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106. Purdue's Engineer of 2020: The journey

Author

Jones, J., Meckl, P., Harris, M., Cox, M., Cekic, O., Okos, M., Osvaldo Campanella, Houze, N., Litster, J., Mosier, N., Radcliffe, D., Tao, B., Delaurentis, D., Brophy, S., Howell, K., Okutsu, M., Penner, A., Wilson, A., and Jamieson, L.

110. Modification of the home environment for the reduction of injuries

Author

Lyons, R. A., John, A., Brophy, S., Jones, S. J., Johansen, A., Kemp, A., Lannon, S., Patterson, J., Rolfe, B., Sander, L. V., and Alison Weightman

Abstract

BACKGROUND: Injury in the home is extremely common, accounting for around a third of all injuries. The majority of injuries of children under five and people aged 75 and over, occur at home. Multifactorial injury prevention interventions have been shown to reduce injuries in the home. However, few studies have focused specifically on the impact of physical adaptations to the home environment and the effectiveness of such interventions needs to be ascertained. OBJECTIVES: To review the evidence for the effect on injuries of modification of the home environment with a primary focus on interventions to reduce physical hazards. SEARCH STRATEGY: We searched The Cochrane Library, MEDLINE, EMBASE, National Research Register and other specialised databases. We also scanned conference proceedings and reference lists. In addition, we contacted experts and trialists in the field. The searches were not restricted by language or publication status. The searches were last updated in December 2004. SELECTION CRITERIA: Randomised controlled trials. DATA COLLECTION AND ANALYSIS: All abstracts were screened by two authors for relevance, outcome and design. Two authors independently assessed methodological quality and extracted data from each eligible study. MAIN RESULTS: We found 18 published and one unpublished trials. Trials were not sufficiently similar to allow pooling of data by statistical analyses, so this review takes a narrative form. Studies were divided into three groups based on the primary population sample; children (five studies), older people (14 studies) and the general population/mixed age group (no studies). None of the studies focusing on children demonstrated a reduction in injuries that might have been due to environmental adaptation in the home; one study reported a reduction in injuries and in hazards but the two could not be linked. Of the 14 included studies in older people, none demonstrated a reduction in injuries due to hazard reduction, although two demonstrated a reduction in falls that could be due to hazard reduction. AUTHORS' CONCLUSIONS: There is insufficient evidence to determine the effects of interventions to modify environmental home hazards. Further interventions to reduce hazards in the home should be evaluated by adequately designed randomised controlled trials measuring injury outcomes. Recruitment of large study samples to measure effect must be a major consideration for future trials.

117. The information needs of people living with ankylosing spondylitis: a questionnaire survey

Author

Cooksey Roxanne, Brophy Sinead, Husain Muhammad Jami, Irvine Elizabeth, Davies Helen, and Siebert Stefan

Subjects
Ankylosing spondylitis, Information sources, Information needs, Education, Information usage, Diseases of the musculoskeletal system, RC925-935
Abstract

Abstract Background Today, health care is patient-centred with patients more involved in medical decision making and taking an active role in managing their disease. It is important that patients are appropriately informed about their condition and that their health care needs are met. We examine the information utilisation, sources and needs of people with Ankylosing Spondylitis (AS). Methods Participants in an existing AS cohort study were asked to complete a postal or online questionnaire containing closed and open-ended questions, regarding their information access and needs. Participants were stratified by age and descriptive statistics were performed using STATA 11, while thematic analysis was performed on open-ended question narratives. Qualitative data was handled in Microsoft Access and explored for emerging themes and patterns of experiences. Results Despite 73% of respondents having internet access, only 49% used the internet to access information regarding AS. Even then, this was only infrequently. Only 50% of respondents reported accessing written information about AS, which was obtained mainly in specialist clinics. Women were more likely than men to access information (63% (women) 46% (men)) regardless of the source, while younger patients were more likely to use online sources. The main source of non-written information was the rheumatologist. Overall, the respondents felt there was sufficient information available, but there was a perception that the tone was often too negative. The majority (95%) of people would like to receive a regular newsletter about AS, containing positive practical and local information. Suggestions were also made for more information about AS to be made available to non-specialist medical professionals and the general public. Conclusions There appears to be sufficient information available for people with AS in the UK and this is mostly accessed by younger AS patients. Many patients, particularly men, choose not to access AS information and concerns were raised about its negative tone. Patients still rely on written and verbal information from their specialists. Future initiatives should focus on the delivery of more positive information, targeting younger participants in particular and increasing the awareness in the general population and wider non-specialist medical community.

Published
2012
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118. HERALD (Health Economics using Routine Anonymised Linked Data)

Author

Husain Muhammad J, Brophy Sinead, Macey Steven, Pinder Leila M, Atkinson Mark D, Cooksey Roxanne, Phillips Ceri J, and Siebert Stefan

Subjects
Computer applications to medicine. Medical informatics, R858-859.7
Abstract

Abstract Background Health economic analysis traditionally relies on patient derived questionnaire data, routine datasets, and outcomes data from experimental randomised control trials and other clinical studies, which are generally used as stand-alone datasets. Herein, we outline the potential implications of linking these datasets to give one single joined up data-resource for health economic analysis. Method The linkage of individual level data from questionnaires with routinely-captured health care data allows the entire patient journey to be mapped both retrospectively and prospectively. We illustrate this with examples from an Ankylosing Spondylitis (AS) cohort by linking patient reported study dataset with the routinely collected general practitioner (GP) data, inpatient (IP) and outpatient (OP) datasets, and Accident and Emergency department data in Wales. The linked data system allows: (1) retrospective and prospective tracking of patient pathways through multiple healthcare facilities; (2) validation and clarification of patient-reported recall data, complementing the questionnaire/routine data information; (3) obtaining objective measure of the costs of chronic conditions for a longer time horizon, and during the pre-diagnosis period; (4) assessment of health service usage, referral histories, prescribed drugs and co-morbidities; and (5) profiling and stratification of patients relating to disease manifestation, lifestyles, co-morbidities, and associated costs. Results Using the GP data system we tracked about 183 AS patients retrospectively and prospectively from the date of questionnaire completion to gather the following information: (a) number of GP events; (b) presence of a GP 'drug' read codes; and (c) the presence of a GP 'diagnostic' read codes. We tracked 236 and 296 AS patients through the OP and IP data systems respectively to count the number of OP visits; and IP admissions and duration. The results are presented under several patient stratification schemes based on disease severity, functions, age, sex, and the onset of disease symptoms. Conclusion The linked data system offers unique opportunities for enhanced longitudinal health economic analysis not possible through the use of traditional isolated datasets. Additionally, this data linkage provides important information to improve diagnostic and referral pathways, and thus helps maximise clinical efficiency and efficiency in the use of resources.

Published
2012
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119. Recommendations to improve physical activity among teenagers- A qualitative study with ethnic minority and European teenagers

Author

Choudhury Sopna, Hill Rebecca, Mistry Rupal, Crowley Annie, Brophy Sinead, Thomas Non E, and Rapport Frances

Subjects
Physical activity, teenagers, ethnic minority, qualitative, focus groups, Public aspects of medicine, RA1-1270
Abstract

Abstract Background To understand the key challenges and explore recommendations from teenagers to promote physical activity with a focus on ethnic minority children. Methods Focus groups with teenagers aged 16-18 of Bangladeshi, Somali or Welsh descent attending a participating school in South Wales, UK. There were seventy four participants (18 Somali, 24 Bangladeshi and 32 Welsh children) divided into 12 focus groups. Results The boys were more positive about the benefits of exercise than the girls and felt there were not enough facilities or enough opportunity for unsupervised activity. The girls felt there was a lack of support to exercise from their family. All the children felt that attitudes to activity for teenagers needed to change, so that there was more family and community support for girls to be active and for boys to have freedom to do activities they wanted without formal supervision. It was felt that older children from all ethnic backgrounds should be involved more in delivering activities and schools needs to provide more frequent and a wider range of activities. Conclusions This study takes a child-focused approach to explore how interventions should be designed to promote physical activity in youth. Interventions need to improve access to facilities but also counteract attitudes that teenagers should be studying or working and not 'hanging about' playing with friends. Thus, the value of activity for teenagers needs to be promoted not just among the teenagers but with their teachers, parents and members of the community.

Published
2011
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120. Parental factors associated with walking to school and participation in organised activities at age 5: Analysis of the Millennium Cohort Study

Author

Rodgers Sarah E, Thomas Non E, Lyons Ronan A, Cooksey Roxanne, Brophy Sinead, and Gravenor Michael B

Subjects
Public aspects of medicine, RA1-1270
Abstract

Abstract Background Physical activity is associated with better health. Two sources of activity for children are walking to school and taking part in organised sports and activities. This study uses a large national cohort to examine factors associated with participation in these activities. Methods The Millennium Cohort study contains 5 year follow-up of 17,561 singleton children recruited between 2000-2002 in the UK. All participants were interviewed in their own homes at 9 months, 3 years and 5 years follow-up and all measures were self reports. Logistic regression and likelihood ratio tests were used. Results Children are less likely to walk to school as income and parental education increase [Adjusted odds: 0.7 (95%CI: 0.6-0.8) for higher income/education compared to low income/no qualifications]. However, if the parent plays with the child in high income families the child is more likely to walk to school [Adjusted odds: 1.67 (95%CI: 1.3-2.1)]. Children taking part in organised activities are from higher income, higher education families, with a car, in a "good" area with non-working mothers. However, in low socio-economic families where the parent plays with the child the child is more likely to take part in organised activities [Adjusted odds: 2.0 (95% CI: 1.5-2.7)]. Conclusions Income is an important determinant of the type of activity available to children. Families that report good health behaviours (non-smoking, low TV viewing) and play with their children show higher levels of physical activity. Thus, parenting practice appears to have a strong impact on their child's physical activity.

Published
2011
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121. Adiponectin levels in people with Latent Autoimmune Diabetes-a case control study

Author

Atkinson Mark, Prior Sarah L, Stephens Jeffrey W, Davies Helen, Brophy Sinead, Bain Stephen, and Williams Rhys

Subjects
Medicine, Biology (General), QH301-705.5, Science (General), Q1-390
Abstract

Abstract Background To examine adiponectin levels in people with Latent Autoimmune Diabetes in Adults using a matched pair case control study. Findings Patients with LADA (n = 64), were matched for sex with type 2 diabetic and non-diabetic controls. A matched paired T-test was used to examine average adiponectin levels in the LADA patients' versus controls. The average adiponectin level for the LADA patients was 9.96 μg/ml compared to 6.4 μg/ml for Type 2 matched controls and 9.6 μg/ml for non-diabetic controls. Mean difference for the LADA-type 2 comparison was calculated after data was log transformed and showed a difference of 1.58 μg/ml (95%CI: 1.28-1.95, p = 0.0001). There was no significant difference between LADA and non-diabetic controls (p = 0.54). Conclusions Adiponectin levels are higher among people with LADA compared to those with type 2 diabetes and are equivalent to levels seen in non-diabetic controls. This suggests that risk of complications in LADA, as with type 1 diabetes may be related more to glycaemic control rather than to factors of the metabolic syndrome.

