Search

IntroductionUnderstanding how socioeconomic markers interact could inform future policies aimed at increasing adherence to a healthy diet.MethodsThis cross-sectional study included 437,860 participants from the UK Biobank. Dietary intake was self-reported. Were used as measures socioeconomic education level, income and Townsend deprivation index. A healthy diet score was defined using current dietary recommendations for nine food items and one point was assigned for meeting the recommendation for each. Good adherence to a healthy diet was defined as the top 75th percentile, while poor adherence was defined as the lowest 25th percentile. Poisson regression was used to investigate adherence to dietary recommendations.ResultsThere were significant trends whereby diet scores tended to be less healthy as deprivation markers increased. The diet score trends were greater for education compared to area deprivation and income. Compared to participants with the highest level of education, those with the lowest education were found to be 48% less likely to adhere to a healthy diet (95% Confidence Interval [CI]: 0.60–0.64). Additionally, participants with the lowest income level were 33% less likely to maintain a healthy diet (95% CI: 0.73–0.81), and those in the most deprived areas were 13% less likely (95% CI: 0.84–0.91).Discussion/conclussionAmong the three measured proxies of socioeconomic status – education, income, and area deprivation – low education emerged as the strongest factor associated with lower adherence to a healthy diet.

Objectives Traumatic brain injury (TBI) is a leading cause of death and disability among young children and adolescents and the effects can be lifelong and wide-reaching. This study aimed to compare the educational and employment outcomes of Scottish schoolchildren previously hospitalised for TBI with their peers. Methods A retrospective, record-linkage population cohort study was conducted using linkage of health and education administrative records. The cohort comprised all 766,244 singleton children born in Scotland and aged between 4 and 18 years who attended Scottish schools at some point between 2009 and 2013. Outcomes included special educational need (SEN), examination attainment, school absence and exclusion, and unemployment. Logistic regression models and generalised estimating equation (GEE) models were run unadjusted and then adjusted for sociodemographic and maternity confounders. Results Of the 766,244 children in the cohort, 4,788 (0.6%) had a history of hospitalisation for TBI. Following adjustment for potential confounders, previous TBI was associated with SEN (OR 1.28, CI 1.18 to 1.39, p < 0.001), absenteeism (IRR 1.09, CI 1.06 to 1.12, p < 0.001), exclusion (IRR 1.33, CI 1.15 to 1.55, p < 0.001), and low attainment (OR 1.30, CI 1.11 to 1.51, p < 0.001). There was no significant association with unemployment 6 months after leaving school (OR 1.03, CI 0.92 to 1.16, p = 0.61). Excluding hospitalisations coded as concussion strengthened the associations. Conclusion Childhood TBI, sufficiently severe to warrant hospitalisation, was associated with a range of adverse educational outcomes. These findings reinforce the importance of preventing TBI where possible. Where not possible, children with a history of TBI should be supported to minimise the adverse impacts on their education.

Background Infant breastfeeding has been associated with reduced incidence of childhood physical and mental health problems. This study investigated relationships between infant feeding methods and the risk of Special Educational Need (SEN). Methods A retrospective population cohort of schoolchildren in Scotland was constructed by linking together health (maternity, birth, and health visitor records) and education (annual school pupil census) databases. Inclusion was restricted to singleton children, born in Scotland from 2004 onwards with available breastfeeding data and who attended local authority mainstream or special schools between 2009 and 2013. Generalised estimating equation models with a binomial distribution and logit link function investigated associations between infant feeding method at 6–8 weeks and any-cause and cause-specific SEN, adjusting for sociodemographic and maternity factors. Findings Of 191 745 children meeting inclusion criteria, 126 907 (66·2%) were formula-fed, 48 473 (25·3%) exclusively breastfed, and 16 365 (8·5%) mixed fed. Overall, 23 141 (12·1%) children required SEN. Compared with formula feeding, mixed feeding and exclusive breastfeeding were associated with decreased any-cause SEN (OR 0·90, 95% CI 0·84–0·95; and 0·78, 0·75–0·82), and SEN attributed to learning disabilities (0·75, 0·65–0·87; and 0·66, 0·59–0·74), and learning difficulties (0·85, 0·77–0·94; and 0·75, 0·70–0·81). Compared with formula feeding, exclusively breastfed children had less communication problems (0·81, 0·74–0·88), social-emotional-behavioural difficulties (0·77, 0·70–0·84), sensory impairments (0·79, 0·65–0·95), physical motor disabilities (0·78, 0·66–0·91), and physical health conditions (0·74, 0·63–0·87). Feeding method was not significantly associated with mental health conditions or autism. Interpretation Many women struggle to exclusively breastfeed for the full 6 months recommended by WHO; however, this study provides evidence that a shorter duration of nonexclusive breastfeeding could nonetheless be beneficial with regard to the development of SEN.

