator Quality and Outcomes Framework: Depression prevalence that measured the annual percentage of adults diagnosed with depression for Lower Super Output Areas (LSOA) from 2011 to 2022. We applied Cluster and Outlier Analysis using the Local Moran's I algorithm. Local effects of deprivation on depression in 2020 examined with Geographically Weighted Regression (GWR). Inequalities in recorded prevalence were presented using Prevalence Rate Ratios (PRR). Results The North West Region of England had the highest concentration of High-High clusters of depression, with 17.4% of the area having high values surrounded by high values in both space and time and the greatest percentage of areas with a high rate of increase (43.1%). Inequalities widened among areas with a high rate of increase in prevalence compared to those with a lower rate of increase, with the PRR increasing from 1.66 (99% CI 1.61-1.70) in 2011 to 1.81 (99% CI 1.76-1.85) by 2022. Deprivation explained 3%-39% of the variance in depression in 2020 across the country. Conclusions It is crucial to monitor depression's spatial patterns and trends and investigate mechanisms of mental health inequalities. Our findings can help identify priority areas and target prevention and intervention strategies in England. Evaluating mental health interventions in different geographic contexts can provide valuable insights to policymakers on the most effective and context-sensitive strategies, enabling them to allocate resources towards preventing the worsening of mental health inequalities.
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Affiliation(s)
- Dialechti Tsimpida
- Department of Public Health, Policy and Systems, University of Liverpool, UK
- Centre for Research on Ageing, University of Southampton, UK
- Department of Gerontology, University of Southampton, UK
| | | | - Konstantinos Daras
- Department of Public Health, Policy and Systems, University of Liverpool, UK
- National Institute for Health Research Applied Research Collaboration North West Coast (NIHR ARC NWC), UK
| | - Rhiannon Corcoran
- National Institute for Health Research Applied Research Collaboration North West Coast (NIHR ARC NWC), UK
- Department of Primary Care and Mental Health, University of Liverpool, UK
| | - Mark Gabbay
- National Institute for Health Research Applied Research Collaboration North West Coast (NIHR ARC NWC), UK
- Department of Primary Care and Mental Health, University of Liverpool, UK
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Plascevic J, Ward J, Viner RM, Hargreaves D, Turner S. Rising Unscheduled Healthcare Utilisation of Children and Young People: How Does the Rise Vary Across Deprivation Quintiles in UK Nations? Health Serv Insights 2024; 17:11786329241245235. [PMID: 38817927 PMCID: PMC11138194 DOI: 10.1177/11786329241245235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 03/09/2024] [Indexed: 06/01/2024] Open
Abstract
This retrospective population-based analysis assessed variations in urgent healthcare use by children and young people (CYP) across UK nations (England, Scotland and Wales) between 2007 and 2017. The study focused on urgent hospital admissions, short stay urgent admissions (SSUA) and Emergency Department (ED) attendances among CYP aged <25 years, stratified by age groups and Index of Multiple Deprivation (IMD) quintile groups. A linear mixed model was used to assess trends in healthcare activity over time and across deprivation quintiles. Urgent admissions, SSUA and ED attendances increased across all deprivation quintiles in all studied nations. Increasing deprivation was consistently associated with higher urgent healthcare utilisation. In England, the rise in urgent admissions and SSUA for CYP was slower for CYP from the quintile of greatest deprivation compared those from the least deprived quintile (respective mean differences 0.69/1000/y [95% CI 0.53, 0.85] and 0.25/1000/y [0.07, 0.42]), leading to a narrowing in health inequality. Conversely, in Scotland, urgent admissions and SSUA increased more rapidly for CYP from all deprivation quintiles, widening health inequality. Understanding the differences we describe here could inform changes to NHS pathways of care across the UK which slow the rise in urgent healthcare use for CYP.
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Affiliation(s)
| | - Joseph Ward
- Population Policy and Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Russell M. Viner
- Population Policy and Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Dougal Hargreaves
- Mohn Centre for Children’s Health & Wellbeing, Imperial College London, London, UK
| | - Steve Turner
- Child Health, University of Aberdeen, Aberdeen, UK
- Women and Children Division, NHS Grampian, Aberdeen, UK
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Yang Z, Arumalla N, Alveyn E, Gallagher S, Price E, Russell MD, Bechman K, Norton S, Galloway J. Trust performance in managing inflammatory arthritis over time in England and Wales: a latent class analysis approach. Rheumatol Adv Pract 2024; 8:rkae053. [PMID: 38765191 PMCID: PMC11101285 DOI: 10.1093/rap/rkae053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 03/20/2024] [Indexed: 05/21/2024] Open
Abstract
Objectives To evaluate trust-level performance in time to initiation of DMARD therapy in patients with early inflammatory arthritis (EIA), with identification of the change in performance trajectories over time and investigation of trust characteristics associated with this change. Methods We included 130 trusts from the UK contributing to the National Early Inflammatory Arthritis Audit (NEIAA) from 2018 to 2020. The primary outcome was days from referral to initiation of DMARD therapy in patients with EIA. Latent class growth mixture models were applied to identify distinct groups of trusts with similar trajectories of performance change over time. We used mixed effects linear and multinomial logistic regression models to evaluate the association between delay in treatment and trust-level characteristics. Results The mean time to DMARD initiation was 53 days (s.d. 18), with an average 0.3-day decrease with each month over time. Four latent trajectories were identified in our cohort, with >77% of individual trusts showing ongoing improvements in decreasing treatment waiting times. Prior to separating by latent class, time to DMARD initiation was shorter in trusts with higher rheumatology staffing, a local EIA treatment pathway and those with access to musculoskeletal ultrasound. Trusts with more nurses in the rheumatology department were less likely to be in the worst performance group [odds ratio 0.69 (95% CI 0.49, 0.93)]. Conclusion In this cohort study, we observed a reduction in treatment waiting time over time. Trusts with better staffed and improved EIA clinical structure are likely to initiate definitive treatment earlier in patients with EIA.
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Affiliation(s)
- Zijing Yang
- Centre for Rheumatic Diseases, Department of Inflammation Biology, King’s College London, London, UK
| | - Nikita Arumalla
- Centre for Rheumatic Diseases, Department of Inflammation Biology, King’s College London, London, UK
| | - Edward Alveyn
- Centre for Rheumatic Diseases, Department of Inflammation Biology, King’s College London, London, UK
| | - Sarah Gallagher
- National Early Inflammatory Arthritis Audit, British Society for Rheumatology, London, UK
| | - Elizabeth Price
- National Early Inflammatory Arthritis Audit, British Society for Rheumatology, London, UK
- Department of Rheumatology, Great Western Hospital, Swindon, UK
| | - Mark D Russell
- Centre for Rheumatic Diseases, Department of Inflammation Biology, King’s College London, London, UK
| | - Katie Bechman
- Centre for Rheumatic Diseases, Department of Inflammation Biology, King’s College London, London, UK
| | - Sam Norton
- Centre for Rheumatic Diseases, Department of Inflammation Biology, King’s College London, London, UK
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - James Galloway
- Centre for Rheumatic Diseases, Department of Inflammation Biology, King’s College London, London, UK
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21
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DelPozo-Banos M, Rodway C, Lee SC, Rouquette OY, Ibrahim S, Lloyd K, Appleby L, Kapur N, John A. Contacts with primary and secondary healthcare before suicide by those under the care of mental health services: case-control, whole-population-based study using person-level linked routine data in Wales, UK during 2000-2015. BJPsych Open 2024; 10:e108. [PMID: 38725371 PMCID: PMC11094447 DOI: 10.1192/bjo.2024.23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 01/31/2024] [Accepted: 02/03/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND People under the care of mental health services are at increased risk of suicide. Existing studies are small in scale and lack comparisons. AIMS To identify opportunities for suicide prevention and underpinning data enhancement in people with recent contact with mental health services. METHOD This population-based study includes people who died by suicide in the year following a mental health services contact in Wales, 2001-2015 (cases), paired with similar patients who did not die by suicide (controls). We linked the National Confidential Inquiry into Suicide and Safety in Mental Health and the Suicide Information Database - Cymru with primary and secondary healthcare records. We present results of conditional logistic regression. RESULTS We matched 1031 cases with 5155 controls. In the year before their death, 98.3% of cases were in contact with healthcare services, and 28.5% presented with self-harm. Cases had more emergency department contacts (odds ratio 2.4, 95% CI 2.1-2.7) and emergency hospital admissions (odds ratio 1.5, 95% CI 1.4-1.7), but fewer primary care contacts (odds ratio 0.7, 95% CI 0.6-0.9) and out-patient appointments (odds ratio 0.2, 95% CI 0.2-0.3) than controls. Odds ratios were larger in females than males for injury and poisoning (odds ratio: 3.3 (95% CI 2.5-4.5) v. 2.6 (95% CI 2.1-3.1)). CONCLUSIONS We may be missing existing opportunities to intervene, particularly in emergency departments and hospital admissions with self-harm presentations and with unattributed self-harm, especially in females. Prevention efforts should focus on strengthening routine care contacts, responding to emergency contacts and better self-harm care. There are benefits to enhancing clinical audit systems with routinely collected data.
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Affiliation(s)
| | - Cathryn Rodway
- National Confidential Inquiry into Suicide and Safety in Mental Health (NCISH), Centre for Mental Health and Safety, School of Health Sciences, University of Manchester, UK
| | | | | | - Saied Ibrahim
- National Confidential Inquiry into Suicide and Safety in Mental Health (NCISH), Centre for Mental Health and Safety, School of Health Sciences, University of Manchester, UK
| | | | - Louis Appleby
- National Confidential Inquiry into Suicide and Safety in Mental Health (NCISH), Centre for Mental Health and Safety, School of Health Sciences, University of Manchester, UK
| | - Navneet Kapur
- National Confidential Inquiry into Suicide and Safety in Mental Health (NCISH), Centre for Mental Health and Safety, School of Health Sciences, University of Manchester, UK; NIHR Greater Manchester Patient Safety Research Collaboration, University of Manchester, UK; and Mersey Care NHS Foundation Trust, Prescot, UK
| | - Ann John
- Swansea University Medical School, UK
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22
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Casey C, Buckley CM, Kearney PM, Griffin MD, Dinneen SF, Griffin TP. Social deprivation and diabetic kidney disease: A European view. J Diabetes Investig 2024; 15:541-556. [PMID: 38279774 PMCID: PMC11060165 DOI: 10.1111/jdi.14156] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 01/10/2024] [Accepted: 01/18/2024] [Indexed: 01/28/2024] Open
Abstract
There is a large body of literature demonstrating a social gradient in health and increasing evidence of an association between social deprivation and diabetes complications. Diabetic kidney disease (DKD) increases mortality in people with diabetes. Socioeconomic deprivation is increasingly recognized as a modifier of risk factors for kidney disease but also an independent risk factor itself for kidney disease. This may not be truly appreciated by clinicians and warrants further attention and exploration. In this review we explore the literature to date from Europe on the relationship between social deprivation and DKD. The majority of the studies showed at least an association with microalbuminuria, an early marker of DKD, while many showed an association with overt nephropathy. This was seen across many countries in Europe using a variety of different measures of deprivation. We reviewed and considered the mechanisms by which deprivation may lead to DKD. Health related behaviors such as smoking and suboptimal control of risk factors such as hypertension, hyperglycemia and elevated body mass index (BMI) accounts for some but not all of the association. Poorer access to healthcare, health literacy, and stress are also discussed as potential mediators of the association. Addressing deprivation is difficult but starting points include targeted interventions for people living in deprived circumstances, equitable roll out of diabetes technology, and flexible outpatient clinic arrangements including virtual and community-based care.
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Affiliation(s)
- Caoimhe Casey
- Centre for Diabetes, Endocrinology and MetabolismGalway University HospitalsGalwayIreland
- School of Public HealthUniversity College CorkCorkIreland
| | | | | | - Matthew D Griffin
- Regenerative Medicine Institute (REMEDI) at CÚRAM SFI Research Centre for Medical Devices, School of MedicineUniversity of GalwayGalwayIreland
- Department of NephrologyGalway University HospitalGalwayIreland
| | - Sean F Dinneen
- Centre for Diabetes, Endocrinology and MetabolismGalway University HospitalsGalwayIreland
- School of MedicineUniversity of GalwayGalwayIreland
| | - Tomás P Griffin
- Centre for Diabetes, Endocrinology and MetabolismGalway University HospitalsGalwayIreland
- School of MedicineUniversity of GalwayGalwayIreland
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23
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Kienast-von Einem C, Panter J, Ogilvie D, Reid A. Exploring residential relocation- differences between newcomers and settled residents in health, travel behaviour and neighbourhood perceptions. Health Place 2024; 87:103254. [PMID: 38701677 DOI: 10.1016/j.healthplace.2024.103254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 04/15/2024] [Accepted: 04/26/2024] [Indexed: 05/05/2024]
Abstract
This study explores whether people who have recently moved to an area differ from longer-term residents in their health, travel behaviour, and perceptions of the environment. Using a large, representative sample from the UKHLS, Newcomers demonstrate significantly lower mental and physical health, reduced car commuting, and a higher likelihood of liking their neighbourhood. Area deprivation, urbanicity, household income, and age emerge as influential moderators with i.e. Newcomers in affluent areas experiencing lower physical health than Settled Residents, and rural Newcomers expressing less neighbourhood satisfaction. Our findings highlight that Newcomers' perceptions of their environment diverge and environmental influences vary among population segments, potentially impacting related health behaviours such as active travel. Furthermore, residential relocation introduces Newcomers with distinct characteristics into areas, affecting the context in which potential population health interventions aiming to influence health behaviours operate. This necessitates a deeper understanding of what influences reactions to the environment as well as ongoing adaptation of environmental interventions to respond to changing contexts within the same location over time.