Published
2010
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122. Protocol for a population-based Ankylosing Spondylitis (PAS) cohort in Wales

Author

Atkinson Mark D, Brophy Sinead, Siebert Stefan, Gravenor Mike B, Phillips Ceri, Ford David V, Jones Kerina H, and Lyons Ronan A

Subjects
Diseases of the musculoskeletal system, RC925-935
Abstract

Abstract Background To develop a population-based cohort of people with ankylosing spondylitis (AS) in Wales using (1) secondary care clinical datasets, (2) patient-derived questionnaire data and (3) routinely-collected information in order to examine disease history and the health economic cost of AS. Methods This data model will include and link (1) secondary care clinician datasets (i.e. electronic patient notes from the rheumatologist) (2) patient completed questionnaires (giving information on disease activity, medication, function, quality of life, work limitations and health service utilisation) and (3) a broad range of routinely collected data (including; GP records, in-patient hospital admission data, emergency department data, laboratory/pathology data and social services databases). The protocol involves the use of a unique and powerful data linkage system which allows datasets to be interlinked and to complement each other. Discussion This cohort can integrate patient supplied, primary and secondary care data into a unified data model. This can be used to study a range of issues such as; the true economic costs to the health care system and the patient, factors associated with the development of severe disease, long term adverse events of new and existing medication and to understand the disease history of this condition. It will benefit patients, clinicians and health care managers. This study forms a pilot project for the use of routine data/patient data linked cohorts for other chronic conditions.

Published
2010
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123. Population based absolute and relative survival to 1 year of people with diabetes following a myocardial infarction: A cohort study using hospital admissions data

Author

Macey Steven M, Weston Clive, Gravenor Michael B, Cooksey Roxanne, Brophy Sinead, John Gareth, Williams Rhys, and Lyons Ronan A

Subjects
Public aspects of medicine, RA1-1270
Abstract

Abstract Background People with diabetes who experience an acute myocardial infarction (AMI) have a higher risk of death and recurrence of AMI. This study was commissioned by the Department for Transport to develop survival tables for people with diabetes following an AMI in order to inform vehicle licensing. Methods A cohort study using data obtained from national hospital admission datasets for England and Wales was carried out selecting all patients attending hospital with an MI for 2003-2006 (inclusion criteria: aged 30+ years, hospital admission for MI (defined using ICD 10 code I21-I22). STATA was used to create survival tables and factors associated with survival were examined using Cox regression. Results Of 157,142 people with an MI in England and Wales between 2003-2006, the relative risk of death or recurrence of MI for those with diabetes (n = 30,407) in the first 90 days was 1.3 (95%CI: 1.26-1.33) crude rates and 1.16 (95%CI: 1.1-1.2) when controlling for age, gender, heart failure and surgery for MI) compared with those without diabetes (n = 129,960). At 91-365 days post AMI the risk was 1.7 (95% CI 1.6-1.8) crude and 1.50 (95%CI: 1.4-1.6) adjusted. The relative risk of death or re-infarction was higher at younger ages for those with diabetes and directly after the AMI (Relative risk; RR: 62.1 for those with diabetes and 28.2 for those without diabetes aged 40-49 [compared with population risk]). Conclusions This is the first study to provide population based tables of age stratified risk of re-infarction or death for people with diabetes compared with those without diabetes. These tables can be used for giving advice to patients, developing a baseline to compare intervention studies or developing license or health insurance guidelines.

Published
2010
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124. Protocol of the baseline assessment for the Environments for Healthy Living (EHL) Wales cohort study

Author

Dunstan Frank, Palmer Stephen, Thornton Catherine A, Thomas Non E, Storey Mel, Brunt Huw, Brophy Sinead, Hill Rebecca A, Paranjothy Shantini, McClure Roderick, Rodgers Sarah E, and Lyons Ronan A

Subjects
Public aspects of medicine, RA1-1270
Abstract

Abstract Background Health is a result of influences operating at multiple levels. For example, inadequate housing, poor educational attainment, and reduced access to health care are clustered together, and are all associated with reduced health. Policies which try to change individual people's behaviour have limited effect when people have little control over their environment. However, structural environmental change and an understanding of the way that influences interact with each other, has the potential to facilitate healthy choices irrespective of personal resources. The aim of Environments for Healthy Living (EHL) is to investigate the impact of gestational and postnatal environments on health, and to examine where structural change can be brought about to optimise health outcomes. The baseline assessment will focus on birth outcomes and maternal and infant health. Methods/Design EHL is a longitudinal birth cohort study. We aim to recruit 1000 pregnant women in the period April 2010 to March 2013. We will examine the impact of the gestational environment (maternal health) and the postnatal environment (housing and neighbourhood conditions) on subsequent health outcomes for the infants born to these women. Data collection will commence during the participants' pregnancy, from approximately 20 weeks gestation. Participants will complete a questionnaire, undergo anthropometric measurements, wear an accelerometer, compile a food diary, and have environmental measures taken within their home. They will also be asked to consent to having a sample of umbilical cord blood taken following delivery of their baby. These data will be complemented by routinely collected electronic data such as health records from GP surgeries, hospital admissions, and child health and development records. Thereafter, participants will be visited annually for follow-up of subsequent exposures and child health outcomes. Discussion The baseline assessment of EHL will provide information concerning the impact of gestational and postnatal environments on birth outcomes and maternal and infant health. The findings can be used to inform the development of complex interventions targeted at structural, environmental factors, intended to reduce ill-health. Long-term follow-up of the cohort will focus on relationships between environmental exposures and the later development of adverse health outcomes, including obesity and diabetes.

Published
2010
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125. Risk factors for childhood obesity at age 5: Analysis of the Millennium Cohort Study

Author

Lyons Ronan A, Mistry Rupal, Thomas Non, Gravenor Michael B, Cooksey Roxanne, Brophy Sinead, and Williams Rhys

Subjects
Public aspects of medicine, RA1-1270
Abstract

Abstract Background Weight at age 5 is a predictor for future health of the individual. This study examines risk factors for childhood obesity with a focus on ethnicity. Methods Data from the Millennium Cohort study were used. 17,561 singleton children of White/European (n = 15,062), Asian (n = 1,845) or African (n = 654) background were selected. Logistic regression and likelihood ratio tests were used to examine factors associated with obesity at age 5. All participants were interviewed in their own homes. The main exposures examined included; Birth weight, sedentary lifestyle, family health behaviours, ethnicity, education and income. Results Children with a sedentary lifestyle, large at birth, with high risk family health behaviours (overweight mothers, smoking near the child, missing breakfast) and from a family with low income or low educational attainment, were more likely to be obese regardless of ethnicity. Feeding solid food before 3 months was associated with obesity in higher income White/European families. Even when controlling for socioeconomic status, ethnic background is an important independent risk factor for childhood obesity [Odds ratio of obesity; was 1.7 (95%CI: 1.2-2.3) for Asian and 2.7 (95%CI: 1.9-3.9) for African children, compared to White/European]. The final adjusted model suggests that increasing income does not have a great impact on lowering obesity levels, but that higher academic qualifications are associated with lower obesity levels [Odds of obesity: 0.63 (95%CI: 0.52-0.77) if primary carer leaves school after age 16 compared at age 16]. Conclusions Education of the primary carer is an important modifiable factor which can be targeted to address rising obesity levels in children. Interventions should be family centred supporting and showing people how they can implement lifestyle changes in their family.

Published
2009
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126. Cross sectional study of childhood obesity and prevalence of risk factors for cardiovascular disease and diabetes in children aged 11–13

Author

Brophy Sinead, Thomas Non, Rees Anwen, Knox Gareth, and Williams Rhys

Subjects
Public aspects of medicine, RA1-1270
Abstract

Abstract Background Childhood obesity levels are rising with estimates suggesting that around one in three children in Western countries are overweight. People from lower socioeconomic status and ethnic minority backgrounds are at higher risk of obesity and subsequent CVD and diabetes. Within this study we examine the prevalence of risk factors for CVD and diabetes (obesity, hypercholesterolemia, hypertension) and examine factors associated with the presence of these risk factors in school children aged 11–13. Methods and design Participants will be recruited from schools across South Wales. Schools will be selected based on catchment area, recruiting those with high ethnic minority or deprived catchment areas. Data collection will take place during the PE lessons and on school premises. Data will include: anthropometrical variables (height, weight, waist, hip and neck circumferences, skinfold thickness at 4 sites), physiological variables (blood pressure and aerobic fitness (20 metre multi stage fitness test (20 MSFT)), diet (self-reported seven-day food diary), physical activity (Physical Activity Questionnire for Adolescents (PAQ-A), accelerometery) and blood tests (fasting glucose, insulin, lipids, fibrinogen (Fg), adiponectin (high molecular weight), C-reactive protein (CRP) and interleukin-6 (IL-6)). Deprivation at the school level will be measured via information on the number of children receiving free school meals. Townsend deprivation scores will be calculated based on the individual childs postcode and self assigned ethnicity for each participating child will be collected. It is anticipated 800 children will be recruited. Multilevel modeling will be used to examine shared and individual factors associated with obesity, stratified by ethnic background, deprivation level and school. Discussion This study is part of a larger project which includes interviews with older children regarding health behaviours and analysis of existing cohort studies (Millennium cohort study) for factors associated with childhood obesity. The project will contribute to the evidence base needed to develop multi-dimensional interventions for addressing childhood obesity.