Cunningham-Burley, McCartney, Campbell, Flaig, Orange et al. assess the ethics and potential benefit of secondary data use from newborn blood spot archives for research in a Citizen’s jury that agreed this was in the public interest. They also investigate and demonstrate the feasibility of using the archives for research purposes.

Objectives To investigate mortality rates and associated factors, and avoidable mortality in children/young people with intellectual disabilities.Design Retrospective cohort; individual record-linked data between Scotland’s 2011 Census and 9.5 years of National Records for Scotland death certification data.Setting General community.Participants Children and young people with intellectual disabilities living in Scotland aged 5–24 years, and an age-matched comparison group.Main outcome measures Deaths up to 2020: age of death, age-standardised mortality ratios (age-SMRs); causes of death including cause-specific age-SMRs/sex-SMRs; and avoidable deaths.Results Death occurred in 260/7247 (3.6%) children/young people with intellectual disabilities (crude mortality rate=388/100 000 person-years) and 528/156 439 (0.3%) children/young people without intellectual disabilities (crude mortality rate=36/100 000 person-years). SMRs for children/young people with versus those without intellectual disabilities were 10.7 for all causes (95% CI 9.47 to 12.1), 5.17 for avoidable death (95% CI 4.19 to 6.37), 2.3 for preventable death (95% CI 1.6 to 3.2) and 16.1 for treatable death (95% CI 12.5 to 20.8). SMRs were highest for children (27.4, 95% CI 20.6 to 36.3) aged 5–9 years, and lowest for young people (6.6, 95% CI 5.1 to 8.6) aged 20–24 years. SMRs were higher in more affluent neighbourhoods. Crude mortality incidences were higher for the children/young people with intellectual disabilities for most International Statistical Classification of Diseases and Related Health Problems, 10th Revision chapters. The most common underlying avoidable causes of mortality for children/young people with intellectual disabilities were epilepsy, aspiration/reflux/choking and respiratory infection, and for children/young people without intellectual disabilities were suicide, accidental drug-related deaths and car accidents.Conclusion Children with intellectual disabilities had significantly higher rates of all-cause, avoidable, treatable and preventable mortality than their peers. The largest differences were for treatable mortality, particularly at ages 5–9 years. Interventions to improve healthcare to reduce treatable mortality should be a priority for children/young people with intellectual disabilities. Examples include improved epilepsy management and risk assessments, and coordinated multidisciplinary actions to reduce aspiration/reflux/choking and respiratory infection. This is necessary across all neighbourhoods.