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Affiliation(s)
- Caroline Kienast-von Einem
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Box 285 Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge CB2 0QQ, United Kingdom; Department of Geography, University of Cambridge, Downing Place, Cambridge CB2 3EN, United Kingdom.
| | - Jenna Panter
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Box 285 Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge CB2 0QQ, United Kingdom.
| | - David Ogilvie
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Box 285 Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge CB2 0QQ, United Kingdom.
| | - Alice Reid
- Department of Geography, University of Cambridge, Downing Place, Cambridge CB2 3EN, United Kingdom.
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24
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Monroy-Iglesias MJ, Martin S, Cargaleiro C, Jones G, Steward L, Murtagh C, Bruno F, Millwaters J, Schizas A, Watson H, Haire A, Haire K, Moss CL, Russell B, Srirajaskanthan R, Van Hemelrijck M, Dolly S. Real-world data evaluating Guy's rapid diagnostic clinic as an alternate pathway for patients with FIT levels below 10. BMJ Open 2024; 14:e080285. [PMID: 38626962 PMCID: PMC11029265 DOI: 10.1136/bmjopen-2023-080285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 03/13/2024] [Indexed: 04/19/2024] Open
Abstract
OBJECTIVE To analyse the effectiveness of rapid diagnostic clinics (RDCs) as an alternative pathway for patients with concerning symptoms and a faecal immunochemical test (FIT) result <10. Our primary endpoint was rate of colorectal cancer (CRC) detection. Second endpoints were rates of other cancers and gastrointestinal (GI) serious benign conditions. Finally, we analysed the specific pathway followed by FIT <10 patients with cancer at Guy's and St Thomas NHS Foundation Trust (GSTT) RDC. DESIGN A retrospective and prospective cohort study. SETTING GSTT RDC, one of England's largest single-centre RDCs. Sociodemographic and clinical characteristics of FIT <10 patients were analysed descriptively. PARTICIPANTS Patients with an FIT result <10, seen at GSTT RDC between 1 January 2020 and 5 May 2023. RESULTS A total of 1299 patients with an FIT<10 were seen at GSTT RDC between January 2020 and May 2023. Of these, 66% (n=861) reported weight loss, 62% (n=805) pain, 37% (n=481) fatigue, 34% (n=444) were anaemic and 23% (n=301) had nausea and vomiting. Among these patients, 7% (n=88) received a cancer diagnosis, 36% (n=462) were identified as having a serious benign condition. Within the patients with cancer, 9% (n=8) were diagnosed with CRC. Among patients with serious benign conditions, 7% (n=31) were referred to colorectal, hepatopancreatobiliary, or upper GI specialists. CONCLUSION This study demonstrates the effectiveness of RDCs as an alternate pathway for FIT <10 patients with ongoing clinical concerns. These results contribute to enhancing patient care and optimising resource allocation within the healthcare system.
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Affiliation(s)
| | - Sabine Martin
- Medical Oncology, Guy's and St Thomas' Hospitals NHS Trust, London, UK
| | - Carlos Cargaleiro
- Medical Oncology, Guy's and St Thomas' Hospitals NHS Trust, London, UK
| | - Geraint Jones
- Medical Oncology, Guy's and St Thomas' Hospitals NHS Trust, London, UK
- Southeast London Cancer Alliance, London, UK
| | - Lindsay Steward
- Medical Oncology, Guy's and St Thomas' Hospitals NHS Trust, London, UK
| | - Colette Murtagh
- Medical Oncology, Guy's and St Thomas' Hospitals NHS Trust, London, UK
| | - Flaminia Bruno
- Medical Oncology, Guy's and St Thomas' Hospitals NHS Trust, London, UK
| | - Juliet Millwaters
- Medical Oncology, Guy's and St Thomas' Hospitals NHS Trust, London, UK
| | - Alexis Schizas
- Department of Colorectal Surgery, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Harriet Watson
- Department of Colorectal Surgery, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Anna Haire
- Translational Oncology and Urology Research, King's College London, London, UK
| | - Kate Haire
- Southeast London Cancer Alliance, London, UK
| | | | - Beth Russell
- Translational Oncology and Urology Research, King's College London, London, UK
| | | | | | - Saoirse Dolly
- Medical Oncology, Guy's and St Thomas' Hospitals NHS Trust, London, UK
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25
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Swords C, Ghedia R, Blanchford H, Arwyn–Jones J, Heward E, Milinis K, Hardman J, Smith ME, Bance M, Muzaffar J, on behalf of INTEGRATE. Socioeconomic and ethnic disparities associated with access to cochlear implantation for severe-to-profound hearing loss: A multicentre observational study of UK adults. PLoS Med 2024; 21:e1004296. [PMID: 38573882 PMCID: PMC10994380 DOI: 10.1371/journal.pmed.1004296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 02/08/2024] [Indexed: 04/06/2024] Open
Abstract
BACKGROUND Patients with severe-to-profound hearing loss may benefit from management with cochlear implants. These patients need a referral to a cochlear implant team for further assessment and possible surgery. The referral pathway may result in varied access to hearing healthcare. This study aimed to explore referral patterns and whether there were any socioeconomic or ethnic associations with the likelihood of referral. The primary outcome was to determine factors influencing referral for implant assessment. The secondary outcome was to identify factors impacting whether healthcare professionals had discussed the option of referral. METHODS AND FINDINGS A multicentre multidisciplinary observational study was conducted in secondary care Otolaryngology and Audiology units in Great Britain. Adults fulfilling NICE (2019) audiometric criteria for implant assessment were identified over a 6-month period between 1 July and 31 December 2021. Patient- and site-specific characteristics were extracted. Multivariable binary logistic regression was employed to compare a range of factors influencing the likelihood of implant discussion and referral including patient-specific (demographics, past medical history, and degree of hearing loss) and site-specific factors (cochlear implant champion and whether the hospital performed implants). Hospitals across all 4 devolved nations of the UK were invited to participate, with data submitted from 36 urban hospitals across England, Scotland, and Wales. Nine hospitals (25%) conducted cochlear implant assessments. The majority of patients lived in England (n = 5,587, 86.2%); the rest lived in Wales (n = 419, 6.5%) and Scotland (n = 233, 3.6%). The mean patient age was 72 ± 19 years (mean ± standard deviation); 54% were male, and 75·3% of participants were white, 6·3% were Asian, 1·5% were black, 0·05% were mixed, and 4·6% were self-defined as a different ethnicity. Of 6,482 submitted patients meeting pure tone audiometric thresholds for cochlear implantation, 311 already had a cochlear implant. Of the remaining 6,171, 35.7% were informed they were eligible for an implant, but only 9.7% were referred for assessment. When adjusted for site- and patient-specific factors, stand-out findings included that adults were less likely to be referred if they lived in more deprived area decile within Indices of Multiple Deprivation (4th (odds ratio (OR): 2·19; 95% confidence interval (CI): [1·31, 3·66]; p = 0·002), 5th (2·02; [1·21, 3·38]; p = 0·05), 6th (2·32; [1·41, 3·83]; p = 0.05), and 8th (2·07; [1·25, 3·42]; p = 0·004)), lived in London (0·40; [0·29, 0·57]; p < 0·001), were male (females 1·52; [1·27, 1·81]; p < 0·001), or were older (0·97; [0·96, 0·97]; p < 0·001). They were less likely to be informed of their potential eligibility if they lived in more deprived areas (4th (1·99; [1·49, 2·66]; p < 0·001), 5th (1·75; [1·31, 2·33], p < 0·001), 6th (1·85; [1·39, 2·45]; p < 0·001), 7th (1·66; [1·25, 2·21]; p < 0·001), and 8th (1·74; [1·31, 2·31]; p < 0·001) deciles), the North of England or London (North 0·74; [0·62, 0·89]; p = 0·001; London 0·44; [0·35, 0·56]; p < 0·001), were of Asian or black ethnic backgrounds compared to white patients (Asian 0·58; [0·43, 0·79]; p < 0·001; black 0·56; [0·34, 0·92]; p = 0·021), were male (females 1·46; [1·31, 1·62]; p < 0·001), or were older (0·98; [0·98, 0·98]; p < 0·001). The study methodology was limited by its observational nature, reliance on accurate documentation of the referring service, and potential underrepresentation of certain demographic groups. CONCLUSIONS The majority of adults meeting pure tone audiometric threshold criteria for cochlear implantation are currently not appropriately referred for assessment. There is scope to target underrepresented patient groups to improve referral rates. Future research should engage stakeholders to explore the reasons behind the disparities. Implementing straightforward measures, such as educational initiatives and automated pop-up tools for immediate identification, can help streamline the referral process.
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Affiliation(s)
- Chloe Swords
- Cambridge Hearing Group, University of Cambridge, Cambridge, United Kingdom
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
- INTEGRATE (The Otolaryngology Trainee Research Network), United Kingdom
| | - Reshma Ghedia
- INTEGRATE (The Otolaryngology Trainee Research Network), United Kingdom
- Royal National ENT and Eastman Dental Hospitals, London, United Kingdom
| | - Hannah Blanchford
- INTEGRATE (The Otolaryngology Trainee Research Network), United Kingdom
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - James Arwyn–Jones
- INTEGRATE (The Otolaryngology Trainee Research Network), United Kingdom
- Charing Cross Hospital, London, United Kingdom
| | - Elliot Heward
- INTEGRATE (The Otolaryngology Trainee Research Network), United Kingdom
- Wythenshawe Hospital, Manchester, United Kingdom
| | - Kristijonas Milinis
- INTEGRATE (The Otolaryngology Trainee Research Network), United Kingdom
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
| | - John Hardman
- INTEGRATE (The Otolaryngology Trainee Research Network), United Kingdom
- Royal Marsden Hospital, Fulham Road, London, United Kingdom
| | - Matthew E. Smith
- Cambridge Hearing Group, University of Cambridge, Cambridge, United Kingdom
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Manohar Bance
- Cambridge Hearing Group, University of Cambridge, Cambridge, United Kingdom
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Jameel Muzaffar
- Cambridge Hearing Group, University of Cambridge, Cambridge, United Kingdom
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Ganbavale S, Papachristou E, Mathers J, Papacosta A, Lennon L, Whincup P, Wannamethee S, Ramsay S. Neighborhood Deprivation and Changes in Oral Health in Older Age: A Longitudinal Population-Based Study. J Dent Res 2024; 103:434-441. [PMID: 38414259 PMCID: PMC10966931 DOI: 10.1177/00220345231224337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/29/2024] Open
Abstract
The aim of this study was to examine the extent to which neighborhood-level socioeconomic factors (objective and perceived) are associated with poor oral health in older adults over time, independent of individual socioeconomic position. Data for this cross-sectional and longitudinal observation study came from a socially and geographically representative cohort of men aged 71 to 92 y in 2010-12 (n = 1,622), drawn from British general practices, which was followed up in 2018-19 (aged 78-98 y; N = 667). Dental measures at both times included number of teeth, periodontal pocket depth, self-rated oral health, and dry mouth. Neighborhood deprivation was based on Index of Multiple Deprivation (IMD) and a cumulative index measuring perceptions about local environment. Individual-level socioeconomic position was based on longest-held occupation. Multilevel and multivariate logistic regressions, adjusted for relevant sociodemographic, behavioral, and health-related factors, were performed to examine the relationships of dental measures with IMD and perceived neighborhood quality index, respectively. Cross-sectionally, risks of tooth loss, periodontal pockets, and dry mouth increased from IMD quintiles 1 to 5 (least to most deprived); odds ratios (ORs) for quintile 5 were 2.22 (95% confidence interval [CI], 1.41-3.51), 2.82 (95% CI, 1.72-4.64), and 1.51 (95% CI, 1.08-2.09), respectively, after adjusting for sociodemographic, behavioral, and health-related factors. Risks of increased pocket depth and dry mouth were significantly greater in quintile 5 (highest problems) of perceived neighborhood quality index compared to quintile 1. Over the 8-y follow-up, deterioration of dentition (tooth loss) was significantly higher in the most deprived IMD quintiles after full adjustment (OR for quintile 5 = 2.32; 95% CI, 1.09-4.89). Deterioration of dentition and dry mouth were significantly greater in quintile 5 of perceived neighborhood quality index. Neighborhood-level factors were associated with poor oral health in older age, both cross-sectionally and longitudinally, particularly with tooth loss, and dry mouth, independent of individual-level socioeconomic position.