Published
2009
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127. Randomized, controlled, parallel-group prospective study to investigate the clinical effectiveness of early insulin treatment in patients with latent autoimmune diabetes in adults

Author

Lloyd Janet, Beaverstock Charles, Wareham Kathie, Richards Kez, Cheung Wei-yee, Stephens Jeffrey W, Bain Stephen, Davies Helen, Brophy Sinead, Page Don, Williams Meurig, Russell Ian, and Williams Rhys

Subjects
Diseases of the endocrine glands. Clinical endocrinology, RC648-665
Abstract

Abstract Background Latent autoimmune diabetes in adults [LADA] is a type 1 diabetes that is slowly developing. This means many people are treated as having type 2 diabetes at diagnosis as they are adults who are not immediately insulin dependent. LADA can be distinguished from type 2 diabetes by antibody tests. Patients who are antibody positive have an autoimmune reaction which is similar to that of type 1 diabetes and is not found in type 2 diabetes. We would like to examine the best way of treating LADA in the early phase of the conditions, with tablets (similar to type 2 diabetes) or with insulin (similar to type 1 diabetes). Methods/design This is an open parallel group prospective randomised trial. Participants need to have a GAD antibody test results of 101 WHO units or more and a diagnosis of diabetes not requiring insulin at diagnosis. Participants will need to have been diagnosed within 12 months and not treated with insulin at study entry. They will be randomised to receive either insulin (NovoMix 30) or tablets (diet treated followed by metformin followed by glitazone (with or without metformin) followed by insulin). Primary outcome assessment will be for change in HbA1c and change in fasting C-peptide over 24 months. Secondary outcome measures will include Quality of life, GAD antibody levels, adverse events, inflammatory markers, insulin resistance, and markers of the metabolic syndrome. Discussion This study seeks the best treatment for early LADA in terms of maintaining glycaemic control and maintaining natural insulin production. Trial registration ISRCTN63815121

Published
2008
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128. Internet-based randomised controlled trials for the evaluation of complementary and alternative medicines: probiotics in spondyloarthropathy

Author

Gravenor Michael B, Brooks Caroline, Burrows Claire L, Brophy Sinead, Siebert Stefan, and Allen Stephen J

Subjects
Diseases of the musculoskeletal system, RC925-935
Abstract

Abstract Background The clinical effectiveness of complementary and alternative medicines (CAMs) is widely debated because of a lack of clinical trials. The internet may provide an effective and economical approach for undertaking randomised controlled trials (RCTs) of low-risk interventions. We investigated whether the internet could be used to perform an internet-based RCT of a CAM fulfilling the revised CONSORT (Consolidated Standards of Reporting Trials) statement quality checklist for reporting of RCTs. A secondary aim was to examine the effect of probiotics compared to placebo in terms of well-being over 12 weeks. Methods People aged ≥18 years with confirmed spondyloarthropathy living in the United Kingdom with internet access were invited to participate in an internet-based RCT of probiotic compared to placebo for improving well-being and bowel symptoms. The intervention was a probiotic containing 4 strains of live bacteria or identical placebo taken by mouth daily for 3 months. The primary outcome measure was the performance of the trial according to the revised CONSORT statement. Results 147 people were randomised into the trial. The internet-based trial of the CAM fulfilled the revised CONSORT statement such as efficient blinding, allocation concealment, intention to treat analysis and flow of participants through the trial. Recruitment of the required number of participants was completed in 19 months. Sixty-five percent (96/147) completed the entire 3 months of the trial. The trial was low cost and demonstrated that in an intention to treat analysis, probiotics did not improve well-being or bowel symptoms. Conclusion The internet-based RCT proved to be a successful and economical method for examining this CAM intervention. Recruitment, adherence and completion rate were all similar to those reported with conventional RCTs but at a fraction of the cost. Internet-based RCTs can fulfil all the criteria of the revised CONSORT statement and are an appropriate method for studying low-risk interventions. Trial registration ISRCTN36133252

Published
2008
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129. The UK Burden of Injury Study – a protocol. [National Research Register number: M0044160889]

Author

Sleney Judith, Groom Lindsay, Carter Rebecca, Phillips Ceri J, Coupland Carol, Brophy Sinead, Christie Nicola, Kendrick Denise, Towner Elizabeth E, Lyons Ronan A, Evans Phillip, Pallister Ian, and Coffey Frank

Subjects
Public aspects of medicine, RA1-1270
Abstract

Abstract Background Globally and nationally large numbers of people are injured each year, yet there is little information on the impact of these injuries on people's lives, on society and on health and social care services. Measurement of the burden of injuries is needed at a global, national and regional level to be able to inform injured people of the likely duration of impairment; to guide policy makers in investing in preventative measures; to facilitate the evaluation and cost effectiveness of interventions and to contribute to international efforts to more accurately assess the global burden of injuries. Methods/Design A prospective, longitudinal multi-centre study of 1333 injured individuals, atttending Emergency Departments or admitted to hospital in four UK areas: Swansea, Surrey, Bristol and Nottingham. Specified quotas of patients with defined injuries covering the whole spectrum will be recruited. Participants (or a proxy) will complete a baseline questionnaire regarding their injury and pre-injury quality of life. Follow up occurs at 1, 4, and 12 months post injury or until return to normal function within 12 months, with measures of health service utilisation, impairment, disability, and health related quality of life. National estimates of the burden of injuries will be calculated by extrapolation from the sample population to national and regional computerised hospital in-patient, emergency department and mortality data. Discussion This study will provide more detailed data on the national burden of injuries than has previously been available in any country and will contribute to international collaborative efforts to more accurately assess the global burden of injuries. The results will be used to advise policy makers on prioritisation of preventive measures, support the evaluation of interventions, and provide guidance on the likely impact and degree of impairment and disability following specific injuries.

Published
2007
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130. Internet-based randomised controlled trials for the evaluation of complementary and alternative medicines: probiotics in spondyloarthropathy.

Author

Brophy S, Burrows CL, Brooks C, Gravenor MB, Siebert S, and Allen SJ

Abstract

Background: The clinical effectiveness of complementary and alternative medicines (CAMs) is widely debated because of a lack of clinical trials. The internet may provide an effective and economical approach for undertaking randomised controlled trials (RCTs) of low-risk interventions. We investigated whether the internet could be used to perform an internet-based RCT of a CAM fulfilling the revised CONSORT (Consolidated Standards of Reporting Trials) statement quality checklist for reporting of RCTs. A secondary aim was to examine the effect of probiotics compared to placebo in terms of well-being over 12 weeks. Methods: People aged ≥18 years with confirmed spondyloarthropathy living in the United Kingdom with internet access were invited to participate in an internet-based RCT of probiotic compared to placebo for improving well-being and bowel symptoms. The intervention was a probiotic containing 4 strains of live bacteria or identical placebo taken by mouth daily for 3 months. The primary outcome measure was the performance of the trial according to the revised CONSORT statement. Results: 147 people were randomised into the trial. The internet-based trial of the CAM fulfilled the revised CONSORT statement such as efficient blinding, allocation concealment, intention to treat analysis and flow of participants through the trial. Recruitment of the required number of participants was completed in 19 months. Sixty-five percent (96/147) completed the entire 3 months of the trial. The trial was low cost and demonstrated that in an intention to treat analysis, probiotics did not improve well-being or bowel symptoms. Conclusion: The internet-based RCT proved to be a successful and economical method for examining this CAM intervention. Recruitment, adherence and completion rate were all similar to those reported with conventional RCTs but at a fraction of the cost. Internet-based RCTs can fulfil all the criteria of the revised CONSORT statement and are an appropriate method for studying low-risk interventions. Trial registration: ISRCTN36133252 [ABSTRACT FROM AUTHOR]

Published
2008

133. Height and body-mass index trajectories of school-aged children and adolescents from 1985 to 2019 in 200 countries and territories: a pooled analysis of 2181 population-based studies with 65 million participants