Background: Prisons had partial exemption from the UK’s 2006/7 smoking bans in enclosed public spaces. They became one of the few workplaces with continuing exposure to second-hand smoke, given the high levels of smoking among people in custody. Despite the introduction of smoke-free prisons elsewhere, evaluations of such ‘bans’ have been very limited to date. Objective: The objective was to provide evidence on the process and impact of implementing a smoke-free policy across a national prison service. Design: The Tobacco in Prisons study was a three-phase, multimethod study exploring the periods before policy formulation (phase 1: pre announcement), during preparation for implementation (phase 2: preparatory) and after implementation (phase 3: post implementation). Setting: The study was set in Scotland’s prisons. Participants: Participants were people in custody, prison staff and providers/users of prison smoking cessation services. Intervention: Comprehensive smoke-free prison rules were implemented across all of Scotland’s prisons in November 2018. Main outcome measures: The main outcome measures were second-hand smoke levels, health outcomes and perspectives/experiences, including facilitators of successful transitions to smoke-free prisons. Data sources: The study utilised cross-sectional surveys of staff (total, n = 3522) and people in custody (total, n = 5956) in each phase; focus groups and/or one-to-one interviews with staff (n = 237 across 34 focus groups; n = 38 interviews), people in custody (n = 62 interviews), providers (n = 103 interviews) and users (n = 45 interviews) of prison smoking cessation services and stakeholders elsewhere (n = 19); measurements of second-hand smoke exposure (e.g. 369,208 minutes of static measures in residential areas at three time points); and routinely collected data (e.g. medications dispensed, inpatient/outpatient visits). Results: Measures of second-hand smoke were substantially (≈ 90%) reduced post implementation, compared with baseline, largely confirming the views of staff and people in custody that illicit smoking is not a major issue post ban. Several factors that contributed to the successful implementation of the smoke-free policy, now accepted as the ‘new normal’, were identified. E-cigarette use has become common, was recognised (by both staff and people in custody) to have facilitated the transition and raises new issues in prisons. The health economic analysis (lifetime model) demonstrated that costs were lower and the number of quality-adjusted life-years was larger for people in custody and staff in the ‘with smoke-free’ policy period than in the ‘without’ policy period, confirming cost-effectiveness against a £20,000 willingness-to-pay threshold. Limitations: The ability to triangulate between different data sources mitigated limitations with constituent data sets. Conclusions: To our knowledge, this is the first study internationally to analyse the views of prison staff and people in custody; objective measurements of second-hand smoke exposure and routine health and other outcomes before, during and after the implementation of a smoke-free prison policy; and to assess cost-effectiveness. The results are relevant to jurisdictions considering similar legislation, whether or not e-cigarettes are permitted. The study provides a model for partnership working and, as a multidimensional study of a national prison system, adds to a previously sparse evidence base internationally. Future work: Priorities are to understand how to support people in custody in remaining smoke free after release from prison, and whether or not interventions can extend benefits to their families; to evaluate new guidance supporting people wishing to reduce or quit vaping; and to understand how prison vaping practices/cultures may strengthen or weaken long-term reductions in smoking. Study registration: This study is registered as Research Registry 4802. Funding: This project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 10, No. 1. See the NIHR Journals Library website for further project information.

Objective To evaluate the extent to which the inter-institutional, inter-disciplinary mobilisation of data and skills in the Farr Institute contributed to establishing the emerging field of data science for health in the UK. Design and Outcome measures We evaluated evidence of six domains characterising a new field of science: • defining central scientific challenges, • demonstrating how the central challenges might be solved, • creating novel interactions among groups of scientists, • training new types of experts, • re-organising universities, • demonstrating impacts in society. We carried out citation, network and time trend analyses of publications, and a narrative review of infrastructure, methods and tools. Setting Four UK centres in London, North England, Scotland and Wales (23 university partners), 2013-2018. Results 1. The Farr Institute helped define a central scientific challenge publishing a research corpus, demonstrating insights from electronic health record (EHR) and administrative data at each stage of the translational cycle in 593 papers with at least one Farr Institute author affiliation on PubMed. 2. The Farr Institute offered some demonstrations of how these scientific challenges might be solved: it established the first four ISO27001 certified trusted research environments in the UK, and approved more than 1000 research users, published on 102 unique EHR and administrative data sources, although there was no clear evidence of an increase in novel, sustained record linkages. The Farr Institute established open platforms for the EHR phenotyping algorithms and validations (>70 diseases, CALIBER). Sample sizes showed some evidence of increase but remained less than 10% of the UK population in primary care-hospital care linked studies. 3.The Farr Institute created novel interactions among researchers: the co-author publication network expanded from 944 unique co-authors (based on 67 publications in the first 30 months) to 3839 unique co-authors (545 papers in the final 30 months). 4. Training expanded substantially with 3 new masters courses, training >400 people at masters, short-course and leadership level and 48 PhD students. 5. Universities reorganised with 4/5 Centres established 27 new faculty (tenured) positions, 3 new university institutes. 6. Emerging evidence of impacts included: > 3200 citations for the 10 most cited papers and Farr research informed eight practice-changing clinical guidelines and policies relevant to the health of millions of UK citizens. Conclusion The Farr Institute played a major role in establishing and growing the field of data science for health in the UK, with some initial evidence of benefits for health and healthcare. The Farr Institute has now expanded into Health Data Research (HDR) UK but key challenges remain including, how to network such activities internationally.