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Affiliation(s)
- S.G. Ganbavale
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, North East England, UK
| | - E. Papachristou
- Department of Primary Care and Population Health, UCL, London, UK
| | - J.C. Mathers
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, North East England, UK
| | - A.O. Papacosta
- Department of Primary Care and Population Health, UCL, London, UK
| | - L.T. Lennon
- Department of Primary Care and Population Health, UCL, London, UK
| | - P.H. Whincup
- Population Health Research Institute, St George’s, University of London, London, UK
| | - S.G. Wannamethee
- Department of Primary Care and Population Health, UCL, London, UK
| | - S.E. Ramsay
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, North East England, UK
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27
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Novillo-Del-Álamo B, Martínez-Varea A, Nieto-Tous M, Morales-Roselló J. Deprived areas and adverse perinatal outcome: a systematic review. Arch Gynecol Obstet 2024; 309:1205-1218. [PMID: 38063892 DOI: 10.1007/s00404-023-07300-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 11/10/2023] [Indexed: 02/25/2024]
Abstract
PURPOSE This systematic review aimed to assess if women living in deprived areas have worse perinatal outcomes than those residing in high-income areas. METHODS Datasets of PubMed, ScienceDirect, CENTRAL, Embase, and Google Scholar were searched for studies comparing perinatal outcomes (preterm birth, small-for-gestational age, and stillbirth) in deprived and non-deprive areas. RESULTS A total of 46 studies were included. The systematic review of the literature revealed a higher risk for adverse perinatal outcomes such as preterm birth, small for gestational age, and stillbirth in deprived areas. CONCLUSION Deprived areas are associated with adverse perinatal outcomes. More multifactorial studies are needed to assess the weight of each factor that composes the socioeconomic gradient of health in adverse perinatal outcomes.
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Affiliation(s)
- Blanca Novillo-Del-Álamo
- Department of Obstetrics and Gynaecology, La Fe University and Polytechnic Hospital, Avenida Fernando Abril Martorell 106, 46026, Valencia, Spain
| | - Alicia Martínez-Varea
- Department of Obstetrics and Gynaecology, La Fe University and Polytechnic Hospital, Avenida Fernando Abril Martorell 106, 46026, Valencia, Spain.
| | - Mar Nieto-Tous
- Department of Obstetrics and Gynaecology, La Fe University and Polytechnic Hospital, Avenida Fernando Abril Martorell 106, 46026, Valencia, Spain
| | - José Morales-Roselló
- Department of Obstetrics and Gynaecology, La Fe University and Polytechnic Hospital, Avenida Fernando Abril Martorell 106, 46026, Valencia, Spain
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Downer MB, Luengo-Fernandez R, Binney LE, Gutnikov S, Silver LE, McColl A, Rothwell PM. Association of multimorbidity with mortality after stroke stratified by age, severity, etiology, and prior disability. Int J Stroke 2024; 19:348-358. [PMID: 37850450 PMCID: PMC10903144 DOI: 10.1177/17474930231210397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 09/11/2023] [Indexed: 10/19/2023]
Abstract
BACKGROUND Multimorbidity is common in patients with stroke and is associated with increased medium- to long-term mortality, but its value for clinical decision-making and case-mix adjustment will depend on other factors, such as age, stroke severity, etiological subtype, prior disability, and vascular risk factors. AIMS In the absence of previous studies, we related multimorbidity to long-term post-stroke mortality with stratification by these factors. METHODS In patients ascertained in a population-based stroke incidence study (Oxford Vascular Study; 2002-2017), we related pre-stroke multimorbidity (weighted/unweighted Charlson comorbidity index (CCI)) to all-cause/vascular/non-vascular mortality (1/5/10 years) using regression models adjusted/stratified by age, sex, predicted early outcome (THRIVE score), stroke severity (NIH stroke scale (NIHSS)), etiology (Trial of Org 10172 in Acute Stroke Treatment (TOAST)), premorbid disability (modified Rankin Scale (mRS)), and non-CCI risk factors (hypertension, hyperlipidemia, atrial fibrillation, smoking, deprivation, anxiety/depression). RESULTS Among 2454 stroke patients (M/SD age: 74.1/13.9 years; 48.9% male; M/SD NIHSS: 5.7/7.0), 1375/56.0% had ⩾ 1 CCI comorbidity and 685/27.9% had ⩾ 2. After age/sex adjustment, multimorbidity (unweighted CCI ⩾ 2 vs 0) predicted (all ps < 0.001) mortality at 1 year (aHR = 1.57, 95% CI = 1.38-1.78), 5 years (aHR = 1.73, 95% CI = 1.53-1.96), and 10 years (aHR = 1.79, 95% CI = 1.58-2.03). Although multimorbidity was independently associated with premorbid disability (mRS > 2: aOR = 2.76, 2.13-3.60) and non-CCI risk factors (hypertension: 1.56, 1.25-1.95; hyperlipidemia: 2.58, 2.03-3.28; atrial fibrillation: 2.31; 1.78-2.98; smoking: 1.37, 1.01-1.86), it predicted death after adjustment for all measured confounders (10-year-aHR = 1.56, 1.37-1.78, p < 0.001), driven mainly by non-vascular death (aHR = 1.89, 1.55-2.29). Predictive value for 10-year all-cause death was greatest in patients with lower expected early mortality: lower THRIVE score (pint < 0.001), age < 75 years (aHR = 2.27, 1.71-3.00), NIHSS < 5 (1.84, 1.53-2.21), and lacunar stroke (3.56, 2.14-5.91). Results were similar using the weighted CCI. CONCLUSION Pre-stroke multimorbidity is highly prevalent and is an independent predictor of death after stroke, supporting its inclusion in case-mix adjustment models and in informing decision-making by patients, families, and carers. Prediction in younger patients and after minor stroke, particularly for non-vascular death, suggests potential clinical utility in targeting interventions that require survival for 5-10 years to achieve a favorable risk/benefit ratio. DATA ACCESS STATEMENT Data requests will be considered by the Oxford Vascular Study (OXVASC) Study Director (P.M.R.-peter.rothwell@ndcn.ox.ac.uk).
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Affiliation(s)
- Matthew B Downer
- Wolfson Centre for the Prevention of Stroke and Dementia, Nuffield Department of Clinical Neurosciences, Wolfson Building—John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Ramon Luengo-Fernandez
- Wolfson Centre for the Prevention of Stroke and Dementia, Nuffield Department of Clinical Neurosciences, Wolfson Building—John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Lucy E Binney
- Wolfson Centre for the Prevention of Stroke and Dementia, Nuffield Department of Clinical Neurosciences, Wolfson Building—John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Sergei Gutnikov
- Wolfson Centre for the Prevention of Stroke and Dementia, Nuffield Department of Clinical Neurosciences, Wolfson Building—John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Louise E Silver
- Wolfson Centre for the Prevention of Stroke and Dementia, Nuffield Department of Clinical Neurosciences, Wolfson Building—John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Aubretia McColl
- Wolfson Centre for the Prevention of Stroke and Dementia, Nuffield Department of Clinical Neurosciences, Wolfson Building—John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Peter M Rothwell
- Wolfson Centre for the Prevention of Stroke and Dementia, Nuffield Department of Clinical Neurosciences, Wolfson Building—John Radcliffe Hospital, University of Oxford, Oxford, UK
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França LGS, Ciarrusta J, Gale-Grant O, Fenn-Moltu S, Fitzgibbon S, Chew A, Falconer S, Dimitrova R, Cordero-Grande L, Price AN, Hughes E, O'Muircheartaigh J, Duff E, Tuulari JJ, Deco G, Counsell SJ, Hajnal JV, Nosarti C, Arichi T, Edwards AD, McAlonan G, Batalle D. Neonatal brain dynamic functional connectivity in term and preterm infants and its association with early childhood neurodevelopment. Nat Commun 2024; 15:16. [PMID: 38331941 PMCID: PMC10853532 DOI: 10.1038/s41467-023-44050-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 11/28/2023] [Indexed: 02/10/2024] Open
Abstract
Brain dynamic functional connectivity characterises transient connections between brain regions. Features of brain dynamics have been linked to emotion and cognition in adult individuals, and atypical patterns have been associated with neurodevelopmental conditions such as autism. Although reliable functional brain networks have been consistently identified in neonates, little is known about the early development of dynamic functional connectivity. In this study we characterise dynamic functional connectivity with functional magnetic resonance imaging (fMRI) in the first few weeks of postnatal life in term-born (n = 324) and preterm-born (n = 66) individuals. We show that a dynamic landscape of brain connectivity is already established by the time of birth in the human brain, characterised by six transient states of neonatal functional connectivity with changing dynamics through the neonatal period. The pattern of dynamic connectivity is atypical in preterm-born infants, and associated with atypical social, sensory, and repetitive behaviours measured by the Quantitative Checklist for Autism in Toddlers (Q-CHAT) scores at 18 months of age.
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Affiliation(s)
- Lucas G S França
- Department of Forensic and Neurodevelopmental Science, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, SE5 8AF, UK
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, SE1 7EH, UK
- Department of Computer and Information Sciences, Faculty of Engineering and Environment, Northumbria University, Newcastle upon Tyne, NE1 8ST, UK
| | - Judit Ciarrusta
- Department of Forensic and Neurodevelopmental Science, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, SE5 8AF, UK
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, SE1 7EH, UK
| | - Oliver Gale-Grant
- Department of Forensic and Neurodevelopmental Science, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, SE5 8AF, UK
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, SE1 7EH, UK
| | - Sunniva Fenn-Moltu
- Department of Forensic and Neurodevelopmental Science, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, SE5 8AF, UK
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, SE1 7EH, UK
| | - Sean Fitzgibbon
- Oxford Centre for Functional Magnetic Resonance Imaging of the Brain, Wellcome Centre for Integrative Neuroimaging, University of Oxford, Oxford, OX3 9DU, UK
| | - Andrew Chew
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, SE1 7EH, UK
| | - Shona Falconer
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, SE1 7EH, UK
| | - Ralica Dimitrova
- Department of Forensic and Neurodevelopmental Science, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, SE5 8AF, UK
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, SE1 7EH, UK
| | - Lucilio Cordero-Grande
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, SE1 7EH, UK
- Biomedical Image Technologies, ETSI Telecomunicación, Universidad Politécnica de Madrid, 28040, Madrid, Spain
- Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina, Instituto de Salud Carlos III, 28029, Madrid, Spain
| | - Anthony N Price
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, SE1 7EH, UK
| | - Emer Hughes
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, SE1 7EH, UK
| | - Jonathan O'Muircheartaigh
- Department of Forensic and Neurodevelopmental Science, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, SE5 8AF, UK
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, SE1 7EH, UK
- MRC Centre for Neurodevelopmental Disorders, King's College London, London, SE1 1UL, UK
| | - Eugene Duff
- Oxford Centre for Functional Magnetic Resonance Imaging of the Brain, Wellcome Centre for Integrative Neuroimaging, University of Oxford, Oxford, OX3 9DU, UK
- Department of Brain Sciences, Imperial College London, London, W12 0BZ, UK
- UK Dementia Research Institute at Imperial College London, London, W12 0BZ, UK
| | - Jetro J Tuulari
- FinnBrain Birth Cohort Study, Turku Brain and Mind Center, Institute of Clinical Medicine, University of Turku, 20500, Turku, Finland
- Turku Collegium for Science and Medicine and Technology, University of Turku, 20500, Turku, Finland
- Department of Psychiatry, University of Turku and Turku University Hospital, 20500, Turku, Finland
| | - Gustavo Deco
- Center for Brain and Cognition, Computational Neuroscience Group, Department of Information and Communication Technologies, Pompeu Fabra University, 08002, Barcelona, Spain
- Catalan Institution for Research and Advanced Studies, 08010, Barcelona, Spain
- Department of Neuropsychology, Max Planck Institute for Human Cognitive and Brain Sciences, 04103, Leipzig, Germany
- School of Psychological Sciences, Monash University, Melbourne, VIC, 3010, Australia
| | - Serena J Counsell
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, SE1 7EH, UK
| | - Joseph V Hajnal
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, SE1 7EH, UK
| | - Chiara Nosarti
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, SE1 7EH, UK
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, SE5 8AF, UK
| | - Tomoki Arichi
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, SE1 7EH, UK
- MRC Centre for Neurodevelopmental Disorders, King's College London, London, SE1 1UL, UK
- Department of Paediatric Neurosciences, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, SE1 7EH, UK
- Department of Bioengineering, Imperial College London, London, SW7 2AZ, UK
| | - A David Edwards
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, SE1 7EH, UK
- MRC Centre for Neurodevelopmental Disorders, King's College London, London, SE1 1UL, UK
| | - Grainne McAlonan
- Department of Forensic and Neurodevelopmental Science, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, SE5 8AF, UK
| | - Dafnis Batalle
- Department of Forensic and Neurodevelopmental Science, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, SE5 8AF, UK.
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, SE1 7EH, UK.