Author

Rodriguez-Martinez, Andrea, Zhou, Bin, Sophiea, Marisa K, Bentham, James, Paciorek, Christopher J, Iurilli, Maria LC, Carrillo-Larco, Rodrigo M, Bennett, James E, Di Cesare, Mariachiara, Taddei, Cristina, Bixby, Honor, Stevens, Gretchen A, Riley, Leanne M, Cowan, Melanie J, Savin, Stefan, Danaei, Goodarz, Chirita-Emandi, Adela, Kengne, Andre P, Khang, Young-Ho, Laxmaiah, Avula, Malekzadeh, Reza, Miranda, J Jaime, Moon, Jin Soo, Popovic, Stevo R, Sorensen, Thorkild IA, Soric, Maroje, Starc, Gregor, Zainuddin, Ahmad A, Gregg, Edward W, Bhutta, Zulfiqar A, Black, Robert, Ezzati, Majid, Abarca-Gomez, Leandra, Abdeen, Ziad A, Abdrakhmanova, Shynar, Ghaffar, Suhaila Abdul, Rahim, Hanan F Abdul, Abu-Rmeileh, Niveen M, Garba, Jamila Abubakar, Acosta-Cazares, Benjamin, Adams, Robert J, Aekplakorn, Wichai, Afsana, Kaosar, Afzal, Shoaib, Agdeppa, Imelda A, Aghazadeh-Attari, Javad, Aguilar-Salinas, Carlos A, Agyemang, Charles, Ahmad, Mohamad Hasnan, Ahmad, Noor Ani, Ahmadi, Ali, Ahmadi, Naser, Ahmed, Soheir H, Ahrens, Wolfgang, Aitmurzaeva, Gulmira, Ajlouni, Kamel, Al-Hazzaa, Hazzaa M, Al-Othman, Amani Rashed, Al-Raddadi, Rajaa, Alarouj, Monira, AlBuhairan, Fadia, AlDhukair, Shahla, Ali, Mohamed M, Alkandari, Abdullah, Alkerwi, Ala'a, Allin, Kristine, Alvarez-Pedrerol, Mar, Aly, Eman, Amarapurkar, Deepak N, Amiri, Parisa, Amougou, Norbert, Amouyel, Philippe, Andersen, Lars Bo, Anderssen, Sigmund A, Angquist, Lars, Anjana, Ranjit Mohan, Ansari-Moghaddam, Alireza, Aounallah-Skhiri, Hajer, Araujo, Joana, Ariansen, Inger, Aris, Tahir, Arku, Raphael E, Arlappa, Nimmathota, Aryal, Krishna K, Aspelund, Thor, Assah, Felix K, Assuncao, Maria Cecilia F, Aung, May Soe, Auvinen, Juha, Avdicova, Maria, Azevedo, Ana, Azimi-Nezhad, Mohsen, Azizi, Fereidoun, Azmin, Mehrdad, Babu, Bontha V, Jorgensen, Maja Baeksgaard, Baharudin, Azli, Bahijri, Suhad, Baker, Jennifer L, Balakrishna, Nagalla, Bamoshmoosh, Mohamed, Banach, Maciej, Bandosz, Piotr, Banegas, Jose R, Baran, Joanna, Barbagallo, 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Ming-Dong, Wang, Ningli, Wang, Qian, Wang, Xiangjun, Wang, Ya Xing, Wang, Ying-Wei, Wannamethee, S Goya, Wareham, Nicholas, Weber, Adelheid, Wedderkopp, Niels, Weerasekera, Deepa, Weghuber, Daniel, Wei, Wenbin, Weres, Aneta, Werner, Bo, Whincup, Peter H, Widhalm, Kurt, Widyahening, Indah S, Wiecek, Andrzej, Wilks, Rainford J, Willeit, Johann, Willeit, Peter, Williams, Julianne, Wilsgaard, Tom, Wojtyniak, Bogdan, Wong-McClure, Roy A, Wong, Andrew, Wong, Jyh Eiin, Wong, Tien Yin, Woo, Jean, Woodward, Mark, Wu, Frederick C, Wu, Jianfeng, Wu, Li Juan, Wu, Shouling, Xu, Haiquan, Xu, Liang, Yaacob, Nor Azwany, Yamborisut, Uruwan, Yan, Weili, Yang, Ling, Yang, Xiaoguang, Yang, Yang, Yardim, Nazan, Yaseri, Mehdi, Yasuharu, Tabara, Ye, Xingwang, Yiallouros, Panayiotis K, Yoosefi, Moein, Yoshihara, Akihiro, You, Qi Sheng, You, San-Lin, Younger-Coleman, Novie O, Yusof, Safiah Md, Yusoff, Ahmad Faudzi, Zaccagni, Luciana, Zafiropulos, Vassilis, Zakavi, Seyed Rasoul, Zamani, Farhad, Zambon, Sabina, Zampelas, Antonis, Zamrazilova, Hana, Zapata, Maria Elisa, Zargar, Abdul Hamid, Zaw, Ko Ko, Zdrojewski, Tomasz, Vrkic, Tajana Zeljkovic, Zeng, Yi, Zhang, Luxia, Zhang, Zhen-Yu, Zhao, Dong, Zhao, Ming-Hui, Zhao, Wenhua, Zhen, Shiqi, Zheng, Wei, Zheng, Yingfeng, Zholdin, Bekbolat, Zhou, Maigeng, Zhu, Dan, Zocalo, Yanina, Cisneros, Julio Zuniga, Zuziak, Monika, Faculdade de Ciências da Nutrição e Alimentação, Instituto de Saúde Pública da Universidade do Porto, Interactions Gène-Environnement en Physiopathologie Cardio-Vasculaire (IGE-PCV), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL), Environnement, Santé, Sociétés (ESS), Centre National de la Recherche Scientifique (CNRS), European Project: 774548, Reproductive Origins of Adult Health and Disease (ROAHD), Rodriguez-Martinez A, Zhou B, Sophiea MK, Bentham J, Paciorek CJ, Iurilli ML, Carrillo-Larco RM, Bennett JE, Di Cesare M, Taddei C, Bixby H, Stevens GA, Riley LM, Cowan MJ, Savin S, 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Mansour-Ghanaei F., Manzato E., Margozzini P., Markaki A., Markey O., Markidou Ioannidou E., Marques-Vidal P., Marques L.P., Marrugat J., Martin-Prevel Y., Martin R., Martorell R., Martos E., Marventano S., Mascarenhas L.P., Masoodi S.R., Mathiesen E.B., Mathur P., Matijasevich A., Matsha T.E., Mavrogianni C., Mazur A., Mbanya J.C.N., McFarlane S.R., McGarvey S.T., McKee M., McLachlan S., McLean R.M., McLean S.B., McNulty B.A., Mediene-Benchekor S., Medzioniene J., Mehdipour P., Mehlig K., Mehrparvar A.H., Meirhaeghe A., Meisfjord J., Meisinger C., Menezes A.M.B., Menon G.R., Mensink G.B., Menzano M.T., Mereke A., Meshram I.I., Metspalu A., Mi J., Michaelsen K.F., Michels N., Mikkel K., Milkowska K., Miller J.C., Minderico C.S., Mini G.K., Miquel J.F., Mirjalili M.R., Mirkopoulou D., Mirrakhimov E., Misigoj-Durakovic M., Mistretta A., Mocanu V., Modesti P.A., Moghaddam S.S., Mohajer B., Mohamed M.K., Mohamed S.F., Mohammad K., Mohammadi Z., Mohammadifard N., Mohammadpourhodki R., Mohan V., Mohanna S., Mohd Yusoff M.F., Mohebbi I., Mohebi F., Moitry M., Molbo D., Mollehave L.T., Moller N.C., Molnar D., Momenan A., Mondo C.K., Monroy-Valle M., Monterrubio-Flores E., Monyeki K.D.K., Moosazadeh M., Moreira L.B., Morejon A., Moreno L.A., Morgan K., Morin S.N., Mortensen E.L., Moschonis G., Mossakowska M., Mostafa A., Mota-Pinto A., Mota J., Motlagh M.E., Motta J., Moura-dos-Santos M.A., Mridha M.K., Msyamboza K.P., Mu T.T., Muc M., Mugosa B., Muiesan M.L., Mukhtorova P., Muller-Nurasyid M., Murphy N., Mursu J., Murtagh E.M., Musa K.I., Music Milanovic S., Musil V., Mustafa N., Nabipour I., Naderimagham S., Nagel G., Naidu B.M., Najafi F., Nakamura H., Namesna J., Nang E.E.K., Nangia V.B., Nankap M., Narake S., Nardone P., Nauck M., Neal W.A., Nejatizadeh A., Nelis K., Nelis L., Nenko I., Neovius M., Nervi F., Nguyen C.T., Nguyen D., Nguyen Q.N., Nieto-Martinez R.E., Nikitin Y.P., Ning G., Ninomiya T., Nishtar S., Noale M., Noboa O.A., Nogueira H., Norat T., Nordendahl M., Nordestgaard B.G., Noto D., Nowak-Szczepanska N., Nsour M.A., Nuhoglu I., Nurk E., O'Neill T.W., O'Reilly D., Obreja G., Ochimana C., Ochoa-Aviles A.M., Oda E., Oh K., Ohara K., Ohlsson C., Ohtsuka R., Olafsson O., Olinto M.T.A., Oliveira I.O., Omar M.A., Onat A., Ong S.K., Ono L.M., Ordunez P., Ornelas R., Ortiz A.P., Ortiz P.J., Osler M., Osmond C., Ostojic S.M., Ostovar A., Otero J.A., Overvad K., Owusu-Dabo E., Paccaud F.M., Padez C., Pagkalos I., Pahomova E., Paiva K.M.D., Pajak A., Palli D., Palloni A., Palmieri L., Pan W.-H., Panda-Jonas S., Pandey A., Panza F., Papandreou D., Park S.-W., Park S., Parnell W.R., Parsaeian M., Pascanu I.M., Pasquet P., Patel N.D., Pednekar M.S., Peer N., Peixoto S.V., Peltonen M., Pereira A.C., Peres M.A., Perez-Farinos N., Perez C.M., Peterkova V., Peters A., Petersmann A., Petkeviciene J., Petrauskiene A., Pettenuzzo E., Peykari N., Pham S.T., Pichardo R.N., Pierannunzio D., Pigeot I., Pikhart H., Pilav A., Pilotto L., Pistelli F., Pitakaka F., Piwonska A., Pizarro A.N., Plans-Rubio P., Poh B.K., Pohlabeln H., Pop R.M., Porta M., Posch G., Poudyal A., Poulimeneas D., Pouraram H., Pourfarzi F., Pourshams A., Poustchi H., Pradeepa R., Price A.J., Price J.F., Providencia R., Puder J.J., Pudule I., Puhakka S.E., Puiu M., Punab M., Qasrawi R.F., Qorbani M., Quoc Bao T., Radic I., Radisauskas R., Rahimikazerooni S., Rahman M., Raitakari O., Raj M., Rakhimova E., Rakhmatulloev S., Rakovac I., Ramachandra Rao S., Ramachandran A., Ramke J., Ramos E., Ramos R., Rampal L., Rampal S., Rarra V., Rascon-Pacheco R.A., Rasmussen M., Rech C.R., Redon J., Reganit P.F.M., Regecova V., Revilla L., Rezaianzadeh A., Ribas-Barba L., Ribeiro R., Riboli E., Richter A., Rigo F., Rinaldo N., Rinke de Wit T.F., Rito A., Ritti-Dias R.M., Rivera J.A., Robitaille C., Roccaldo R., Rodrigues D., Rodriguez-Artalejo F., Rodriguez-Perez M.D.C., Rodriguez-Villamizar L.A., Roggenbuck U., Rojas-Martinez R., Rojroongwasinkul N., Romaguera D., Romeo E.L., Rosario R.V., Rosengren A., Rouse I., Roy J.G., Rubinstein A., Ruhli F.J., Ruidavets J.-B., Ruiz-Betancourt B.S., Ruiz Moreno E., Rusakova I.A., Russell Jonsson K., Russo P., Rust P., Rutkowski M., Sabanayagam C., Sacchini E., Sachdev H.S., Sadjadi A., Safarpour A.R., Safi S., Safiri S., Saidi O., Saki N., Salanave B., Salazar Martinez E., Salmeron D., Salomaa V., Salonen J.T., Salvetti M., Samoutian M., Sanchez-Abanto J., Sandjaja, Sans S., Santa Marina L., Santos D.A., Santos I.S., Santos L.C., Santos M.P., Santos O., Santos R., Santos Sanz S., Saramies J.L., Sardinha L.B., Sarrafzadegan N., Sathish T., Saum K.-U., Savva S., Savy M., Sawada N., Sbaraini M., Scazufca M., Schaan B.D., Schaffrath Rosario A., Schargrodsky H., Schienkiewitz A., Schindler K., Schipf S., Schmidt C.O., Schmidt I.M., Schnohr P., Schottker B., Schramm S., Schroder H., Schultsz C., Schutte A.E., Sebert S., Sein A.A., Selamat R., Sember V., Sen A., Senbanjo I.O., Sepanlou S.G., Sequera V., Serra-Majem L., Servais J., Sevcikova L., Shalnova S.A., Shamah-Levy T., Shamshirgaran M., Shanthirani C.S., Sharafkhah M., Sharma S.K., Shaw J.E., Shayanrad A., Shayesteh A.A., Shengelia L., Shi Z., Shibuya K., Shimizu-Furusawa H., Shin D.W., Shin Y., Shirani M., Shiri R., Shrestha N., Si-Ramlee K., Siani A., Siantar R., Sibai A.M., Silva A.M., Silva D.A.S., Simon M., Simons J., Simons L.A., Sjoberg A., Sjostrom M., Skodje G., Slowikowska-Hilczer J., Slusarczyk P., Smeeth L., So H.-K., Soares F.C., Sobek G., Sobngwi E., Sodemann M., Soderberg S., Soekatri M.Y., Soemantri A., Sofat R., Solfrizzi V., Somi M.H., Sonestedt E., Song Y., Sorgjerd E.P., Sossa Jerome C., Soto-Rojas V.E., Soumare A., Sovic S., Sparboe-Nilsen B., Sparrenberger K., Spinelli A., Spiroski I., Staessen J.A., Stamm H., Stathopoulou M.G., Staub K., Stavreski B., Steene-Johannessen J., Stehle P., Stein A.D., Stergiou G.S., Stessman J., Stevanovic R., Stieber J., Stockl D., Stocks T., Stokwiszewski J., Stoyanova E., Stratton G., Stronks K., Strufaldi M.W., Sturua L., Suarez-Medina R., Suka M., Sun C.-A., Sundstrom J., Sung Y.-T., Sunyer J., Suriyawongpaisal P., Swinburn B.A., Sy R.G., Syddall H.E., Sylva R.C., Szklo M., Szponar L., Tai E.S., Tammesoo M.-L., Tamosiunas A., Tan E.J., Tang X., Tanser F., Tao Y., Tarawneh M.R., Tarp J., Tarqui-Mamani C.B., Taxova Braunerova R., Taylor A., Taylor J., Tchibindat F., Tebar W.R., Tell G.S., Tello T., Thankappan K.R., Theobald H., Theodoridis X., Thijs L., Thomas N., Thuesen B.H., Ticha L., Timmermans E.J., Tjonneland A., Tolonen H.K., Tolstrup J.S., Topbas M., Topor-Madry R., Torheim L.E., Tormo M.J., Tornaritis M.J., Torrent M., Torres-Collado L., Toselli S., Traissac P., Tran T.T.-H., Trichopoulos D., Trichopoulou A., Trinh O.T., Trivedi A., Tshepo L., Tsigga M., Tsugane S., Tuliakova A.M., Tulloch-Reid M.K., Tullu F., Tuomainen T.-P., Tuomilehto J., Turley M.L., Tynelius P., Tzotzas T., Tzourio C., Ueda P., Ugel E., Ukoli F.A., Ulmer H., Unal B., Usupova Z., Uusitalo H.M., Uysal N., Vaitkeviciute J., Valdivia G., Vale S., Valvi D., van Dam R.M., Van der Heyden J., van der Schouw Y.T., Van Herck K., Van Minh H., van Valkengoed I.G., Vanderschueren D., Vanuzzo D., Varbo A., Varela-Moreiras G., Varona-Perez P., Vasan S.K., Vega T., Veidebaum T., Velasquez-Melendez G., Velika B., Veronesi G., Verschuren W.M., Victora C.G., Viegi G., Viet L., Villalpando S., Vineis P., Vioque J., Virtanen J.K., Visser M., Visvikis-Siest S., Viswanathan B., Vladulescu M., Vlasoff T., Vocanec D., Volzke H., Voutilainen A., Voutilainen S., Vrijheid M., Vrijkotte T.G., Wade A.N., Wagner A., Waldhor T., Walton J., Wambiya E.O., Wan Bebakar W.M., Wan Mohamud W.N., Wanderley Junior R.D.S., Wang M.-D., Wang N., Wang Q., Wang X., Wang Y.X., Wang Y.-W., Wannamethee S.G., Wareham N., Weber A., Wedderkopp N., Weerasekera D., Weghuber D., Wei W., Weres A., Werner B., Whincup P.H., Widhalm K., Widyahening I.S., Wiecek A., Wilks R.J., Willeit J., Willeit P., Williams J., Wilsgaard T., Wojtyniak B., Wong-McClure R.A., Wong A., Wong J.E., Wong T.Y., Woo J., Woodward M., Wu F.C., Wu J., Wu L.J., Wu S., Xu H., Xu L., Yaacob N.A., Yamborisut U., Yan W., Yang L., Yang X., Yang Y., Yardim N., Yaseri M., Yasuharu T., Ye X., Yiallouros P.K., Yoosefi M., Yoshihara A., You Q.S., You S.-L., Younger-Coleman N.O., Yusof S.M., Yusoff A.F., Zaccagni L., Zafiropulos V., Zakavi S.R., Zamani F., Zambon S., Zampelas A., Zamrazilova H., Zapata M.E., Zargar A.H., Zaw K.K., Zdrojewski T., Zeljkovic Vrkic T., Zeng Y., Zhang L., Zhang Z.-Y., Zhao D., Zhao M.-H., Zhao W., Zhen S., Zheng W., Zheng Y., Zholdin B., Zhou M., Zhu D., Zocalo Y., Zuniga Cisneros J., Zuziak M., and Ezzati M.