Introduction: Individual, social and economic circumstances faced by young mothers can challenge a successful start in life for their children. Intervening early might enhance life chances for both mother and child. The Family Nurse Partnership (FNP) is an intensive nurse-led home visiting programme developed in the US which aims to improve prenatal health behaviours, birth outcomes, child development and health outcomes, and maternal life course. Establishing evidence of effectiveness beyond the original US setting is important to understand where further adaptation is required within a country specific context. Objective: This study will form one strand of the Scottish Governments’ plan to evaluate the effectiveness of FNP as compared to usual care for mothers and their children in Scotland and will focus only on outcomes that can be identified using routine administrative data systems. Methods: This study is a natural experiment with a case-cohort design using linked anonymised routine health, educational and social care data. Cases will be women enrolled as FNP Clients in ten NHS Health Boards in Scotland and Controls will be women who met FNP eligibility criteria but were pregnant at a time when the programme was not recruiting. Outcomes are mapped to the Scottish FNP logic model. All comparative analyses will be pre-specified, conducted on an intention to treat basis and will use multilevel regression models to compare outcomes between groups. Discussion: The study protocol is based upon the specification of FNP commissioned by the Scottish Government. This study design is novel for the evaluation of the FNP/NFP programmes which are primarily evaluated with an RCT. Outcomes included within the study have been selected on the basis that they are outcomes FNP aims to influence and where there is routine data available to assess the outcome.

Background: It is widely recognised that drink driving is a leading cause of road traffic accidents (RTAs). There is evidence that changing the drink-drive limit from a blood alcohol concentration of 0.08 to 0.05 g/dl is effective in reducing RTAs. Scotland changed the blood alcohol concentration limit to 0.05 g/dl on 5 December 2014. Aims: To assess whether or not the numbers and rates of RTAs and per capita alcohol consumption in Scotland were reduced because of the 2014 drink-drive legislation. To assess whether or not the 2014 change in legislation provided good value for money. Design: A natural experimental, quantitative study. The control group was England and Wales, that is, the other countries in Great Britain, where the drink-drive legislation remained unchanged. Setting: Great Britain. Participants: The entire population of Scotland, England and Wales for the period of January 2013–December 2016. Intervention: The change to drink-drive legislation in Scotland. Outcome measures: The counts and rates of RTAs; and per capita alcohol consumption. Methods: For the numbers and rates of RTAs (both traffic flow and population denominators were used), and separately for the intervention and control trial groups, negative binomial regression models were fitted to panel data sets to test for a change in outcome level after the new 2014 legislation was in place. To obtain a ‘difference-in-differences’ (DiD)-type measure of effect, an interaction term between the intervention group indicator and the binary covariate for indicating pre and post change in legislation (‘pseudo’-change for the control group) was assessed. For off- and on-trade per capita alcohol sales, and separately for the intervention and control trial group, seasonal autoregressive integrated moving average error models were fitted to the relevant time series. Results: The change to drink-drive legislation was associated with a 2% relative decrease in RTAs in Scotland [relative risk (RR) 0.98, 95% CI 0.91 to 1.04; p = 0.53]. However, the pseudo-change in legislation was associated with a 5% decrease in RTAs in England and Wales (RR 0.95, 95% CI 0.90 to 1.00; p = 0.05). For RTA rates, with traffic flow as the denominator, the DiD-type estimate indicated a 7% increase in rates for Scotland relative to England and Wales (unadjusted RR 1.07, 95% CI 0.98 to 1.17; p = 0.1). The change to drink-drive legislation was associated with a 0.3% relative decrease in per capita off-trade sales (–0.3%, 95% CI –1.7% to 1.1%; p = 0.71) and a 0.7% decrease in per capita on-trade sales (–0.7%, 95% CI –0.8% to –0.5%; p