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Phillips T, Harris S, Aiyegbusi OL, Lucas B, Benavente M, Roderick PJ, Cockwell P, Kalra PA, Wheeler DC, Taal MW, Fraser SDS. Potentially modifiable factors associated with health-related quality of life among people with chronic kidney disease: baseline findings from the National Unified Renal Translational Research Enterprise CKD (NURTuRE-CKD) cohort. Clin Kidney J 2024; 17:sfae010. [PMID: 38313684 PMCID: PMC10836575 DOI: 10.1093/ckj/sfae010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Indexed: 02/06/2024] Open
Abstract
Background Many non-modifiable factors are associated with poorer health-related quality of life (HRQoL) experienced by people with chronic kidney disease (CKD). We hypothesize that potentially modifiable factors for poor HRQoL can be identified among CKD patients, providing potential targets for intervention. Method The National Unified Renal Translational Research Enterprise Chronic Kidney Disease (NURTuRE-CKD) cohort study recruited 2996 participants from nephrology centres with all stages of non-dialysis-dependent CKD. Baseline data collection for sociodemographic, anthropometric, biochemical and clinical information, including Integrated Palliative care Outcome Scale renal, Hospital Anxiety and Depression score (HADS) and the 5-level EuroQol-5D (EQ-5D-5L) as HRQoL measure, took place between 2017 and 2019. EQ-5D-5L dimensions (mobility, self-care, usual activities, pain/discomfort, anxiety/depression) were mapped to an EQ-5D-3L value set to derive index value. Multivariable mixed effects regression models, adjusted for known factors affecting HRQoL with recruitment region as a random effect, were fit to assess potentially modifiable factors associated with index value (linear) and within each dimension (logistic). Results Among the 2958/2996 (98.7%) participants with complete EQ-5D data, 2201 (74.4%) reported problems in at least one EQ-5D-5L dimension. Multivariable linear regression identified independent associations between poorer HRQoL (EQ-5D-3L index value) and obesity (body mass index ≥30.0 kg/m2, β -0.037, 95% CI -0.058 to -0.016, P = .001), HADS depression score ≥8 (β -0.159, -0.182 to -0.137, P < .001), anxiety score ≥8 (β -0.090, -0.110 to -0.069, P < .001), taking ≥10 medications (β -0.065, -0.085 to -0.046, P < .001), sarcopenia (β -0.062, -0.080 to -0.043, P < .001) haemoglobin <100 g/L (β -0.047, -0.085 to -0.010, P = .012) and pain (β -0.134, -0.152 to -0.117, P < .001). Smoking and prescription of prednisolone independently associated with problems in self-care and usual activities respectively. Renin-angiotensin system inhibitor (RASi) prescription associated with fewer problems with mobility and usual activities. Conclusion Potentially modifiable factors including obesity, pain, depression, anxiety, anaemia, polypharmacy, smoking, steroid use and sarcopenia associated with poorer HRQoL in this cohort, whilst RASi use was associated with better HRQoL in two dimensions.
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Affiliation(s)
- Thomas Phillips
- School of Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Scott Harris
- School of Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Olalekan Lee Aiyegbusi
- Centre for Patient-Reported Outcome Research (CPROR), University of Birmingham, Birmingham, UK
| | - Bethany Lucas
- Centre for Kidney Research and Innovation, Academic Unit for Translational Medical Sciences, School of Medicine, University of Nottingham, Nottingham, UK
- Department of Renal Medicine, Royal Derby Hospital, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
| | - Melissa Benavente
- Centre for Kidney Research and Innovation, Academic Unit for Translational Medical Sciences, School of Medicine, University of Nottingham, Nottingham, UK
- Department of Renal Medicine, Royal Derby Hospital, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
| | - Paul J Roderick
- School of Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Paul Cockwell
- Centre for Patient-Reported Outcome Research (CPROR), University of Birmingham, Birmingham, UK
- Department of Renal Medicine, Queen Elizabeth Hospital, University Hospitals of Birmingham, Birmingham, UK
| | - Philip A Kalra
- Department of Renal Medicine, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Salford, UK
| | - David C Wheeler
- Department of Renal Medicine, University College London, London, UK
| | - Maarten W Taal
- Centre for Kidney Research and Innovation, Academic Unit for Translational Medical Sciences, School of Medicine, University of Nottingham, Nottingham, UK
- Department of Renal Medicine, Royal Derby Hospital, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
| | - Simon D S Fraser
- School of Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Southampton, UK
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King AJ, Hudson J, Azuara-Blanco A, Kirwan JF, Goyal S, Lim KS, Maclennan G. Effects of socioeconomic status on baseline values and outcomes at 24 months in the Treatment of Advanced Glaucoma Study randomised controlled Trial. Br J Ophthalmol 2024; 108:203-210. [PMID: 36596663 DOI: 10.1136/bjo-2022-321922] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 12/22/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND/AIMS Socioeconomic status (SES) is associated with late disease presentation and poorer outcomes. We evaluate the effect of SES on treatment outcomes and report the correlation between SES and baseline characteristics of participants in the Treatment of Advanced Glaucoma Study. METHODS Pragmatic multicentre randomised controlled trial. Four hundred and fifty-three patients presenting with advanced open-angle glaucoma in at least one eye (Hodapp-Parrish-Anderson classification). Participants were randomised to either glaucoma drops (medical arm) or trabeculectomy (surgery arm). Clinical characteristics, Quality of life measurement (QoL) and SES defined by the Index of Multiple Deprivation are reported. Subgroup analysis explored treatment effect modifications of SES at 24 months. Correlation between SES and baseline characteristics was tested with the χ2 test of association for dichotomous variables and pairwise Pearson's correlation for continuous variables. RESULTS The mean visual field mean deviation was -17.2 (6.7)dB for the most deprived quintile of participants and -13.0 (5.5) for the least deprived quintile in the index eye. At diagnosis, there was a strong correlation between SES and ethnicity, age, extent of visual field loss and number of visits to opticians prior to diagnosis. At 24 months, there was no evidence that the treatment effect was moderated by SES. CONCLUSIONS In patients presenting with advanced glaucoma. SES at baseline is correlated with poorer visual function, poorer Visual Function Questionnaire-25 QoL, ethnicity, age and number visits to an optician in the years preceding diagnosis. SES at baseline does not have an effect of the success of treatment at 24 months. TRIAL REGISTRATION NUMBER ISRCTN56878850.
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Affiliation(s)
- Anthony J King
- Departament of Ophthalmology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Jemma Hudson
- Centre for Healthcare Randomised Trials (CHaRT), University of Aberdeen Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | | | - James F Kirwan
- Department of Ophthalmology, Queen Alexandra Hospital, Portsmouth, UK
| | - Saurabh Goyal
- Department of Ophthalmology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Kin Sheng Lim
- Department of Ophthalmology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Graeme Maclennan
- Centre for Healthcare Randomised Trials (CHaRT), University of Aberdeen Health Services Research Unit, University of Aberdeen, Aberdeen, UK
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Gupta S, Jordan IK, Mariño-Ramírez L. Sick individuals, sick populations revisited: a test of the Rose hypothesis for type 2 diabetes disparities. BMJ PUBLIC HEALTH 2023; 1:e000655. [PMID: 38239263 PMCID: PMC10795613 DOI: 10.1136/bmjph-2023-000655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/22/2024]
Abstract
Introduction The Rose hypothesis predicts that since genetic variation is greater within than between populations, genetic risk factors will be associated with individuals' risk of disease but not population disparities, and since socioenvironmental variation is greater between than within populations, socioenvironmental risk factors will be associated with population disparities but not individuals' disease risk. Methods We used the UK Biobank to test the Rose hypothesis for type 2 diabetes (T2D) ethnic disparities in the UK. Our cohort consists of 26 912 participants from Asian, black and white ethnic groups. Participants were characterised as T2D cases or controls based on the presence or absence of T2D diagnosis codes in electronic health records. T2D genetic risk was measured using a polygenic risk score (PRS), and socioeconomic deprivation was measured with the Townsend Index (TI). The variation of genetic (PRS) and socioeconomic (TI) risk factors within and between ethnic groups was calculated using analysis of variance. Multivariable logistic regression was used to associate PRS and TI with T2D cases, and mediation analysis was used to analyse the effect of PRS and TI on T2D ethnic group disparities. Results T2D prevalence differs for Asian 23.34% (OR=5.14, CI=4.68 to 5.65), black 16.64% (OR=3.81, CI=3.44 to 4.22) and white 7.35% (reference) ethnic groups in the UK. Both genetic and socioenvironmental T2D risk factors show greater within (w) than between (b) ethnic group variation: PRS w=64.60%, b=35.40%; TI w=71.18%, b=28.19%. Nevertheless, both genetic risk (PRS OR=1.96, CI=1.87 to 2.07) and socioeconomic deprivation (TI OR=1.09, CI=1.08 to 1.10) are associated with T2D individual risk and mediate T2D ethnic disparities (Asian PRS=22.5%, TI=9.8%; black PRS=32.0%, TI=25.3%). Conclusion A relative excess of within-group versus between-group variation does not preclude T2D risk factors from contributing to T2D ethnic disparities. Our results support an integrative approach to health disparities research that includes both genetic and socioenvironmental risk factors.
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Affiliation(s)
- Sonali Gupta
- National Institute on Minority Health and Health Disparities, National Institutes of Health, Rockville, Maryland, USA
| | - I King Jordan
- School of Biological Sciences, Georgia Institute of Technology, Atlanta, Georgia, USA
| | - Leonardo Mariño-Ramírez
- National Institute on Minority Health and Health Disparities, National Institutes of Health, Rockville, Maryland, USA
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Helmark C, Harrison A, Pedersen SS, Doherty P. Screening for - and prevalence of - anxiety and depression in cardiac rehabilitation in the post-COVID era. An observational study. Int J Cardiol 2023; 393:131379. [PMID: 37734491 DOI: 10.1016/j.ijcard.2023.131379] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 09/11/2023] [Accepted: 09/18/2023] [Indexed: 09/23/2023]
Abstract
BACKGROUND Approximately 20-30% of patients with a cardiac disease suffer from anxiety and/or depression, leading to poor health outcomes. To identify this subgroup, clinical guidelines recommend screening for anxiety and depression in cardiac rehabilitation (CR). It is unknown how screening practice is delivered post-COVID. METHODS This observational study used data from the National Audit of Cardiac Rehabilitation from April 2018-March 2022. Descriptive statistics were used to assess screening rates and prevalence, while a multivariate logistic regression model was performed to analyse determinants for screening for anxiety and depression among patients participating in cardiac rehabilitation. RESULTS The population consisted of 245,705 patients, where 128,643 (52.4%) were screened and 117,062 (47.6%) were not. Patients attending CR during first year of COVID-19 were less likely to be screened. Patients with female gender, living alone, non-white ethnicity, living in the most deprived areas, current smoking, and physical inactivity were less likely to be screened, while patients who were revascularized, having an objective physical fitness test, and attending a certified CR center were more likely to be screened. For patients attending CR during COVID-19, the prevalence of anxiety and depression decreased significantly. For anxiety the prevalence dropped from 34.4% to 15.8%, for depression the prevalence dropped from 33.5% to 16.5%. CONCLUSION CR service provision was negatively impacted during COVID-19, leading to much lower screening for anxiety and depression in the CR setting. Prevalence of anxiety and depression decreased during COVID-19 for this population, possibly because psychologically affected patients refrained from attending CR.
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Affiliation(s)
- Charlotte Helmark
- Department of Cardiology, Zealand University Hospital, Sygehusvej 10, 4000 Roskilde, Denmark; Department of Psychology, University of Southern Denmark, Campusvej 55, 5330 Odense M, Denmark.
| | - Alex Harrison
- Department of Health Sciences, University of York, Heslington, York, YO10 5DD, United Kingdom
| | - Susanne S Pedersen
- Department of Psychology, University of Southern Denmark, Campusvej 55, 5330 Odense M, Denmark; Department of Cardiology, Odense University Hospital, J. B. Winsloews Vej 4, 5000 Odense, Denmark
| | - Patrick Doherty
- Department of Health Sciences, University of York, Heslington, York, YO10 5DD, United Kingdom
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Mikolai J, Dorey P, Keenan K, Kulu H. Spatial patterns of COVID-19 and non-COVID-19 mortality across waves of infection in England, Wales, and Scotland. Soc Sci Med 2023; 338:116330. [PMID: 37907058 DOI: 10.1016/j.socscimed.2023.116330] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 09/12/2023] [Accepted: 10/10/2023] [Indexed: 11/02/2023]
Abstract
Recent studies have established the key individual-level risk factors of COVID-19 mortality such as age, gender, ethnicity, and socio-economic status. However, the spread of infectious diseases is a spatial and temporal process implying that COVID-19 mortality and its determinants may vary sub-nationally and over time. We investigate the spatial patterns of age-standardised death rates due to COVID-19 and their correlates across local authority districts in England, Wales, and Scotland across three waves of infection. Using a Spatial Durbin model, we explore within- and between-country variation and account for spatial dependency. Areas with a higher share of ethnic minorities and higher levels of deprivation had higher rates of COVID-19 mortality. However, the share of ethnic minorities and population density in an area were more important predictors of COVID-19 mortality in earlier waves of the pandemic than in later waves, whereas area-level deprivation has become a more important predictor over time. Second, during the first wave of the pandemic, population density had a significant spillover effect on COVID-19 mortality, indicating that the pandemic spread from big cities to neighbouring areas. Third, after accounting for differences in ethnic composition, deprivation, and population density, initial cross-country differences in COVID-19 mortality almost disappeared. COVID-19 mortality remained higher in Scotland than in England and Wales in the third wave when COVID-19 mortality was relatively low in all three countries. Interpreting these results in the context of higher overall (long-term) non-COVID-19 mortality in Scotland suggests that Scotland may have performed better than expected during the first two waves. Our study highlights that accounting for both spatial and temporal factors is essential for understanding social and demographic risk factors of mortality during pandemics.