Subjects
Male, body-mass index, ADULTHOOD, Adolescents, pituuskasvu, Pediatrics, Body Mass Index, 0302 clinical medicine, Child Development, nuoret, Public health surveillance, Medicine, Health Status Indicators, 10. No inequality, Child, 11 Medical and Health Sciences, Body mass index, ComputingMilieux_MISCELLANEOUS, education.field_of_study, VDP::Medisinske Fag: 700::Helsefag: 800::Samfunnsmedisin, sosialmedisin: 801, General Medicine, Body mass indexes, kansainvälinen vertailu, 3. Good health, Geography, Health, 030220 oncology & carcinogenesis, Child, Preschool, Medical and Health sciences, purl.org/becyt/ford/3 [https], medicine.medical_specialty, School-aged adolescents, Socio-culturale, lapset (ikäryhmät), Nursing, territories, ravinto, purl.org/becyt/ford/3.3 [https], 03 medical and health sciences, School Children, SDG 3 - Good Health and Well-being, SYSTEMATIC ANALYSIS, Humans, school-aged children and adolescents, Montenegro, education, Science & Technology, Omvårdnad, Health sciences, Medical and Health sciences, Ciências médicas e da saúde, Bayes Theorem, Anthropometry, Adolescent Development, medicine.disease, TRENDS, Height and Body-mass Index, Faculdade de Ciências Sociais, UNDERNUTRITION, Height index trajectories, Height, body mass index, children , epidemiology, risk factors, growth, Stature, Demography, Settore MED/09 - Medicina Interna, Internationality, [SDV]Life Sciences [q-bio], 030204 cardiovascular system & hematology, Body-mass index trajectories, Epidemiology, Medicine and Health Sciences, risk factors, countries, EPIDEMIOLOGY, height, children, adolescents, BMI, 030212 general & internal medicine, painoindeksi, Child development, 2. Zero hunger, Medicine(all), School age child, obestity children cardiovascular, Population Health, 1. No poverty, Pediatrik, Public Health, Global Health, Social Medicine and Epidemiology, 3142 Public health care science, environmental and occupational health, Pooled analysis, NUTRITION, Female, medicine.symptom, pooled analysis, Life Sciences & Biomedicine, terveys, height, BMI, nutrition, health, children, adolescents, Adolescent, growth, Population, body-mass, Population based, Body-mass index, Young Adult, Medicine, General & Internal, Meta-Analysis as Topic, General & Internal Medicine, parasitic diseases, Weight gain, School-aged childrens, Age trajectories, business.industry, Height, Weight, Body Height, Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi, Malnutrition, ONSET, Ciências da Saúde, Ciências médicas e da saúde, School-aged children, VDP::Medical disciplines: 700::Health sciences: 800::Community medicine, Social medicine: 801, business, terveysriskit, Estilos de Vida e Impacto na Saúde
Abstract

BACKGROUND: Comparable global data on health and nutrition of school-aged children and adolescents are scarce. We aimed to estimate age trajectories and time trends in mean height and mean body-mass index (BMI), which measures weight gain beyond what is expected from height gain, for school-aged children and adolescents., METHODS: For this pooled analysis, we used a database of cardiometabolic risk factors collated by the Non-Communicable Disease Risk Factor Collaboration. We applied a Bayesian hierarchical model to estimate trends from 1985 to 2019 in mean height and mean BMI in 1-year age groups for ages 5–19 years. The model allowed for non-linear changes over time in mean height and mean BMI and for non-linear changes with age of children and adolescents, including periods of rapid growth during adolescence., FINDINGS: We pooled data from 2181 population-based studies, with measurements of height and weight in 65 million participants in 200 countries and territories. In 2019, we estimated a difference of 20 cm or higher in mean height of 19-year-old adolescents between countries with the tallest populations (the Netherlands, Montenegro, Estonia, and Bosnia and Herzegovina for boys; and the Netherlands, Montenegro, Denmark, and Iceland for girls) and those with the shortest populations (Timor-Leste, Laos, Solomon Islands, and Papua New Guinea for boys; and Guatemala, Bangladesh, Nepal, and Timor-Leste for girls). In the same year, the difference between the highest mean BMI (in Pacific island countries, Kuwait, Bahrain, The Bahamas, Chile, the USA, and New Zealand for both boys and girls and in South Africa for girls) and lowest mean BMI (in India, Bangladesh, Timor-Leste, Ethiopia, and Chad for boys and girls; and in Japan and Romania for girls) was approximately 9–10 kg/m2. In some countries, children aged 5 years started with healthier height or BMI than the global median and, in some cases, as healthy as the best performing countries, but they became progressively less healthy compared with their comparators as they grew older by not growing as tall (eg, boys in Austria and Barbados, and girls in Belgium and Puerto Rico) or gaining too much weight for their height (eg, girls and boys in Kuwait, Bahrain, Fiji, Jamaica, and Mexico; and girls in South Africa and New Zealand). In other countries, growing children overtook the height of their comparators (eg, Latvia, Czech Republic, Morocco, and Iran) or curbed their weight gain (eg, Italy, France, and Croatia) in late childhood and adolescence. When changes in both height and BMI were considered, girls in South Korea, Vietnam, Saudi Arabia, Turkey, and some central Asian countries (eg, Armenia and Azerbaijan), and boys in central and western Europe (eg, Portugal, Denmark, Poland, and Montenegro) had the healthiest changes in anthropometric status over the past 3·5 decades because, compared with children and adolescents in other countries, they had a much larger gain in height than they did in BMI. The unhealthiest changes—gaining too little height, too much weight for their height compared with children in other countries, or both—occurred in many countries in sub-Saharan Africa, New Zealand, and the USA for boys and girls; in Malaysia and some Pacific island nations for boys; and in Mexico for girls., INTERPRETATION: The height and BMI trajectories over age and time of school-aged children and adolescents are highly variable across countries, which indicates heterogeneous nutritional quality and lifelong health advantages and risks., Wellcome Trust, AstraZeneca Young Health Programme, EU., peer-reviewed

Published
2020

134. Receipt of social services intervention in childhood, educational attainment and emergency hospital admissions: longitudinal analyses of national administrative health, social care, and education data in Wales, UK.