Introduction The Family Nurse Partnership(FNP) is an intensive home-visiting service for teenage first-time mothers (and children), developed/trialled in the US and adapted/trialled across Europe.The Scottish Government(SG) aims to build on and supplement the existing national/international evidence base for FNP, to assess effectiveness and opportunities for optimisation of the programme, for future decision making in Scotland. Objectives and Approach The evaluation commissioned is a natural experiment of FNP, taking advantage of the existing information infrastructure in Scotland. This natural experiment represents an important opportunity to determine programme impact upon many key programme outcomes using routinely collected data at a lower cost than a comparably sized effectiveness trial. Key objectives are: to identify clients in receipt of FNP-support and a control sample of matched families who would meet criteria for FNP but did not receive support, to obtain approval and through anonymised data linkage link to health and other data, and to determine the effect of FNP across a range of maternal and child outcomes. Results The succes of the natural experiment design in trying to replicate the gold standard design of the RCT will be presented and will cover the following topics: (how cases and a comparable group of first-time teenage women have been identified across 10 Health Boards (HBs) between 2009 and 2016 using data made available by the electronic Data Research and Innovation Service (eDRIS) from FNP, NHS Scotland and SG; the matching process of the cases and controls using propensity score methods to ensure an unbiased comparison; the linkage to health, social care and educational datasets and the approval processes involved, and the strengths and limitations of using routine data to evaluate relevant study outcomes that map to a logic model. Conclusion/Implications The impact of this evaluation into the effectiveness of FNP in Scotland will establish a robustly matched study cohort, a more strealmined linkage and approval process, and identification of outcomes not only for a short-term follow-up but also for a longer-term follow-up of the teenage mothers and their children.

Background Tobacco control (TC) mass media campaigns (MMCs) are an important component of tobacco control strategies and are effective in reducing smoking prevalence. However, with increasing pressure on public health budgets, there has been a shift in some countries from MMCs to much cheaper community-based initiatives. Methods Using multivariate time series analyses we examined the relationships between exposure to TV MMCs (adult TV viewer ratings (TVRs); and quitting behaviour (calls to Smokeline, prescriptions for NRT), and reduction in numbers of smokers. In the economic analysis, we compared the costs and effects of TV MMCs against a 'No TV/do-nothing' alternative, from a public sector payer perspective (Scottish Government and NHS). Results TV MMCs increased calls to Smokeline by 385.9 calls (95% CI, 171.0 - 600.7) per 1 SD TVRs (194). This was sustained for 6 months. Adverts that evoked positive feelings generated the largest increase in calls (69.7%: 46.1, 93.0). The increase in NRT prescriptions was insignificant (£1,361.4: -£9,138 - £11,860.9). An increase of one TVR/month reduced the number of smokers by 41 (- 40.9: -102.07, 20.24). Although, statistically insignificant, our economic analysis indicates that TV MMCs generated an additional 116,885 quit attempts and 7,305 sustained 52-week quits per annum compared with no TV MMCs. The incremental cost per 52-week quitter was £102, which is highly cost-effective. With the very low annual cost of TV MMCs of £0.66 per smoker and potential lifetime savings in terms of avoiding cost of smoking related diseases, the lifetime model resulted in overall cost savings (-£319:-£974,-£31) and QALY gains (0.016: 0.0017,0.048) that were significant and demonstrated little uncertainty. Conclusions This study provides convincing evidence that tobacco control TV MMCs can increase quit attempts and are both effective and cost-effective in reducing the number of smokers. Their continued use, as part of a comprehensive TC strategy, is strongly recommended.