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Affiliation(s)
- Júlia Mikolai
- ESRC Centre for Population Change, United Kingdom; University of St Andrews, United Kingdom.
| | | | - Katherine Keenan
- ESRC Centre for Population Change, United Kingdom; University of St Andrews, United Kingdom
| | - Hill Kulu
- ESRC Centre for Population Change, United Kingdom; University of St Andrews, United Kingdom
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Abed Al Ahad M. The association of long-term exposure to outdoor air pollution with all-cause GP visits and hospital admissions by ethnicity and country of birth in the United Kingdom. PLoS One 2023; 18:e0275414. [PMID: 37819897 PMCID: PMC10566689 DOI: 10.1371/journal.pone.0275414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Accepted: 09/11/2023] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND Air pollution is associated with poor health. Yet, more research is needed to reveal the association of long-term exposure to outdoor air pollution with less studied health outcomes like hospital admissions and general-practitioner (GP) visits and whether this association is stronger for ethnic minorities compared to the rest of population. This study investigates the association between air pollution and all-cause GP visits and hospital admissions by ethnicity in the United-Kingdom (UK). METHODS We used individual-level longitudinal data from the "UK Household Longitudinal Study" including 46,442 adult individuals who provided 140,466 responses across five years (2015-2019). This data was linked to yearly concentrations of NO2, SO2, and particulate-matter (PM10, PM2.5) outdoor pollution using the Lower Super Output Area (LSOA) of residence for each individual. Multilevel mixed-effects ordered logistic models were used to assess the association between air pollution and all-cause GP visits and hospital admissions. RESULTS We found higher odds of hospital admissions per 1 μg/m3 increase in annual concentrations of NO2 (OR = 1.008; 95%CI = 1.004-1.012), SO2 (OR = 1.048; 95%CI = 1.014-1.083), PM10 (OR = 1.011; 95%CI = 1.003-1.018), and PM2.5 (OR = 1.018; 95%CI = 1.007-1.029) pollutants. Higher odds of GP visits were also observed with increased exposure to NO2 (OR = 1.010; 95%CI = 1.006-1.014) and SO2 (OR = 1.114; 95%CI = 1.077-1.152) pollutants. The observed associations did not differ across ethnic groups, but by country of birth, they were more pronounced in individuals born outside UK than those born in UK. CONCLUSION This study supports an association between higher exposure to outdoor air pollution and increased all-cause hospital admissions and GP visits. Further longitudinal studies with longer follow-up time periods may be able to reveal more definite conclusions on the influence of ethnicity on the association between long-term outdoor air pollution and both hospital admissions and GP visits.
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Affiliation(s)
- Mary Abed Al Ahad
- School of Geography and Sustainable Development, University of St Andrews, Scotland, United Kingdom
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Hübelová D, Caha J, Janošíková L, Kozumplíková A. A holistic model of health inequalities for health policy and state administration: a case study in the regions of the Czech Republic. Int J Equity Health 2023; 22:183. [PMID: 37670373 PMCID: PMC10481637 DOI: 10.1186/s12939-023-01996-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 08/23/2023] [Indexed: 09/07/2023] Open
Abstract
BACKGROUND Health inequities exist within and between societies at different hierarchical levels. Despite overall improvements in health status in European Union countries, disparities persist among socially, economically, and societally disadvantaged individuals. This study aims to develop a holistic model of health determinants, examining the complex relationship between various determinants of health inequalities and their association with health condition. METHODS Health inequalities and conditions were assessed at the territorial level of Local Administrative Units (LAU1) in the Czech Republic. A dataset of 57 indicators was created, categorized into seven determinants of health and one health condition category. The necessary data were obtained from publicly available databases. Comparisons were made between 2001-2003 and 2016-2019. Various methods were employed, including composite indicator creation, correlation analysis, the Wilcoxon test, aggregate index calculation, cluster analysis, and data visualization using the LISA method. RESULTS The correlation matrix revealed strong relationships between health inequality categories in both periods. The most significant associations were observed between Economic status and social protection and Education in the first period. However, dependencies weakened in the later period, approaching values of approximately 0.50. The Wilcoxon test confirmed variations in determinant values over time, except for three specific determinants. Data visualization identified persistently adverse or worsening health inequalities in specific LAU1, focusing on categories such as Economic status and social protection, Education, Demographic situation, Environmental status, Individual living status, and Road safety and crime. The health condition indices showed no significant change over time, while the aggregate index of health inequalities improved with widened differences. CONCLUSION Spatial inequalities in health persist in the Czech Republic, influenced by economic, social, demographic, and environmental factors, as well as local healthcare accessibility. Both inner and outer peripheries exhibit poor health outcomes, challenging the assumption that urban areas fare better. The combination of poverty and vulnerabilities exacerbates these inequalities. Despite the low rates of social exclusion and poverty, regional health inequalities persist in the long term. Effectively addressing health inequalities requires interdisciplinary collaboration and evidence-based policy interventions. Efforts should focus on creating supportive social and physical environments, strengthening the healthcare system, and fostering cooperation with non-medical disciplines.
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Affiliation(s)
- Dana Hübelová
- Department of Social Studies, Mendel University in Brno, Zemedelska 1, Brno, 613 00, Czech Republic
| | - Jan Caha
- Department of Regional Development, Mendel University in Brno, Zemedelska 1, Brno, 613 00, Czech Republic
| | - Lenka Janošíková
- Department of Regional Development, Mendel University in Brno, Zemedelska 1, Brno, 613 00, Czech Republic
| | - Alice Kozumplíková
- Department of Social Studies, Mendel University in Brno, Zemedelska 1, Brno, 613 00, Czech Republic.
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Butler D, O'Donovan D, Johnston J, Hart ND. Are GP training opportunities in Northern Ireland widening or closing the gap on health inequalities? An analysis of Northern Ireland deprivation data. BJGP Open 2023; 7:BJGPO.2022.0178. [PMID: 37019473 PMCID: PMC10646194 DOI: 10.3399/bjgpo.2022.0178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 02/22/2023] [Accepted: 04/03/2023] [Indexed: 04/07/2023] Open
Abstract
BACKGROUND Increasing the GP workforce will not necessarily level up healthcare provision. Instead, increasing GP training numbers could worsen health inequity and inequalities. This is especially true if there are fewer opportunities to learn, train, and build confidence in underserved, socioeconomically deprived areas. AIM To investigate the representation of socioeconomic deprivation in postgraduate GP training practices in Northern Ireland (NI). DESIGN & SETTING An analysis of socioeconomic deprivation indices and scores of GP practices in NI involved in postgraudate GP training. METHOD The socioeconomic deprivation indices and scores of GP postgraduate training practices were compared against general practice in NI by examining the representation of practices whose patients live in areas of blanket deprivation, higher deprivation, and higher affluence. RESULTS Of 319 practices in NI, 195 (61%) were registered as postgraduate training practices and had a statistically significantly lower deprivation score (3.02±0.21) compared with non-training practices (3.2±0.32), t(255) -2.02, P = 0.041. The proportion of training practices with blanket deprivation and higher levels of deprivation was underrepresented, with the current postgraduate GP training practices having more affluent populations. CONCLUSION Postgraduate training practices had a statistically significant lower deprivation score and did not fully reflect the socioeconomic make-up of wider NI general practice. The results, however, are more favourable than in other areas of the UK and better than undergraduate teaching opportunities in general practice. Health inequalities will worsen if the representation of general practice training in areas of greater socioeconomic deprivation is not increased.
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Affiliation(s)
- Daniel Butler
- School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
- Northern Ireland Medical and Dental Training Agency, Belfast, UK
| | - Diarmuid O'Donovan
- School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
- Public Health Agency, Ontario, Canada
| | - Jennifer Johnston
- School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
| | - Nigel D Hart
- School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
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Khand A, Brankin-Frisby T, Gornall M, Hatherley J, Raj R, Campbell M, Salmon T, Yang YH, Grainger R. Independent Predictors of Repeat Emergency Room Presentations: Insights from a Cohort of 1066 Consecutive Patients with Non-Cardiac Chest Pain Generating 4770 Repeat Presentations. J Clin Med 2023; 12:5290. [PMID: 37629331 PMCID: PMC10455527 DOI: 10.3390/jcm12165290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 07/08/2023] [Accepted: 07/19/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND AND IMPORTANCE Chest pain (CP) is one of the most frequent presentations to the emergency department (ED), a large proportion of which is non-cardiac chest pain (NCCP). Repeat attendances to ED are common and impose considerable burden to overstretched departments. OBJECTIVE Our aim was to determine drivers for repeat ED presentations using NCCP as the primary cause of index presentation. DESIGN, SETTING AND PARTICIPANTS This was a retrospective cohort study of 1066 consecutive presentations with NCCP to a major urban hospital ED in North England. Index of Multiple Deprivation (IMD), a postcode-derived validated index of deprivation, was computed. Charlson comorbidity index (CCI) was determined by reference to known comorbidity variables. Repeat presentation to ED to any national hospital was determined by a national linked database (population 53.5 million). Independent predictors of ED representation were computed using logistic regression analysis. RESULTS Median age was 43 (IQR 28-59), and 50.8% were male. Furthermore, 27.8%, 8.1% and 3.8% suffered from chronic obstructive pulmonary disease (COPD), hypertension and diabetes mellitus, respectively. The most frequent diagnoses, using ICD-10 coding, were non-cardiac chest pain (55.1%), followed by respiratory conditions (14.7%). One-year incidence of adjudicated myocardial infarction, urgent or emergency coronary revascularisation and all-cause death was 0.6%, 2% and 5.3%, respectively. There was a total of 4770 ED repeat presentations 1 year prior to or following index presentation with NCCP in this cohort. Independent (multivariate) predictors for frequent re-presentation (defined as ≥2 representations) were a history of COPD (OR [odds ratio] 2.06, p = 0.001), previous MI (OR3.6, p = 0.020) and a Charlson comorbidity index ≥1 (OR 1.51, p = 0.030). The frequency of previous MI was low as only 3% had sustained a previous MI. CONCLUSIONS This analysis indicates that COPD and complex health care needs (represented by high CCI), but not socio-economic deprivation, should be health policy targets for lessening repeat ED presentations. What is already known on this topic: Repeat presentations with non-ischaemic chest pain are common, placing a considerable burden on emergency departments. WHAT THIS STUDY ADDS COPD and complex health care needs, denoted by Charlson comorbidity index, are implicated as drivers for repeat presentation to accident and emergency department. Socio-economic deprivation was not an independent predictor of re-presentation. How might this study affect research, practice, or policy: Community-based support for COPD and complex health care needs may reduce frequency of ED attendance.
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Affiliation(s)
- Aleem Khand
- Liverpool University Hospitals NHS Foundation Trust, Liverpool L9 7AL, UK (T.S.); (Y.-h.Y.)
- Liverpool Heart and Chest Hospital, Liverpool L14 3PE, UK
- Department of Ageing and Chronic Diseases, University of Liverpool, Liverpool L69 3BX, UK
| | - Thomas Brankin-Frisby
- Liverpool University Hospitals NHS Foundation Trust, Liverpool L9 7AL, UK (T.S.); (Y.-h.Y.)
| | - Matthew Gornall
- Clinical Trials Unit, University of Liverpool, Liverpool L69 3BX, UK
| | - James Hatherley
- Liverpool University Hospitals NHS Foundation Trust, Liverpool L9 7AL, UK (T.S.); (Y.-h.Y.)
| | - Ray Raj
- Liverpool University Hospitals NHS Foundation Trust, Liverpool L9 7AL, UK (T.S.); (Y.-h.Y.)
| | - Michael Campbell
- Liverpool University Hospitals NHS Foundation Trust, Liverpool L9 7AL, UK (T.S.); (Y.-h.Y.)
| | - Thomas Salmon
- Liverpool University Hospitals NHS Foundation Trust, Liverpool L9 7AL, UK (T.S.); (Y.-h.Y.)
| | - Yi-han Yang
- Liverpool University Hospitals NHS Foundation Trust, Liverpool L9 7AL, UK (T.S.); (Y.-h.Y.)
| | - Ruth Grainger
- North-West Coast Academic Science Network, Cheshire WA4 4AB, UK
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Plumb L, Casula A, Sinha MD, Inward CD, Marks SD, Medcalf J, Nitsch D. Epidemiology of childhood acute kidney injury in England using e-alerts. Clin Kidney J 2023; 16:1288-1297. [PMID: 37529656 PMCID: PMC10387403 DOI: 10.1093/ckj/sfad070] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Indexed: 08/03/2023] Open
Abstract
Background Few studies describe the epidemiology of childhood acute kidney injury (AKI) nationally. Laboratories in England are required to issue electronic (e-)alerts for AKI based on serum creatinine changes. This study describes a national cohort of children who received an AKI alert and their clinical course. Methods A cross-section of AKI episodes from 2017 are described. Hospital record linkage enabled description of AKI-associated hospitalizations including length of stay (LOS) and critical care requirement. Risk associations with critical care (hospitalized cohort) and 30-day mortality (total cohort) were examined using multivariable logistic regression. Results In 2017, 7788 children (52% male, median age 4.4 years, interquartile range 0.9-11.5 years) experienced 8927 AKI episodes; 8% occurred during birth admissions. Of 5582 children with hospitalized AKI, 25% required critical care. In children experiencing an AKI episode unrelated to their birth admission, Asian ethnicity, young (<1 year) or old (16-<18 years) age (reference 1-<5 years), and high peak AKI stage had higher odds of critical care. LOS was higher with peak AKI stage, irrespective of critical care admission. Overall, 30-day mortality rate was 3% (n = 251); youngest and oldest age groups, hospital-acquired AKI, higher peak stage and critical care requirement had higher odds of death. For children experiencing AKI alerts during their birth admission, no association was seen between higher peak AKI stage and critical care admission. Conclusions Risk associations for adverse AKI outcomes differed among children according to AKI type and whether hospitalization was related to birth. Understanding the factors driving AKI development and progression may help inform interventions to minimize morbidity.