Author

Lowthian E, Moore G, Evans A, Anthony R, Rahman MA, Daniel R, Brophy S, Scourfield J, Taylor C, Paranjothy S, and Long S

Subjects
Humans, Wales, Female, Male, Child, Adolescent, Retrospective Studies, Longitudinal Studies, Emergency Service, Hospital statistics & numerical data, Adverse Childhood Experiences statistics & numerical data, Child, Preschool, Hospitalization statistics & numerical data, Foster Home Care statistics & numerical data, Social Work statistics & numerical data, Educational Status
Abstract

Background: Research consistently finds poorer health and educational outcomes for children who have experienced out-of-home care relative to the general population. Few studies have explored differences between those in care and those in receipt of intervention from social services but not in care. Children receiving social services interventions often experience Adverse Childhood Experiences (ACEs), and deprivation, which are known to negatively impact outcomes. We aimed to estimate the association of different social services interventions with educational outcomes and hospital admissions, while adjusting for ACEs and deprivation., Methods: We linked retrospective, routinely collected administrative records from health, education, and social care to create a cohort via the Secure Anonymised Information Linkage (SAIL) databank in Wales, UK. We analysed data for children and household members (N = 30,439) across four different groups: [1] no social care intervention; [2] children in need but not in care (CIN); [3] children on the Child Protection Register but not in care (CPR); [4] children in care - i.e. removed from the family home and looked after by the local authority (CLA). Our primary outcome was education outcomes at age 16 years. Secondary outcomes were all cause emergency hospital admissions, and emergency admissions for external causes/injuries., Results: Children in receipt of social services intervention were more likely to not attain the expected level upon leaving statutory education at age 16 after adjusting for ACEs and other characteristics (for children who had been in out-of-home care (conditional OR: 1·76, (95%CI) 1·25 - 2·48), in need (2·51, 2·00-3·15) and those at risk (i.e., on the child protection register) (4·04, 2·44 - 6·68). For all-cause emergency admissions, all social care groups were at greater risk compared to children in the general population (children in care (conditional HR: 1·31, 1·01-1·68), children in need (1·62, 1·38 - 1·90), and children at risk (1·51, 1·11 - 2·04)., Conclusions: All groups receiving social service intervention experience poorer educational and health outcomes than peers in the general population. Children who remain with their home parents or caregivers but are identified as 'in need' or 'at risk' by social care practitioners require further research. Integrated support is needed from multiple sectors, including health, educational and social care., (© 2024. The Author(s).)

Published
2024
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135. A systematic review of non-clinician trauma-based interventions for school-age youth.

Author

Avery F, Kennedy N, James M, Jones H, Amos R, Bellis M, Hughes K, and Brophy S

Subjects
Humans, Child, Adolescent, Child, Preschool, Mental Health, Schools, Female, Male, Adverse Childhood Experiences
Abstract

Exposure to adverse childhood experiences (ACEs) is recognised globally as a risk factor for health problems in later life. Awareness of ACEs and associated trauma is increasing within schools and educational settings, as well as the demand for supportive services to address needs. However, there is a lack of clear evidence for effective interventions which can be delivered by non-clinicians (e.g., the school staff themselves). Thus, we undertook a systematic review to answer the question: What evidence exists for the efficacy of non-clinician delivered trauma-based interventions for improving mental health in school-age youth (4-18 years) who have experienced ACEs? The protocol for the review is registered in the PROSPERO International Prospective Register of Systematic Reviews (ID: CRD42023417286). We conducted a search across five electronic databases for studies published between January 2013 and April 2023 that reported on interventions suitable for non-clinician delivery, were published in English in the last 10 years, and involved participants aged 4-18 years (school-age) that had exposure to ACEs. Of the 4097 studies identified through the search, 326 were retrieved for full text screening, and 25 were included in the final review. Data were extracted from included articles for analysis and selected studies were quality assessed using validated assessment tools. Data were analysed through narrative synthesis. There was considerable heterogeneity in study design, outcome measures, and the interventions being studied. Interventions included CBT, mindfulness and art-based programs. A key finding was that there is a lack of high-quality research evidence to inform non-clinician delivered trauma-informed interventions. Many included studies were weak quality due to convenience sampling of participants and potential bias. Cognitive Behavioural Therapy (CBT)-based approaches are tentatively suggested as a suitable target for future rigorous evaluations of interventions addressing ACE-related trauma recovery and mental health improvement in school-age youth., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Avery et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Published
2024
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136. Health worker protests and the COVID-19 pandemic: an interrupted time-series analysis.

Author

Sharma K, Brophy S, Law M, and Sriram V

Subjects
Humans, Pandemics, Global Health, COVID-19 epidemiology, Interrupted Time Series Analysis, Health Personnel, SARS-CoV-2
Abstract

Objective: To assess the impact of the coronavirus disease 2019 (COVID-19) pandemic on protests by health workers., Methods: We conducted an interrupted time series analysis of data from 159 countries for 2 years before and after the World Health Organization classified COVID-19 as a pandemic in March 2020, thus between 2018 and 2022. We produced models examining two main outcomes: (i) the total weekly number of health worker protests globally; and (ii) the number of countries with one or more health worker protests in a given week., Findings: In total, there were 18 322 health worker protests in 133 countries between 2018 and 2022. The number of weekly health worker protests globally increased by 47% (30.1/63.5), an increase of 30.1 protests per week (95% confidence interval, CI: 11.7-48.6) at the onset of the COVID-19 pandemic. Furthermore, the number of countries experiencing such protests in a given week increased by 24% (5.7/24.1) following the declaration of the pandemic (an increase of 5.7 countries; 95% CI: 3.5-7.8)., Conclusion: The pandemic increased the overall level of health worker protests globally as well as the number of countries experiencing such protests. These protests highlight discontent in the health workforce. Given the ongoing global health workforce crisis, understanding and addressing the drivers of health worker discontent is important for global health policy and security., ((c) 2024 The authors; licensee World Health Organization.)

Published
2024
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137. Thermal Pharyngeal Injury Resulting From Vaping: A Case Report.

Author

Brophy S, Combs J, and Hutchison J

Abstract

Thermal injury to the pharyngeal structures is uncommon, and clinicians generally attribute these injuries to consuming hot foods or liquids. While thermal injuries have been reported with the ingestion of hot substances, thermal injuries from vape pens have not been widely described in the literature. We present a case of a 35-year-old male who presented to the emergency department (ED) with oropharyngeal burns after utilizing a vape pen that malfunctioned. The patient had visible burns on his uvula, as well as on the soft and hard palate. Additionally, he had symptoms of difficulty swallowing and a hoarse voice, which raised concerns about a possible deeper airway or lung injury. The patient required a flexible nasopharyngolaryngoscopy by a head and neck surgeon, which revealed mild edema and erythema of the epiglottis and the arytenoids. The patient was admitted to the hospital overnight for observation and treatment with analgesia and dexamethasone. The following morning, the patient's symptoms had improved. The repeat nasopharyngolaryngoscopy showed improvement in the swelling of the epiglottis and arytenoids, and the patient was deemed stable for discharge. This case brings attention to the variety of injuries possible from e-cigarette use and the importance of prompt management of oropharyngeal thermal injuries., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Brophy et al.)

Published
2024
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138. Echogenic intracardiac foci detection and location in the second-trimester ultrasound and association with fetal outcomes: A systematic literature review.

Author

Jones HE, Battaglia S, Hurt L, Uzun O, and Brophy S

Subjects
Female, Humans, Pregnancy, Chromosome Aberrations, Pregnancy Outcome, Premature Birth, Heart Defects, Congenital diagnostic imaging, Pregnancy Trimester, Second, Ultrasonography, Prenatal methods
Abstract

Background: Echogenic Intracardiac Foci (EIF) are non-structural markers identified during the routine 18-20-week foetal anomaly ultrasound scan yet their clinical significance on future outcomes for the infant is unclear., Objective: To examine the association between EIF and risk of preterm birth, chromosomal abnormalities, and cardiac abnormalities., Design: A review across four databases to identify English language journal articles of EIF using a cohort study design. All studies were reviewed for quality using the Critical Appraisal Skills Programme (CASP) checklist and data extracted for comparison and analysis., Results: 19 papers from 9 different countries were included. Combining these studies showed 4.6% (95% CI = 4.55-4.65%) of all pregnancies had EIF which was on the left in 86% of cases, on the right in 3% of cases and bilaterally in 10%. There was no evidence that EIF was associated with higher rates of preterm birth. However, it is possible that infants with EIF were more likely to be terminated rather than be born preterm as there was a 2.1% (range 0.3-4.2%) rate of termination or death of the foetus after week 20 among those with EIF. There was no evidence that EIF alone is highly predictive of chromosomal abnormalities. There was evidence that EIF is associated with higher rates of minor cardiac abnormalities (e.g. ventricular septal defect, tricuspid regurgitation or mitral regurgitation)) with 5.1% (224 of 4385) of those with EIF showing cardiac abnormalities (3.08% in retrospective studies and 17.85% in prospective studies). However, the risk of cardiac defects was only higher with right-sided EIF and where the EIF persisted into the third trimester. However, this is a rare event and would be seen in an estimated 4 per 10,000 pregnancies., Conclusion: EIF alone was not associated with adverse outcomes for the infant. Only persistent EIF on the right side showed evidence of carrying a higher risk of cardiac abnormality and would warrant further follow-up., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Jones et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Published
2024
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139. Changes in self-reported health and wellbeing outcomes in 36,951 primary school children from 2014 to 2022 in Wales: an analysis using annual survey data.

Author

Einhorn J, James M, Kennedy N, Marchant E, and Brophy S

Subjects
Child, Humans, Self Report, Surveys and Questionnaires, Schools, Pandemics, Fruit
Abstract

Introduction: This study examines the changes in childhood self-reported health and wellbeing between 2014 and 2022., Methods: An annual survey delivered by HAPPEN-Wales, in collaboration with 500 primary schools, captured self-reported data on physical health, dietary habits, mental health, and overall wellbeing for children aged 8-11 years., Results: The findings reveal a decline in physical health between 2014 and 2022, as evidenced by reduced abilities in swimming and cycling. For example, 68% of children (95%CI: 67%-69%) reported being able to swim 25m in 2022, compared to 85% (95% CI: 83%-87%) in 2018. Additionally, unhealthy eating habits, such as decreased fruit and vegetable consumption and increased consumption of sugary snacks, have become more prevalent. Mental health issues, including emotional and behavioural difficulties, have also increased, with emotional difficulties affecting 13%-15% of children in 2017-2018 and now impacting 29% of children in 2021-2022. Moreover, indicators of wellbeing, autonomy, and competence have declined., Discussion: Importantly, this trend of declining health and wellbeing predates the onset of the Covid-19 pandemic, suggesting that it is not solely attributed to the pandemic's effects. The health of primary school children has been on a declining trajectory since 2018/2019 and has continued to decline through the COVID recovery period. The study suggests that these trends are unlikely to improve without targeted intervention and policy focus., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Einhorn, James, Kennedy, Marchant and Brophy.)

Published
2024
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140. Cohort profile: Born in Wales-a birth cohort with maternity, parental and child data linkage for life course research in Wales, UK.