ABSTRACT Background Although pharmacotherapy is to be avoided wherever possible during pregnancy, aggressive pharmacotherapy is required for the treatment of pregnancy associated hypertension, which remains a leading cause of morbidity and mortality in the UK. While the teratogenic effects of angiotensin-converting enzyme inhibitors are well documented, the possible long term effects, on the child, following in utero exposure to other antihypertensive agents remains unknown. Approach The aim of this study was to systematically review all published literature relevant to possible adverse outcomes on the child associated with in utero exposure to antihypertensive medications. OVID (Medline, Embase), Scopus, EBSCO Collections (PsycINFO, CINAHL), The Cochrane Library and Web of Science databases were searched from January 1950 to January 2016 and a total of 688 papers were identified. Following review 43 primary studies and 4 Meta-analyses were eligible for inclusion. The Critical Appraisal Skills Programme (CASP) checklists were used to assess study quality. Results Three studies were of excellent quality the remainder were either mediocre or poor. Increased risk of low birth weight, low size for gestational age, preterm birth and congenital defects following in utero exposure to all antihypertensive agents were identified. The clinical importance of these reported risks is unclear, as many study findings were based on small case numbers. Four studies of mediocre quality reported on the relationship between in utero exposure and neurological adverse effects in offspring. Two studies reported an increased risk of attention deficit hyperactivity disorder following exposure to labetalol, and an increased risk of sleep disorders following exposure to methyldopa and clonidine. The remaining two studies identified no such associations. Conclusions This systematic review demonstrates a lack of published high quality studies. Available published studies indicate an increased risk of adverse child health outcomes, although it is unclear whether these outcomes are clinically significant. This review is the first step in a larger project, which is exploring child health outcomes in Scotland following in utero exposure to antihypertensive and psychotropic medications. Dispensed drug data will be used to identify mothers who have been prescribed antihypertensive or psychotropic medication during pregnancy. National databases (PIS, SMR02, SMR01, etc.) will be used to cross-link mother and child data to identify in utero exposure to the drugs of interest, and the resulting child outcomes. All aspects of child health outcomes will be assessed to identify possible adverse effects from in utero exposure to medications.

ABSTRACT Objectives This population wide record linkage study linked Scottish education data to a number of administrative health datasets to explore the impact of childhood chronic ill health on subsequent educational and health outcomes. Chronic conditions investigated in this study were diabetes, asthma, epilepsy, ADHD and depression. Specific educational outcomes of interest were academic attainment, school leaver destination, absence levels, exclusions and record of special educational need (SEN). Children were also followed up for hospital admissions and all-cause mortality. Approach Pupil census data and associated education records for all children attending primary and secondary schools in Scotland between 2009 and 2013 were linked to national prescribing data, hospital admissions (acute, psychiatric and cancer), death records and their mother’s maternity records to enable a range of different chronic conditions to be studied whilst controlling for various confounders. Specific drugs are prescribed for some particular chronic conditions therefore children identified from prescribing data as receiving these drugs at the time of the school census were assumed to have these conditions. Hospital admissions and death records provided information on subsequent admissions and mortality. Linking all children to their mother’s maternity records provided ability to control for a range of obstetric factors, birth outcomes and maternal antecedents. Results Diabetes, asthma, epilepsy, ADHD and depression were significantly associated with increased numbers of absences at school and increased risk of SEN. All of the conditions with the exception of diabetes were significantly associated with poorer subsequent educational grade attainment. ADHD and depression were significantly associated with increased numbers of exclusions at school whilst asthma was significantly associated with less exclusion. Epilepsy, ADHD and depression were significantly associated with poorer leaver destination 6 months after leaving school. Conclusion Compared to peers, children who had ADHD or depression were most adversely affected experiencing poorer educational outcomes in all five of the educational domains investigated. Children with epilepsy experienced poorer outcomes across four domains. Children with diabetes and asthma experienced more absence and increased SEN and asthmatic children experienced poorer attainment. Children who have these chronic illnesses at school appear to be at an educational disadvantage therefore further understanding of the intricate relationships between health and education is an on-going important area of public health.

Cathie Sudlow and colleagues describe the UK Biobank, a large population-based prospective study, established to allow investigation of the genetic and non-genetic determinants of the diseases of middle and old age.

UK Biobank is an ambitious post-genomic project involving the recruitment and follow-up of 500 000 volunteers aged 45 to 69 years. Many primary care teams will be involved in the study directly or indirectly. The programme of research will use at least five data sources: paper-based questionnaires, blood samples, genotype information derived from the bloods, clinical/prescribing data from the medical records, and data on deaths. We describe three of the key challenges to primary care informatics posed by this project: patient recruitment, confidentiality, and data management. We then describe solutions proposed in Scotland, based on existing technologies. Some of these may be applicable elsewhere in the other Regional Collaborating Centres and other largescale collaborative projects which rely on primary care informatics.