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Affiliation(s)
| | - Anna Casula
- UK Renal Registry, UK Kidney Association, Bristol, UK
| | - Manish D Sinha
- Evelina London Children's Hospital, Guys and St Thomas’ NHS Foundation Trust, London, UK
- British Heart Foundation Centre, Kings College London, London, UK
| | - Carol D Inward
- Department of Paediatric Nephrology, University Hospitals Bristol & Weston NHS Foundation Trust, Bristol, UK
| | - Stephen D Marks
- Department of Paediatric Nephrology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
- NIHR Great Ormond Street Hospital Biomedical Research Centre, University College London Great Ormond Street Institute of Child Health, London, UK
| | - James Medcalf
- UK Renal Registry, UK Kidney Association, Bristol, UK
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Dorothea Nitsch
- UK Renal Registry, UK Kidney Association, Bristol, UK
- Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
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Cliffe C, Cusick M, Vellupillai S, Shear M, Downs J, Epstein S, Pathak J, Dutta R. A multisite comparison using electronic health records and natural language processing to identify the association between suicidality and hospital readmission amongst patients with eating disorders. Int J Eat Disord 2023; 56:1581-1592. [PMID: 37194359 PMCID: PMC10524005 DOI: 10.1002/eat.23980] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 04/21/2023] [Accepted: 04/21/2023] [Indexed: 05/18/2023]
Abstract
OBJECTIVES To describe and compare the association between suicidality and subsequent readmission for patients hospitalized for eating disorder treatment, within 2 years of discharge, at two large academic medical centers in two different countries. METHODS Over an 8-year study window from January 2009 to March 2017, we identified all inpatient eating disorder admissions at Weill Cornell Medicine, New York, USA (WCM) and South London and Maudsley Foundation NHS Trust, London, UK (SLaM). To establish each patient's-suicidality profile, we applied two natural language processing (NLP) algorithms, independently developed at the two institutions, and detected suicidality in clinical notes documented in the first week of admission. We calculated the odds ratios (OR) for any subsequent readmission within 2 years postdischarge and determined whether this was to another eating disorder unit, other psychiatric unit, a general medical hospital admission or emergency room attendance. RESULTS We identified 1126 and 420 eating disorder inpatient admissions at WCM and SLaM, respectively. In the WCM cohort, evidence of above average suicidality during the first week of admission was significantly associated with an increased risk of noneating disorder-related psychiatric readmission (OR 3.48 95% CI = 2.03-5.99, p-value < .001), but a similar pattern was not observed in the SLaM cohort (OR 1.34, 95% CI = 0.75-2.37, p = .32), there was no significant increase in risk of admission. In both cohorts, personality disorder increased the risk of any psychiatric readmission within 2 years. DISCUSSION Patterns of increased risk of psychiatric readmission from above average suicidality detected via NLP during inpatient eating disorder admissions differed in our two patient cohorts. However, comorbid diagnoses such as personality disorder increased the risk of any psychiatric readmission across both cohorts. PUBLIC SIGNIFICANCE Suicidality amongst is eating disorders is an extremely common presentation and it is important we further our understanding of identifying those most at risk. This research also provides a novel study design, comparing two NLP algorithms on electronic health record data based in the United States and United Kingdom on eating disorder inpatients. Studies researching both UK and US mental health patients are sparse therefore this study provides novel data.
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Affiliation(s)
- Charlotte Cliffe
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- South London & Maudsley Foundation NHS Trust, London, UK
| | - Marika Cusick
- Division of Population Health Sciences, Cornell University, New York, New York, USA
- Department of Health Policy, Stanford School of Medicine, Stanford, CA, USA
| | - Sumithra Vellupillai
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Matthew Shear
- Department of Psychiatry, Weill Cornell Medicine, New York, New York, USA
- Psychiatry, New York Presbyterian Hospital, White Plains, New York, USA
| | - Johnny Downs
- South London & Maudsley Foundation NHS Trust, London, UK
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Sophie Epstein
- South London & Maudsley Foundation NHS Trust, London, UK
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Jyotishman Pathak
- Division of Population Health Sciences, Cornell University, New York, New York, USA
| | - Rina Dutta
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- South London & Maudsley Foundation NHS Trust, London, UK
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Zhou Y, Singh H, Hamilton W, Archer S, Tan S, Brimicombe J, Lyratzopoulos G, Walter FM. Improving the diagnostic process for patients with possible bladder and kidney cancer: a mixed-methods study to identify potential missed diagnostic opportunities. Br J Gen Pract 2023; 73:e575-e585. [PMID: 37253628 PMCID: PMC10242858 DOI: 10.3399/bjgp.2022.0602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 02/03/2023] [Accepted: 02/28/2023] [Indexed: 06/01/2023] Open
Abstract
BACKGROUND Patients with bladder and kidney cancer may experience diagnostic delays. AIM To identify patterns of suboptimal care and contributors of potential missed diagnostic opportunities (MDOs). DESIGN AND SETTING Prospective, mixed-methods study recruiting participants from nine general practices in Eastern England between June 2018 and October 2019. METHOD Patients with possible bladder and kidney cancer were identified using eligibility criteria based on National Institute for Health and Care Excellence (NICE) guidelines for suspected cancer. Primary care records were reviewed at recruitment and at 1 year for data on symptoms, tests, referrals, and diagnosis. Referral predictors were examined using logistic regression. Semi-structured interviews were undertaken with 15 patients to explore their experiences of the diagnostic process, and these were analysed thematically. RESULTS Participants (n = 940) were mostly female (n = 657, 69.9%), with a median age of 71 years (interquartile range 64-77 years). In total, 268 (28.5%) received a referral and 465 (48.5%) had a final diagnosis of urinary tract infection (UTI). There were 33 (3.5%) patients who were diagnosed with cancer, including prostate (n = 17), bladder (n = 7), and upper urothelial tract (n = 1) cancers. Among referred patients, those who had a final diagnosis of UTI had the longest time to referral (median 81.5 days). Only one-third of patients with recurrent UTIs were referred despite meeting NICE referral guidelines. Qualitative findings revealed barriers during the diagnostic process, including inadequate clinical examination, female patients given repeated antibiotics without clinical reviews, and suboptimal communication of test results to patients. CONCLUSION Older females with UTIs might be at increased risk of MDOs for cancer. Targeting barriers during the initial diagnostic assessment and follow-up might improve quality of diagnosis.
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Affiliation(s)
- Yin Zhou
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Hardeep Singh
- Center for Innovations in Quality, Effectiveness and Safety, Michael E DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, TX, US
| | | | - Stephanie Archer
- Department of Public Health and Primary Care, University of Cambridge, Cambridge and Department of Psychology, University of Cambridge, Cambridge, UK
| | - Sapphire Tan
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - James Brimicombe
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Georgios Lyratzopoulos
- Epidemiology of Cancer Healthcare and Outcomes (ECHO), Department of Behavioural Science and Health, Institute of Epidemiology and Health Care (IEHC), University College London, London, UK
| | - Fiona M Walter
- Department of Public Health and Primary Care, University of Cambridge, Cambridge and Wolfson Institute of Population Health, Queen Mary University of London, London, UK
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Chivers S, Cleary A, Knowles R, Babu-Narayan SV, Simpson JM, Nashat H, Dimopoulos K, Gatzoulis MA, Wilson D, Prica M, Anthony J, Clift PF, Jowett V, Jenkins P, Khodaghalian B, Jones CB, Hardiman A, Head C, Miller O, Chung NA, Mahmood U, Bu'Lock FA, Ramcharan TK, Chikermane A, Shortland J, Tometzki A, Crossland DS, Reinhardt Z, Lewis C, Rittey L, Hares D, Panagiotopoulou O, Smith B, Najih L M, Bharucha T, Daubeney PE. COVID-19 in congenital heart disease (COaCHeD) study. Open Heart 2023; 10:e002356. [PMID: 37460271 PMCID: PMC10357297 DOI: 10.1136/openhrt-2023-002356] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 06/23/2023] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND COVID-19 has caused significant worldwide morbidity and mortality. Congenital heart disease (CHD) is likely to increase vulnerability and understanding the predictors of adverse outcomes is key to optimising care. OBJECTIVE Ascertain the impact of COVID-19 on people with CHD and define risk factors for adverse outcomes. METHODS Multicentre UK study undertaken 1 March 2020-30 June 2021 during the COVID-19 pandemic. Data were collected on CHD diagnoses, clinical presentation and outcomes. Multivariable logistic regression with multiple imputation was performed to explore predictors of death and hospitalisation. RESULTS There were 405 reported cases (127 paediatric/278 adult). In children (age <16 years), there were 5 (3.9%) deaths. Adjusted ORs (AORs) for hospitalisation in children were significantly lower with each ascending year of age (OR 0.85, 95% CI 0.75 to 0.96 (p<0.01)). In adults, there were 24 (8.6%) deaths (19 with comorbidities) and 74 (26.6%) hospital admissions. AORs for death in adults were significantly increased with each year of age (OR 1.05, 95% CI 1.01 to 1.10 (p<0.01)) and with pulmonary arterial hypertension (PAH; OR 5.99, 95% CI 1.34 to 26.91 (p=0.02)). AORs for hospitalisation in adults were significantly higher with each additional year of age (OR 1.03, 95% CI 1.00 to 1.05 (p=0.04)), additional comorbidities (OR 3.23, 95% CI 1.31 to 7.97 (p=0.01)) and genetic disease (OR 2.87, 95% CI 1.04 to 7.94 (p=0.04)). CONCLUSIONS Children were at low risk of death and hospitalisation secondary to COVID-19 even with severe CHD, but hospital admission rates were higher in younger children, independent of comorbidity. In adults, higher likelihood of death was associated with increasing age and PAH, and of hospitalisation with age, comorbidities and genetic disease. An individualised approach, based on age and comorbidities, should be taken to COVID-19 management in patients with CHD.