Author

Jones H, Seaborne MJ, Kennedy NL, James M, Dredge S, Bandyopadhyay A, Battaglia A, Davies S, and Brophy S

Subjects
Pregnancy, Child, Humans, Male, Female, Wales epidemiology, Life Change Events, Minority Groups, Information Storage and Retrieval, Parents, Birth Cohort, Ethnicity
Abstract

Purpose: Using Wales's national dataset for maternity and births as a core dataset, we have linked related datasets to create a more complete and comprehensive entire country birth cohort. Data of anonymised identified persons are linked on the individual level to data from health, social care and education data within the Secure Anonymised Information Linkage (SAIL) Databank. Each individual is assigned an encrypted Anonymised Linking Field; this field is used to link anonymised individuals across datasets. We present the descriptive data available in the core dataset, and the future expansion plans for the database beyond its initial development stage., Participants: Descriptive information from 2011 to 2023 has been gathered from the National Community Child Health Database (NCCHD) in SAIL. This comprehensive dataset comprises over 400 000 child electronic records. Additionally, survey responses about health and well-being from a cross-section of the population including 2500 parents and 30 000 primary school children have been collected for enriched personal responses and linkage to the data spine., Findings to Date: The electronic cohort comprises all children born in Wales since 2011, with follow-up conducted until they finish primary school at age 11. The child cohort is 51%: 49% female: male, and 7.8% are from ethnic minority backgrounds. When considering age distribution, 26.8% of children are under the age of 5, while 63.2% fall within the age range of 5-11., Future Plans: Born in Wales will expand by 30 000 new births annually in Wales (in NCCHD), while including follow-up data of children and parents already in the database. Supplementary datasets complement the existing linkage, including primary care, hospital data, educational attainment and social care. Future research includes exploring the long-term implications of COVID-19 on child health and development, and examining the impact of parental work environment on child health and development., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Published
2024
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141. Factors associated with low school readiness, a linked health and education data study in Wales, UK.

Author

Bandyopadhyay A, Marchant E, Jones H, Parker M, Evans J, and Brophy S

Subjects
Child, Male, Humans, Longitudinal Studies, Wales epidemiology, Educational Status, Cohort Studies, Schools
Abstract

Background: School readiness is a measure of a child's cognitive, social, and emotional readiness to begin formal schooling. Children with low school readiness need additional support from schools for learning, developing required social and academic skills, and catching-up with their school-ready peers. This study aims to identify the most significant risk factors associated with low school readiness using linked routine data for children in Wales., Method: This was a longitudinal cohort study using linked data. The cohort comprises of children who completed the Foundation Phase assessment between 2012 and 2018. Individuals were identified by linking Welsh Demographic Service and Pre16 Education Attainment datasets. School readiness was assessed via the binary outcome of the Foundation Phase assessment (achieved/not achieved). This study used multivariable logistic regression model and a decision tree to identify and weight the most important risk factors associated with low school readiness., Results: In order of importance, logistic regression identified maternal learning difficulties (adjusted odds ratio 5.35(95% confidence interval 3.97-7.22)), childhood epilepsy (2.95(2.39-3.66)), very low birth weight (2.24(1.86-2.70), being a boy (2.11(2.04-2.19)), being on free school meals (1.85(1.78-1.93)), living in the most deprived areas (1.67(1.57-1.77)), maternal death (1.47(1.09-1.98)), and maternal diabetes (1.46(1.23-1.78)) as factors associated with low school readiness. Using a decision tree, eligibility for free school meals, being a boy, absence/low attendance at school, being born late in the academic year, being a low birthweight child, and not being breastfed were factors which were associated with low school readiness., Conclusion: This work suggests that public health interventions focusing on children who are: boys, living in deprived areas, have poor early years attendance, have parents with learning difficulties, have parents with an illness or have illnesses themselves, would make the most difference to school readiness in the population., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Bandyopadhyay et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Published
2023
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142. Contrasting terrestrial and marine ecospace dynamics after the end-Triassic mass extinction event.

Author

Cribb AT, Formoso KK, Woolley CH, Beech J, Brophy S, Byrne P, Cassady VC, Godbold AL, Larina E, Maxeiner PP, Wu YH, Corsetti FA, and Bottjer DJ

Subjects
Fossils, Databases, Factual, Biodiversity, Ecosystem, Extinction, Biological
Abstract

Mass extinctions have fundamentally altered the structure of the biosphere throughout Earth's history. The ecological severity of mass extinctions is well studied in marine ecosystems by categorizing marine taxa into functional groups based on 'ecospace' approaches, but the ecological response of terrestrial ecosystems to mass extinctions is less well understood due to the lack of a comparable methodology. Here, we present a new terrestrial ecospace framework that categorizes fauna into functional groups as defined by tiering, motility and feeding traits. We applied the new terrestrial and traditional marine ecospace analyses to data from the Paleobiology Database across the end-Triassic mass extinction-a time of catastrophic global warming-to compare changes between the marine and terrestrial biospheres. We found that terrestrial functional groups experienced higher extinction severity, that taxonomic and functional richness are more tightly coupled in the terrestrial, and that the terrestrial realm continued to experience high ecological dissimilarity in the wake of the extinction. Although signals of extinction severity and ecological turnover are sensitive to the quality of the terrestrial fossil record, our findings suggest greater ecological pressure from the end-Triassic mass extinction on terrestrial ecosystems than marine ecosystems, contributing to more prolonged terrestrial ecological flux.

Published
2023
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143. Using administrative data to evaluate national policy impacts on child and maternal health: a research framework from the Maternal and Child Health Network (MatCHNet).

Author

Stewart E, Brophy S, Cookson R, Gilbert R, Given J, Hardelid P, Harron K, Leyland A, Pearce A, Wood R, and Dundas R

Subjects
Child, Female, Humans, Family, Health Policy, Policy, Child Health, Health Equity, Maternal Health
Abstract

Reducing health inequalities by addressing the social circumstances in which children are conceived and raised is a societal priority. Early interventions are key to improving outcomes in childhood and long-term into adulthood. Across the UK nations, there is strong political commitment to invest in the early years. National policy interventions aim to tackle health inequalities and deliver health equity for all children. Evidence to determine the effectiveness of socio-structural policies on child health outcomes is especially pressing given the current social and economic challenges facing policy-makers and families with children. As an alternative to clinical trials or evaluating local interventions, we propose a research framework that supports evaluating the impact of whole country policies on child health outcomes. Three key research challenges must be addressed to enable such evaluations and improve policy for child health: (1) policy prioritisation, (2) identification of comparable data and (3) application of robust methods., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and permissions. Published by BMJ.)

Published
2023
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145. Detection and evaluation of signals associated with exposure to individual and combination of medications in pregnancy: a signal detection study protocol.

Author

Subramanian A, Lee SI, Hemali Sudasinghe SPB, Wambua S, Phillips K, Singh M, Azcoaga-Lorenzo A, Cockburn N, Wang J, Fagbamigbe A, Usman M, Damase-Michel C, Yau C, Kent L, McCowan C, OReilly D, Santorelli G, Hope H, Kennedy J, Mhereeg M, Abel KM, Eastwood KA, Black M, Loane M, Moss N, Brophy S, Brocklehurst P, Dolk H, Nelson-Piercy C, and Nirantharakumar K

Subjects
Humans, Female, Pregnancy, Adolescent, Young Adult, Adult, Middle Aged, Pregnancy Trimester, First, Surveys and Questionnaires, Northern Ireland, Case-Control Studies, Risk Assessment
Abstract

Introduction: Considering the high prevalence of polypharmacy in pregnant women and the knowledge gap in the risk-benefit safety profile of their often-complex treatment plan, more research is needed to optimise prescribing. In this study, we aim to detect adverse and protective effect signals of exposure to individual and pairwise combinations of medications during pregnancy., Methods and Analysis: Using a range of real-world data sources from the UK, we aim to conduct a pharmacovigilance study to assess the safety of medications prescribed during the preconception period (3 months prior to conception) and first trimester of pregnancy. Women aged between 15 and 49 years with a record of pregnancy within the Clinical Practice Research Datalink (CPRD) Pregnancy Register, the Welsh Secure Anonymised Information Linkage (SAIL), the Scottish Morbidity Record (SMR) data sets and the Northern Ireland Maternity System (NIMATS) will be included. A series of case control studies will be conducted to estimate measures of disproportionality, detecting signals of association between a range of pregnancy outcomes and exposure to individual and combinations of medications. A multidisciplinary expert team will be invited to a signal detection workshop. By employing a structured framework, signals will be transparently assessed by each member of the team using a questionnaire appraising the signals on aspects of temporality, selection, time and measurement-related biases and confounding by underlying disease or comedications. Through group discussion, the expert team will reach consensus on each of the medication exposure-outcome signal, thereby excluding spurious signals, leaving signals suggestive of causal associations for further evaluation., Ethics and Dissemination: Ethical approval has been obtained from the Independent Scientific Advisory Committee, SAIL Information Governance Review Panel, University of St. Andrews Teaching and Research Ethics Committee and Office for Research Ethics Committees Northern Ireland (ORECNI) for access and use of CPRD, SAIL, SMR and NIMATS data, respectively., Competing Interests: Competing interests: AS has no declarations during the study period; after the study was completed, she has left the University of Birmingham and taken a post in AstraZeneca. The other authors declare no competing interests., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY. Published by BMJ.)

Published
2023
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146. Maternal multimorbidity and preterm birth in Scotland: an observational record-linkage study.

Author

Azcoaga-Lorenzo A, Fagbamigbe AF, Agrawal U, Black M, Usman M, Lee SI, Eastwood KA, Moss N, Plachcinski R, Nelson-Piercy C, Brophy S, O'Reilly D, Nirantharakumar K, and McCowan C

Subjects
Infant, Newborn, Pregnancy, Infant, Female, Humans, Middle Aged, Multimorbidity, Retrospective Studies, Family, Scotland epidemiology, Premature Birth epidemiology
Abstract

Background: Multimorbidity is common in women across the life course. Preterm birth is the single biggest cause of neonatal mortality and morbidity. We aim to estimate the prevalence of multimorbidity in pregnant women and to examine the association between maternal multimorbidity and PTB., Methods: This is a retrospective cohort study using electronic health records from the Scottish Morbidity Records. All pregnancies among women aged 15 to 49 with a conception date between 1 January 2014 and 31 December 2018 were included. Multimorbidity was defined as the presence of two or more pre-existing long-term physical or mental health conditions, and complex multimorbidity as the presence of four or more. It was calculated at the time of conception using a predefined list of 79 conditions published by the MuM-PreDiCT consortium. PTB was defined as babies born alive between 24 and less than 37 completed weeks of gestation. We used Generalised Estimating Equations adjusted for maternal age, socioeconomic status, number of previous pregnancies, BMI, and smoking history to estimate the effect of maternal pre-existing multimorbidity. Absolut rates are reported in the results and tables, whilst Odds Ratios (ORs) are adjusted (aOR)., Results: Thirty thousand five hundred fifty-seven singleton births from 27,711 pregnant women were included in the analysis. The prevalence of pre-existing multimorbidity and complex multimorbidity was 16.8% (95% CI: 16.4-17.2) and 3.6% (95% CI: 3.3-3.8), respectively. The prevalence of multimorbidity in the youngest age group was 10.2%(95% CI: 8.8-11.6), while in those 40 to 44, it was 21.4% (95% CI: 18.4-24.4), and in the 45 to 49 age group, it was 20% (95% CI: 8.9-31.1). In women without multimorbidity, the prevalence of PTB was 6.7%; it was 11.6% in women with multimorbidity and 15.6% in women with complex multimorbidity. After adjusting for maternal age, socioeconomic status, number of previous pregnancies, Body Mass Index (BMI), and smoking, multimorbidity was associated with higher odds of PTB (aOR = 1.64, 95% CI: 1.48-1.82)., Conclusions: Multimorbidity at the time of conception was present in one in six women and was associated with an increased risk of preterm birth. Multimorbidity presents a significant health burden to women and their offspring. Routine and comprehensive evaluation of women with multimorbidity before and during pregnancy is urgently needed., (© 2023. BioMed Central Ltd., part of Springer Nature.)