RESUMO: Objetivo: Avaliar a prevalência dos indicadores de doenças crônicas não transmíssiveis (DCNT), incluindo exames laboratoriais, na população de mulheres brasileiras em idade reprodutiva segundo o recebimento do benefício Bolsa Família (BF). Métodos: Consideraram-se as 3.131 mulheres de 18 a 49 anos que participaram da submamostra de exames laboratoriais da Pesquisa Nacional de Saúde (PNS). Foram comparados indicadores entre as mulheres em idade reprodutiva (18 a 49 anos) que disseram ter ou não Bolsa Família e calculados prevalência e intervalo de confiança (IC) usando χ2 de Pearson. Resultados: Observou-se que as mulheres em idade reprodutiva beneficiárias do BF quando comparadas às não beneficiárias têm piores desfechos em saúde, como maior ocorrência de sobrepeso (33,5%) e obesidade (26,9%) (p < 0,001), hipertensão 13,4% versus 4,4% (p < 0,001), uso de tabaco (11,2%) versus 8,2% (p = 0,029), além de 6,2% perceberem sua saúde pior, em comparação a 2,4% das mulheres não beneficiárias (p

Objectives: To determine the effectiveness of Mobile health augmented Cardiac rehabilitation (MCard) on health-related quality of life (HRQoL) among post-acute coronary syndrome (post-ACS) patients., Methods: At the Armed Forces Institute of Cardiology (AFIC), a tertiary care hospital in Rawalpindi, Pakistan, a two-arm randomised controlled trial was conducted in which mobile health augmented cardiac rehabilitation (MCard) was developed and implemented on post-ACS patients from January 2019 until March 2021. The trial conforms to the CONSORT statement 2010. The post-ACS patients were randomly allocated (1:1) to an intervention group (received MCard; counselling, empowering with self-monitoring devices, short text messages, in addition to standard post-ACS care) or control group (standard post-ACS care). HRQoL was assessed by generic Short Form-12 and MacNew quality of life myocardial infarction (QLMI) tools. Participants were followed for 24 weeks with data collection and analysis at three time points (baseline, 12 weeks and 24 weeks)., Results: At baseline, 160 patients (80 in each group; mean age 52.66±8.46 years; 126 male, 78.75%) were recruited, of which 121(75.62%) continued and were analysed at 12-weeks and 119(74.37%) at 24-weeks. The mean SF-12 physical component score significantly improved in the MCard group at 12 weeks follow-up (48.93 vs control 43.87, p<.001) and 24 weeks (53.52 vs 46.82 p<.001). The mean SF-12 mental component scores also improved significantly in the MCard group at 12 weeks follow-up (44.84 vs control 41.40, p<.001) and 24 weeks follow-up (48.95 vs 40.12, p<.001). At 12-and 24-week follow-up, all domains of MacNew QLMI (social, emotional, physical and global) were also statistically significant (p<.001) improved in the MCard group, unlike the control group., Conclusion: MCard is an effective and acceptable intervention at improving all domains of HRQoL. There was an improvement in physical, mental, social, emotional and global domains among the MCard group in comparison to the control group. The addition of MCard programs to post-ACS standard care may improve patient outcomes and reduce the burden on the health care setting., (Copyright: © Pakistan Journal of Medical Sciences.)

Objectives: To determine the effectiveness of mobile health augmented cardiac rehabilitation (MCard) on health-related quality of life (HRQoL), clinical and behavioural outcomes in post-ACS., Methods: A single-centre, single-blinded, two-arm randomised controlled trial is planned at Armed Forces Institute of Cardiology (AFIC), Pakistan. The duration was two years, that is from January 2019 till December 2020. A total of 160 participants were recruited and randomly allocated to the control group or the intervention group. Intervention is a mobile health augmented cardiac rehabilitation (MCard), a medically supervised cardiac rehabilitation program for 23-24 weeks. The phase one includes individual counselling during the hospital stay and in phase two includes communication of standardised messages related to healthy lifestyle modification through a specifically designed software., Results: This clinical trial results will give insight into the impact of MCard in improving the health outcomes (HRQoL, clinical and behavioural) of participants. If proven to be effective, this technology can be scaled up and implemented in other cardiac centres in the country. It utilises fewer human resources and can be delivered at a lower cost., Conclusion: The study protocol will be giving evidence either MCard can contribute to improving the HRQoL, clinical and behavioural outcomes of post-ACS patients following hospital discharge. Considering the COVID-9 situation, this is the perfect time to implement and evaluate the effectiveness of MCard on health outcomes among post-ACS patients., (Copyright: © Pakistan Journal of Medical Sciences.)