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Affiliation(s)
- Sian Chivers
- Department of Congenital Cardiology, Royal Brompton & Harefield NHS Foundation Trust, London, UK
- Department of Congenital Cardiology, Evelina London Children's Hospital, London, UK
| | - Aoife Cleary
- Department of Congenital Cardiology, Evelina London Children's Hospital, London, UK
- Department of Congenital Cardiology, Great Ormond Street Hospital for Children, London, UK
| | - Rachel Knowles
- Department of Public Health Medicine, Great Ormond Street Hospital for Children, London, UK
- UCL Great Ormond Street Institute of Child Health Population Policy and Practice, London, UK
| | - Sonya V Babu-Narayan
- Department of Congenital Cardiology, Royal Brompton & Harefield NHS Foundation Trust, London, UK
- Imperial College London, London, UK
| | - John M Simpson
- Department of Congenital Cardiology, Evelina London Children's Hospital, London, UK
| | - Heba Nashat
- Department of Adult Congenital heart disease, Royal Brompton & Harefield NHS Foundation Trust, London, UK
| | - Konstantinos Dimopoulos
- Department of Adult Congenital heart disease, Royal Brompton & Harefield NHS Foundation Trust, London, UK
| | - Michael A Gatzoulis
- Department of Adult Congenital heart disease, Royal Brompton & Harefield NHS Foundation Trust, London, UK
| | - Dirk Wilson
- Department of Congenital Cardiology, University Hospital of Wales Healthcare NHS Trust, Cardiff, UK
| | - Milos Prica
- Department of Adult Congenital heart disease, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - James Anthony
- Department of Adult Congenital heart disease, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Paul F Clift
- Department of Adult Congenital heart disease, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Victoria Jowett
- Department of Congenital Cardiology, Great Ormond Street Hospital for Children, London, UK
| | - Petra Jenkins
- Department of Adult Congenital heart disease, Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, UK
| | - Bernadette Khodaghalian
- Department of Congenital Cardiology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Caroline B Jones
- Department of Congenital Cardiology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Antonia Hardiman
- Department of Adult Congenital heart disease, Norfolk and Norwich University Hospital NHS Trust, Norwich, UK
| | - Catherine Head
- Department of Adult Congenital heart disease, Norfolk and Norwich University Hospital NHS Trust, Norwich, UK
| | - Owen Miller
- Department of Congenital Cardiology, Evelina London Children's Hospital, London, UK
| | - Natali Ay Chung
- Department of Adult Congenital heart disease, St Thomas' Hospital, London, UK
| | - Umar Mahmood
- Department of Congenital Cardiology, Glenfield Hospital East Midlands Congenital Heart Centre, Leicester, UK
| | - Frances A Bu'Lock
- Department of Congenital Cardiology, Glenfield Hospital East Midlands Congenital Heart Centre, Leicester, UK
| | - Tristan Kw Ramcharan
- Department of Congenital Cardiology, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Ashish Chikermane
- Department of Congenital Cardiology, Birmingham Children's Hospital NHS Foundation Trust, Birmingham, UK
| | - Jennifer Shortland
- Department of Congenital Cardiology, Bristol Royal Hospital for Children, Bristol, UK
| | - Andrew Tometzki
- Department of Congenital Cardiology, Bristol Royal Hospital for Children, Bristol, UK
| | - David S Crossland
- Department of Congenital Cardiology, Freeman Hospital Cardiothoracic Centre, Newcastle upon Tyne, UK
| | - Zdenka Reinhardt
- Department of Congenital Cardiology, Freeman Hospital Cardiothoracic Centre, Newcastle upon Tyne, UK
| | - Clive Lewis
- Department of Adult Congenital heart disease, Papworth Hospital, Cambridge, UK
| | - Leila Rittey
- Department of Congenital Cardiology, Leeds Children's Hospital, Leeds, UK
| | - Dominic Hares
- Department of Congenital Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Olga Panagiotopoulou
- Department of Congenital Cardiology, Royal Hospital for Sick Children Yorkhill, Glasgow, UK
| | - Benjamin Smith
- Department of Congenital Cardiology, Royal Hospital for Sick Children Yorkhill, Glasgow, UK
| | - Muhammad Najih L
- Department of Congenital Cardiology, Southampton Children's Hospital, Southampton, UK
| | - Tara Bharucha
- Department of Congenital Cardiology, Southampton Children's Hospital, Southampton, UK
| | - Piers Ef Daubeney
- Department of Congenital Cardiology, Royal Brompton and Harefield NHS Trust, London, UK
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Leniz J, Davies JM, Bone AE, Hocaoglu M, Verne J, Barclay S, Murtagh FEM, Fraser LK, Higginson IJ, Sleeman KE. Deaths at home, area-based deprivation and the effect of the Covid-19 pandemic: An analysis of mortality data across four nations. Palliat Med 2023; 37:1034-1039. [PMID: 37088955 PMCID: PMC10125882 DOI: 10.1177/02692163231167212] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
Abstract
BACKGROUND The number and proportion of home deaths in the UK increased during the Covid-19 pandemic. It is not known whether these changes were experienced disproportionately by people from different socioeconomic groups. AIM To examine the association between home death and socioeconomic position during the Covid-19 pandemic, and how this changed between 2019 and 2020. DESIGN Retrospective cohort study using population-based individual-level mortality data. SETTING/PARTICIPANTS All registered deaths in England, Wales, Scotland and Northern Ireland. The proportion of home deaths between 28th March and 31st December 2020 was compared with the same period in 2019. We used Poisson regression models to evaluate the association between decedent's area-based level of deprivation and risk of home death, as well as the interaction between deprivation and year of death, for each nation separately. RESULTS Between the 28th March and 31st December 2020, 409,718 deaths were recorded in England, 46,372 in Scotland, 26,410 in Wales and 13,404 in Northern Ireland. All four nations showed an increase in the adjusted proportion of home deaths between 2019 and 2020, ranging from 21 to 28%. This increase was lowest for people living in the most deprived areas in all nations, with evidence of a deprivation gradient in England. CONCLUSIONS The Covid-19 pandemic exacerbated a previously described socioeconomic inequality in place of death in the UK. Further research to understand the reasons for this change and if this inequality has been sustained is needed.
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Affiliation(s)
- Javiera Leniz
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK
- Pontificia Universidad Católica de Chile, Escuela de Medicina, Departamento de Salud Pública, Santiago, Chile
| | - Joanna M Davies
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK
| | - Anna E Bone
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK
| | - Mevhibe Hocaoglu
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK
- Harvard Medical School, Blavatnik Institute, Global Health and Social Medicine, Boston, MA, USA
| | - Julia Verne
- Office for Health Improvement and Disparities, Department of Health and Social Care, London, UK
| | - Stephen Barclay
- Martin House Research Centre, Department of Health Sciences, University of York, Heslington, York, UK
| | - Fliss E M Murtagh
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, Cambridgeshire, UK
| | - Lorna K Fraser
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
| | - Irene J Higginson
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK
| | - Katherine E Sleeman
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK
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Fenn-Moltu S, Fitzgibbon SP, Ciarrusta J, Eyre M, Cordero-Grande L, Chew A, Falconer S, Gale-Grant O, Harper N, Dimitrova R, Vecchiato K, Fenchel D, Javed A, Earl M, Price AN, Hughes E, Duff EP, O’Muircheartaigh J, Nosarti C, Arichi T, Rueckert D, Counsell S, Hajnal JV, Edwards AD, McAlonan G, Batalle D. Development of neonatal brain functional centrality and alterations associated with preterm birth. Cereb Cortex 2023; 33:5585-5596. [PMID: 36408638 PMCID: PMC10152096 DOI: 10.1093/cercor/bhac444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 09/21/2022] [Accepted: 10/11/2022] [Indexed: 11/22/2022] Open
Abstract
Formation of the functional connectome in early life underpins future learning and behavior. However, our understanding of how the functional organization of brain regions into interconnected hubs (centrality) matures in the early postnatal period is limited, especially in response to factors associated with adverse neurodevelopmental outcomes such as preterm birth. We characterized voxel-wise functional centrality (weighted degree) in 366 neonates from the Developing Human Connectome Project. We tested the hypothesis that functional centrality matures with age at scan in term-born babies and is disrupted by preterm birth. Finally, we asked whether neonatal functional centrality predicts general neurodevelopmental outcomes at 18 months. We report an age-related increase in functional centrality predominantly within visual regions and a decrease within the motor and auditory regions in term-born infants. Preterm-born infants scanned at term equivalent age had higher functional centrality predominantly within visual regions and lower measures in motor regions. Functional centrality was not related to outcome at 18 months old. Thus, preterm birth appears to affect functional centrality in regions undergoing substantial development during the perinatal period. Our work raises the question of whether these alterations are adaptive or disruptive and whether they predict neurodevelopmental characteristics that are more subtle or emerge later in life.
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Affiliation(s)
- Sunniva Fenn-Moltu
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, SE5 8AF, United Kingdom
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, SE1 7EH, United Kingdom
| | - Sean P Fitzgibbon
- Wellcome Centre for Integrative Neuroimaging (WIN FMRIB), University of Oxford, Oxford, OX3 9DU, United Kingdom
| | - Judit Ciarrusta
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, SE5 8AF, United Kingdom
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, SE1 7EH, United Kingdom
| | - Michael Eyre
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, SE1 7EH, United Kingdom
| | - Lucilio Cordero-Grande
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, SE1 7EH, United Kingdom
- Biomedical Image Technologies, ETSI Telecomunicación, Universidad Politécnica de Madrid & CIBER-BBN, Madrid, 28040, Spain
| | - Andrew Chew
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, SE1 7EH, United Kingdom
| | - Shona Falconer
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, SE1 7EH, United Kingdom
| | - Oliver Gale-Grant
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, SE5 8AF, United Kingdom
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, SE1 7EH, United Kingdom
- MRC Centre for Neurodevelopmental Disorders, King’s College London, London, SE1 1UL, United Kingdom
| | - Nicholas Harper
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, SE1 7EH, United Kingdom
| | - Ralica Dimitrova
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, SE5 8AF, United Kingdom
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, SE1 7EH, United Kingdom
| | - Katy Vecchiato
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, SE5 8AF, United Kingdom
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, SE1 7EH, United Kingdom
| | - Daphna Fenchel
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, SE5 8AF, United Kingdom
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, SE1 7EH, United Kingdom
- MRC Centre for Neurodevelopmental Disorders, King’s College London, London, SE1 1UL, United Kingdom
| | - Ayesha Javed
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, SE5 8AF, United Kingdom
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, SE1 7EH, United Kingdom
| | - Megan Earl
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, SE5 8AF, United Kingdom
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, SE1 7EH, United Kingdom
- Paediatric Liver, GI and Nutrition Centre and MowatLabs, King’s College London, London, SE5 9RS, United Kingdom
| | - Anthony N Price
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, SE1 7EH, United Kingdom
| | - Emer Hughes
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, SE1 7EH, United Kingdom
| | - Eugene P Duff
- Wellcome Centre for Integrative Neuroimaging (WIN FMRIB), University of Oxford, Oxford, OX3 9DU, United Kingdom
- Department of Paediatrics, University of Oxford, Oxford, OX3 9DU, United Kingdom
| | - Jonathan O’Muircheartaigh
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, SE5 8AF, United Kingdom
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, SE1 7EH, United Kingdom
- MRC Centre for Neurodevelopmental Disorders, King’s College London, London, SE1 1UL, United Kingdom
| | - Chiara Nosarti
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, SE1 7EH, United Kingdom
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry Psychology and Neuroscience, King’s College London, London, SE5 8AF, United Kingdom
| | - Tomoki Arichi
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, SE1 7EH, United Kingdom
- MRC Centre for Neurodevelopmental Disorders, King’s College London, London, SE1 1UL, United Kingdom
- Paediatric Neurosciences, Evelina London Children’s Hospital, Guy’s and St Thomas’ NHS Foundation Trust, London, SE1 7EH, United Kingdom
- Department of Bioengineering, Imperial College London, London, SW7 2AZ, United Kingdom
| | - Daniel Rueckert
- Biomedical Image Analysis Group, Imperial College London, London, SW7 2AZ, United Kingdom
- Institute for AI and Informatics in Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, 81675, Germany
| | - Serena Counsell
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, SE1 7EH, United Kingdom
| | - Joseph V Hajnal
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, SE1 7EH, United Kingdom
| | - A David Edwards
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, SE1 7EH, United Kingdom
- MRC Centre for Neurodevelopmental Disorders, King’s College London, London, SE1 1UL, United Kingdom
| | - Grainne McAlonan
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, SE5 8AF, United Kingdom
- MRC Centre for Neurodevelopmental Disorders, King’s College London, London, SE1 1UL, United Kingdom
| | - Dafnis Batalle
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, SE5 8AF, United Kingdom
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, London, SE1 7EH, United Kingdom
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Yapp LZ, Scott CEH, MacDonald DJ, Howie CR, Simpson AHRW, Clement ND. Primary knee arthroplasty for osteoarthritis restores patients' health-related quality of life to normal population levels. Bone Joint J 2023; 105-B:365-372. [PMID: 36924161 DOI: 10.1302/0301-620x.105b4.bjj-2022-0659.r1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
This study investigates whether primary knee arthroplasty (KA) restores health-related quality of life (HRQoL) to levels expected in the general population. This retrospective case-control study compared HRQoL data from two sources: patients undergoing primary KA in a university-teaching hospital (2013 to 2019), and the Health Survey for England (HSE; 2010 to 2012). Patient-level data from the HSE were used to represent the general population. Propensity score matching was used to balance covariates and facilitate group comparisons. A propensity score was estimated using logistic regression based upon the covariates sex, age, and BMI. Two matched cohorts with 3,029 patients each were obtained for the adjusted analyses (median age 70.3 (interquartile range (IQR) 64 to 77); number of female patients 3,233 (53.4%); median BMI 29.7 kg/m2 (IQR 26.5 to 33.7)). HRQoL was measured using the three-level version of the EuroQol five-dimension questionnaire (EQ-5D-3L), and summarized using the Index and EuroQol visual analogue scale (EQ-VAS) scores. Patients awaiting KA had significantly lower EQ-5D-3L Index scores than the general population (median 0.620 (IQR 0.16 to 0.69) vs median 0.796 (IQR 0.69 to 1.00); p < 0.001). By one year postoperatively, the median EQ-5D-3L Index score improved significantly in the KA cohort (mean change 0.32 (SD 0.33); p < 0.001), and demonstrated no clinically relevant differences when compared to the general population (median 0.796 (IQR 0.69 to 1.00) vs median 0.796 (IQR 0.69 to 1.00)). Compared to the general population cohort, the postoperative EQ-VAS was significantly higher in the KA cohort (p < 0.001). Subgroup comparisons demonstrated that older age groups had statistically better EQ-VAS scores than matched peers in the general population. Patients awaiting KA for osteoarthritis had significantly poorer HRQoL than the general population. However, within one year of surgery, primary KA restored HRQoL to levels expected for the patient's age-, BMI-, and sex-matched peers.