Published
2023
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147. COVID-19 vaccination in pregnancy: the impact of multimorbidity and smoking status on vaccine hesitancy, a cohort study of 25,111 women in Wales, UK.

Author

Mhereeg M, Jones H, Kennedy J, Seaborne M, Parker M, Kennedy N, Akbari A, Zuccolo L, Azcoaga-Lorenzo A, Davies A, Nirantharakumar K, and Brophy S

Subjects
Pregnancy, Female, Humans, Cohort Studies, Vaccination Hesitancy, Wales epidemiology, Multimorbidity, SARS-CoV-2, Vaccination, Smoking, COVID-19 Vaccines, COVID-19 epidemiology, COVID-19 prevention & control
Abstract

Background: Multimorbidity, smoking status, and pregnancy are identified as three risk factors associated with more severe outcomes following a SARS-CoV-2 infection, thus vaccination uptake is crucial for pregnant women living with multimorbidity and a history of smoking. This study aimed to examine the impact of multimorbidity, smoking status, and demographics (age, ethnic group, area of deprivation) on vaccine hesitancy among pregnant women in Wales using electronic health records (EHR) linkage., Methods: This cohort study utilised routinely collected, individual-level, anonymised population-scale linked data within the Secure Anonymised Information Linkage (SAIL) Databank. Pregnant women were identified from 13th April 2021 to 31st December 2021. Survival analysis was employed to examine and compare the length of time to vaccination uptake in pregnancy by considering multimorbidity, smoking status, as well as depression, diabetes, asthma, and cardiovascular conditions independently. The study also assessed the variation in uptake by multimorbidity, smoking status, and demographics, both jointly and separately for the independent conditions, using hazard ratios (HR) derived from the Cox regression model., Results: Within the population cohort, 8,203 (32.7%) received at least one dose of the COVID-19 vaccine during pregnancy, with 8,572 (34.1%) remaining unvaccinated throughout the follow-up period, and 8,336 (33.2%) receiving the vaccine postpartum. Women aged 30 years or older were more likely to have the vaccine in pregnancy. Those who had depression were slightly but significantly more likely to have the vaccine compared to those without depression (HR = 1.08, 95% CI 1.03 to 1.14, p = 0.002). Women living with multimorbidity were 1.12 times more likely to have the vaccine compared to those living without multimorbidity (HR = 1.12, 95% CI 1.04 to 1.19, p = 0.001). Vaccine uptakes were significantly lower among both current smokers and former smokers compared to never smokers (HR = 0.87, 95% CI 0.81 to 0.94, p < 0.001 and HR = 0.92, 95% CI 0.85 to 0.98, p = 0.015 respectively). Uptake was also lower among those living in the most deprived areas compared to those living in the most affluent areas (HR = 0.89, 95% CI 0.83 to 0.96, p = 0.002)., Conclusion: Younger women, living without multimorbidity, current and former smokers, and those living in the more deprived areas are less likely to have the vaccine, thus, a targeted approach to vaccinations may be required for these groups. Pregnant individuals living with multimorbidity exhibit a slight but statistically significant reduction in vaccine hesitancy towards COVID-19 during pregnancy., (© 2023. BioMed Central Ltd., part of Springer Nature.)

Published
2023
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148. Adversity profiles of children receiving care and support from social services: A latent-class analysis of school-aged children in Wales.

Author

Anthony R, Scourfield J, Moore G, Paranjothy S, Evans A, Brophy S, Daniel R, and Long S

Subjects
Female, Pregnancy, Humans, Child, Cross-Sectional Studies, Wales epidemiology, Risk Factors, Social Work, Family Characteristics
Abstract

Background: Children receive care and support from social services due to the risk of harm or impeded development or because of disability. This study aimed to identify typologies of adversity experienced by children receiving care and support from social services and to explore how typologies differ by sociodemographic characteristics., Methods: This is a cross-sectional study of 'Children Receiving Care and Support' (N = 12 792) during 2017/2018 in Wales, UK. We sought to (1) examine the prevalence of household adversities experienced by children in receipt of care and support from social services; (2) identify typologies of household adversities; and (3) explore how typologies of household adversities differ by family characteristics (demographics, measures of social disadvantage, perinatal and care factors)., Results: We found evidence for multiple risk factor constellations. The four-class solution suggested four distinct classes of adversities: child disability (50.0%), low adversities (20.3%), family poor health (6.7%) and multiple risks (23.0%). Children in the 'multiple risk' class were significantly more likely to be younger, more deprived and 'looked after' by the local authority compared with those in the 'low adversities' class., Conclusions: Given the presence of different constellations of household adversities, policies and interventions that address multiple risk factors simultaneously may be more effective and have longer-lasting benefits., (© 2023 The Authors. Child: Care, Health and Development published by John Wiley & Sons Ltd.)

Published
2023
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149. The development of a core outcome set for studies of pregnant women with multimorbidity.

Author

Lee SI, Hanley S, Vowles Z, Plachcinski R, Moss N, Singh M, Gale C, Fagbamigbe AF, Azcoaga-Lorenzo A, Subramanian A, Taylor B, Nelson-Piercy C, Damase-Michel C, Yau C, McCowan C, O'Reilly D, Santorelli G, Dolk H, Hope H, Phillips K, Abel KM, Eastwood KA, Kent L, Locock L, Loane M, Mhereeg M, Brocklehurst P, McCann S, Brophy S, Wambua S, Hemali Sudasinghe SPB, Thangaratinam S, Nirantharakumar K, and Black M

Subjects
Pregnancy, Infant, Newborn, Infant, Child, Humans, Female, Quality of Life, Mothers, Outcome Assessment, Health Care, Pregnant Women, Multimorbidity
Abstract

Background: Heterogeneity in reported outcomes can limit the synthesis of research evidence. A core outcome set informs what outcomes are important and should be measured as a minimum in all future studies. We report the development of a core outcome set applicable to observational and interventional studies of pregnant women with multimorbidity., Methods: We developed the core outcome set in four stages: (i) a systematic literature search, (ii) three focus groups with UK stakeholders, (iii) two rounds of Delphi surveys with international stakeholders and (iv) two international virtual consensus meetings. Stakeholders included women with multimorbidity and experience of pregnancy in the last 5 years, or are planning a pregnancy, their partners, health or social care professionals and researchers. Study adverts were shared through stakeholder charities and organisations., Results: Twenty-six studies were included in the systematic literature search (2017 to 2021) reporting 185 outcomes. Thematic analysis of the focus groups added a further 28 outcomes. Two hundred and nine stakeholders completed the first Delphi survey. One hundred and sixteen stakeholders completed the second Delphi survey where 45 outcomes reached Consensus In (≥70% of all participants rating an outcome as Critically Important). Thirteen stakeholders reviewed 15 Borderline outcomes in the first consensus meeting and included seven additional outcomes. Seventeen stakeholders reviewed these 52 outcomes in a second consensus meeting, the threshold was ≥80% of all participants voting for inclusion. The final core outcome set included 11 outcomes. The five maternal outcomes were as follows: maternal death, severe maternal morbidity, change in existing long-term conditions (physical and mental), quality and experience of care and development of new mental health conditions. The six child outcomes were as follows: survival of baby, gestational age at birth, neurodevelopmental conditions/impairment, quality of life, birth weight and separation of baby from mother for health care needs., Conclusions: Multimorbidity in pregnancy is a new and complex clinical research area. Following a rigorous process, this complexity was meaningfully reduced to a core outcome set that balances the views of a diverse stakeholder group., (© 2023. BioMed Central Ltd., part of Springer Nature.)

Published
2023
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150. Key outcomes for reporting in studies of pregnant women with multiple long-term conditions: a qualitative study.

Author

Lee SI, Hanley S, Vowles Z, Plachcinski R, Azcoaga-Lorenzo A, Taylor B, Nelson-Piercy C, McCowan C, O'Reilly D, Hope H, Abel KM, Eastwood KA, Locock L, Singh M, Moss N, Brophy S, Nirantharakumar K, Thangaratinam S, and Black M

Subjects
Child, Female, Pregnancy, Humans, Quality of Life, Qualitative Research, Parturition, Pregnant Women psychology, Maternal Health Services
Abstract

Background: Maternal multiple long-term conditions are associated with adverse outcomes for mother and child. We conducted a qualitative study to inform a core outcome set for studies of pregnant women with multiple long-term conditions., Methods: Women with two or more pre-existing long-term physical or mental health conditions, who had been pregnant in the last five years or planning a pregnancy, their partners and health care professionals were eligible. Recruitment was through social media, patients and health care professionals' organisations and personal contacts. Participants who contacted the study team were purposively sampled for maximum variation. Three virtual focus groups were conducted from December 2021 to March 2022 in the United Kingdom: (i) health care professionals (n = 8), (ii) women with multiple long-term conditions (n = 6), and (iii) women with multiple long-term conditions (n = 6) and partners (n = 2). There was representation from women with 20 different physical health conditions and four mental health conditions; health care professionals from obstetrics, obstetric/maternal medicine, midwifery, neonatology, perinatal psychiatry, and general practice. Participants were asked what outcomes should be reported in all studies of pregnant women with multiple long-term conditions. Inductive thematic analysis was conducted. Outcomes identified in the focus groups were mapped to those identified in a systematic literature search in the core outcome set development., Results: The focus groups identified 63 outcomes, including maternal (n = 43), children's (n = 16) and health care utilisation (n = 4) outcomes. Twenty-eight outcomes were new when mapped to the systematic literature search. Outcomes considered important were generally similar across stakeholder groups. Women emphasised outcomes related to care processes, such as information sharing when transitioning between health care teams and stages of pregnancy (continuity of care). Both women and partners wanted to be involved in care decisions and to feel informed of the risks to the pregnancy and baby. Health care professionals additionally prioritised non-clinical outcomes, including quality of life and financial implications for the women; and longer-term outcomes, such as children's developmental outcomes., Conclusions: The findings will inform the design of a core outcome set. Participants' experiences provided useful insights of how maternity care for pregnant women with multiple long-term conditions can be improved., (© 2023. The Author(s).)

Published
2023
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