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Affiliation(s)
- Liam Z Yapp
- Department of Orthopaedics, Division of Clinical and Surgical Sciences, University of Edinburgh, Edinburgh, UK
- Department of Trauma & Orthopaedic Surgery, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Chloe E H Scott
- Department of Orthopaedics, Division of Clinical and Surgical Sciences, University of Edinburgh, Edinburgh, UK
- Department of Trauma & Orthopaedic Surgery, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Deborah J MacDonald
- Department of Orthopaedics, Division of Clinical and Surgical Sciences, University of Edinburgh, Edinburgh, UK
- Department of Trauma & Orthopaedic Surgery, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Colin R Howie
- Department of Orthopaedics, Division of Clinical and Surgical Sciences, University of Edinburgh, Edinburgh, UK
- Department of Trauma & Orthopaedic Surgery, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - A Hamish R W Simpson
- Department of Orthopaedics, Division of Clinical and Surgical Sciences, University of Edinburgh, Edinburgh, UK
- Department of Trauma & Orthopaedic Surgery, Royal Infirmary of Edinburgh, Edinburgh, UK
- Bone & Joint Research , London, UK
| | - Nick D Clement
- Department of Orthopaedics, Division of Clinical and Surgical Sciences, University of Edinburgh, Edinburgh, UK
- Department of Trauma & Orthopaedic Surgery, Royal Infirmary of Edinburgh, Edinburgh, UK
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Nelson D, McGonagle I, Jackson C, Tsuro T, Scott E, Gussy M, Kane R. Health-Promoting Behaviours following Primary Treatment for Cancer: A Rural-Urban Comparison from a Cross-Sectional Study. Curr Oncol 2023; 30:1585-1597. [PMID: 36826083 PMCID: PMC9955107 DOI: 10.3390/curroncol30020122] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 01/22/2023] [Accepted: 01/24/2023] [Indexed: 01/27/2023] Open
Abstract
AIM To compare health-promoting behaviours among rural and urban residents following primary treatment for cancer. METHODS A cross-sectional survey collecting demographic variables and data pertaining to health-promoting behaviours, documented using the 52-item Health Promotion Lifestyle Profile II (HPLP-II) measure, which is categorised into six subscales: (1) health responsibility, (2) spiritual growth, (3) physical activity, (4) interpersonal relations, (5) nutrition, and (6) stress management. Residence was defined using the U.K. Office for National Statistics RUC 2011 Rural Urban Classifications. The Index of Multiple Deprivation (IMD) Decile was used to measure deprivation. Quantitative data were analysed using independent samples t-test and multiple linear regression. Qualitative data from open-ended questions were analysed thematically. RESULTS In total, 227 participants with a range of cancer types completed the questionnaire. Fifty-three percent were residents in urban areas and forty-five percent in rural areas. Rural participants scored significantly higher on health responsibility (p = 0.001), nutrition (p = 0.001), spiritual growth (p = 0.004), and interpersonal relationships (p = 0.001), as well as on the overall HPLP-II (p = 0.001). When controlling for deprivation, age, marital status, and education, rural-urban residence was a significant predictor of exhibiting health-promoting behaviours. A central theme from the qualitative data was the concept of "moving on" from cancer following treatment, by making adjustments to physical, social, psychological, spiritual, and emotional wellbeing. CONCLUSIONS This research revealed, for the first time, differences in health-promoting behaviours among rural and urban U.K. populations who have completed primary cancer treatment. Rural residence can provide a positive environment for engaging with health-promoting behaviours following a cancer diagnosis and treatment.
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Affiliation(s)
- David Nelson
- Lincoln International Institute for Rural Health, College of Social Science, University of Lincoln, Lincoln LN6 7TS, UK
- Macmillan Cancer Support, London SE1 7UQ, UK
- Correspondence: ; Tel.: +44-(0)1522-837343
| | - Ian McGonagle
- School of Health and Social Care, College of Social Science, University of Lincoln, Lincoln LN6 7TS, UK
| | - Christine Jackson
- School of Health and Social Care, College of Social Science, University of Lincoln, Lincoln LN6 7TS, UK
| | - Trish Tsuro
- United Lincolnshire Hospitals NHS Trust, Research and Innovation Department, Pilgrim Hospital, Boston PE21 9QS, UK
| | - Emily Scott
- Lincolnshire Partnership NHS Foundation Trust, Peter Hodgkinson Centre, Lincoln County Hospital, Lincoln LN2 5UA, UK
| | - Mark Gussy
- Lincoln International Institute for Rural Health, College of Social Science, University of Lincoln, Lincoln LN6 7TS, UK
- La Trobe Rural Health School, College of Science, Health and Engineering, La Trobe University, Bendigo P.O. Box 199, Australia
| | - Ros Kane
- School of Health and Social Care, College of Social Science, University of Lincoln, Lincoln LN6 7TS, UK
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Yapp LZ, Clement ND, Moran M, Clarke JV, Simpson AHRW, Scott CEH. The estimated lifetime risk of revision after primary knee arthroplasty is influenced by age, sex, and indication. Bone Joint J 2022; 104-B:1313-1322. [DOI: 10.1302/0301-620x.104b12.bjj-2021-1631.r3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Aims The aim of this study was to assess factors associated with the estimated lifetime risk of revision surgery after primary knee arthroplasty (KA). Methods All patients from the Scottish Arthroplasty Project dataset undergoing primary KA during the period 1 January 1998 to 31 December 2019 were included. The cumulative incidence function for revision and death was calculated up to 20 years. Adjusted analyses used cause-specific Cox regression modelling to determine the influence of patient factors. The lifetime risk was calculated as a percentage for patients aged between 45 and 99 years using multiple-decrement life table methodology. Results The estimated lifetime risk of revision ranged between 32.7% (95% confidence interval (CI) 22.6 to 47.3) for patients aged 45 to 49 years and 0.6% (95% CI 0.1 to 4.5) for patients aged over 90 years. At 20 years, the overall cumulative incidence of revision (6.8% (95% CI 6.6 to 7.0)) was significantly less than that of death (66.3% (95% CI 65.4 to 67.1)). Adjusted analyses demonstrated converse effect of increasing age on risk of revision (hazard ratio (HR) 0.5 (95% CI 0.5 to 0.6)) and death (HR 3.6 (95% CI 3.4 to 3.7)). Male sex was associated with increased risks of revision (HR 1.1 (95% CI 1.1 to 1.2); p < 0.001) and death (HR 1.4 (95% CI 1.3 to 1.4); p < 0.001). Compared to patients undergoing primary KA for osteoarthritis, patients with inflammatory arthropathy had a higher risk of death (HR 1.7 (95% CI 1.7 to 1.8); p < 0.001), but were less likely to be revised (HR 0.9 (95% CI 0.7 to 1.0); p < 0.001). Patients with a greater number of comorbidities (HR 1.4 (95% CI 1.3 to 1.4)) and greater levels of socioeconomic deprivation (HR 1.4 (95% CI 1.4 to 1.5)) were at increased risk of death, but neither increased the risk of revision. Conclusion The estimated lifetime risk of revision KA varied depending on patient sex, age, and underlying diagnosis. Patients aged between 45 and 49 years had a one in three risk of undergoing revision surgery within their lifetime, which decreased with age to one in 159 in those aged 90 years or more. Cite this article: Bone Joint J 2022;104-B(12):1313–1322.
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Affiliation(s)
- Liam Z. Yapp
- Department of Orthopaedics, Division of Clinical and Surgical Sciences, University of Edinburgh, Edinburgh, UK
- Scottish Arthroplasty Project, NHS Public Health Scotland, Edinburgh, UK
- Department of Trauma & Orthopaedic Surgery, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Nick D. Clement
- Department of Orthopaedics, Division of Clinical and Surgical Sciences, University of Edinburgh, Edinburgh, UK
- Department of Trauma & Orthopaedic Surgery, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Matthew Moran
- Department of Orthopaedics, Division of Clinical and Surgical Sciences, University of Edinburgh, Edinburgh, UK
- Scottish Arthroplasty Project, NHS Public Health Scotland, Edinburgh, UK
- Department of Trauma & Orthopaedic Surgery, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Jon V. Clarke
- Scottish Arthroplasty Project, NHS Public Health Scotland, Edinburgh, UK
- Golden Jubilee University National Hospital, Clydebank, UK
| | - A. Hamish R. W. Simpson
- Department of Orthopaedics, Division of Clinical and Surgical Sciences, University of Edinburgh, Edinburgh, UK
- Department of Trauma & Orthopaedic Surgery, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Chloe E. H. Scott
- Department of Orthopaedics, Division of Clinical and Surgical Sciences, University of Edinburgh, Edinburgh, UK
- Department of Trauma & Orthopaedic Surgery, Royal Infirmary of Edinburgh, Edinburgh, UK
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Redican E, Murphy J, McBride O, Bunting L, Shevlin M. The Prevalence, Patterns and Correlates of Childhood Trauma Exposure in a Nationally Representative Sample of Young People in Northern Ireland. JOURNAL OF CHILD & ADOLESCENT TRAUMA 2022; 15:963-976. [PMID: 35571535 PMCID: PMC9077031 DOI: 10.1007/s40653-022-00449-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 02/28/2022] [Indexed: 06/15/2023]
Abstract
PURPOSE Childhood trauma (CT) exposure is common, with many young people affected by multiple co-occurring traumas. METHODS Participants were a representative sample of 11-19-year-olds (n = 1293), who participated in the largest ever representative survey of youth mental health in Northern Ireland (NI) - the NI Youth Wellbeing Prevalence Survey 2020. This study used latent class analysis (LCA) to identify typologies that were most representative of trauma experience and co-occurrence among young people living in NI. Demographic, parental and deprivation variables were then used within a multinomial logistic regression analysis to describe trauma class membership. RESULTS Over 35% (n = 478) of participants reported exposure to at least one CT, with over 50% (n = 259) of trauma-exposed young people reporting multiple trauma exposure. LCA results provided support for a three-class model; 'low-exposure', 'moderate-exposure: community-victimization' and 'high-exposure: sexual-trauma'. While none of the child, parental or familial covariates differentiated members of the 'moderate-exposure: community-victimization' from 'low-exposure', those in 'high-exposure: sexual-trauma' were over four and a half times more likely to belong to a family in receipt of income benefits and over ten times more likely to have experienced some form of out-of-home care. CONCLUSIONS This study highlights the presence of three distinct trauma classes in the NI adolescent population. In particular, this study identifies a small minority of young people who have experienced multiple CT's, including sexually based traumas, with these traumas most likely to have occurred in the context of out-of-home care and familial poverty.
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Affiliation(s)
- Enya Redican
- School of Psychology, Ulster University, Coleraine, UK
| | - Jamie Murphy
- School of Psychology, Ulster University, Coleraine, UK
| | - Orla McBride
- School of Psychology, Ulster University, Coleraine, UK
| | | | - Mark Shevlin
- School of Psychology, Ulster University, Coleraine, UK
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McNeill SG, O'Donovan D, Hart N. Access to healthcare for people experiencing homelessness in the post-conflict society of Northern Ireland. Med Confl Surviv 2022; 38:274-279. [PMID: 36167493 DOI: 10.1080/13623699.2022.2116553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
| | | | - Nigel Hart
- Centre for Public Health, Queen's University Belfast
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50
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Lloyd CD, Norman PD, McLennan D. Deprivation in England, 1971-2020. APPLIED SPATIAL ANALYSIS AND POLICY 2022; 16:461-484. [PMID: 36405332 PMCID: PMC9667433 DOI: 10.1007/s12061-022-09486-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 09/13/2022] [Indexed: 06/16/2023]
Abstract
Measures of small area deprivation have played a major role in targeting resources in the UK. The English Index of Multiple Deprivation (IMD) is the official measure of small area deprivation in England and it has been used to allocate billions of pounds of government money. The success of schemes to reduce deprivation can only be assessed by measuring changes in deprivation over time. In addition, the effect of such schemes is likely to be a partly a function of the deprivation history of an area. More generally, the trajectory of deprivation, and not just its current state, is important in understanding the likely impacts of deprivation on those who live in deprived areas. This paper combines the strengths of the IMD as a broad-ranging measure based on administrative data (here, using the 2004, 2007, 2010, 2015 and 2019 indices) and the Townsend score derived from Census data for a much longer time period (1971 to 2011). In addition, benefit claimant count data are used as a proxy for unemployment following the national Covid-19 lockdowns. The paper identifies some major trends in small area deprivation and unemployment over the period 1971 to 2020 and it highlights some key similarities and differences between the Townsend score and the IMD and makes links to changes in unemployment in 2020. Areas with very long term deprivation are identified and the strong association between job losses following Covid-19 lockdown and deprivation histories is demonstrated. The analyses are used to argue that deprivation trajectories should be considered if effective strategies for reducing spatial inequalities are to be developed.
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Affiliation(s)
- C. D. Lloyd
- Geography, School of Natural and Built Environment, Queen’s University Belfast, Belfast, UK
| | - P. D. Norman
- School of Geography, University of Leeds, Leeds, UK
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