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Snooks H, Watkins A, Lyons J, Akbari A, Bailey R, Bethell L, Carson-Stevens A, Dale J, Edwards A, Emery H, Evans BA, Jolles S, John A, Kingston M, Porter A, Sewell B, Williams V, Lyons RA. Corrigendum to "Did the UK's public health shielding policy protect the clinically extremely vulnerable during the COVID-19 pandemic in wales? Results of EVITE immunity, a linked data retrospective study" [Public Health 218 (2023) 12-20]. Public Health 2023; 222:229. [PMID: 37463828 PMCID: PMC11021201 DOI: 10.1016/j.puhe.2023.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Affiliation(s)
- H Snooks
- Swansea University, Medical School, ILS 2, Singleton Park, SA2 8PP, Swansea, UK.
| | - A Watkins
- Swansea University, Medical School, ILS 2, Singleton Park, SA2 8PP, Swansea, UK
| | - J Lyons
- Population Data Science, Swansea University, Medical School, Data Science Building, Singleton Park, SA2 8PP, Swansea, UK
| | - A Akbari
- Population Data Science, Swansea University, Medical School, Data Science Building, Singleton Park, SA2 8PP, Swansea, UK
| | - R Bailey
- Population Data Science, Swansea University, Medical School, Data Science Building, Singleton Park, SA2 8PP, Swansea, UK
| | - L Bethell
- Swansea University, Medical School, ILS 2, Singleton Park, SA2 8PP, Swansea, UK
| | - A Carson-Stevens
- Cardiff University, Division of Population Medicine, University Hospital of Wales, Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS, UK
| | - J Dale
- The University of Warwick, Medical School, Coventry CV4 7AL, UK
| | - A Edwards
- Cardiff University, Division of Population Medicine, University Hospital of Wales, Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS, UK
| | - H Emery
- Swansea University, Medical School, ILS 2, Singleton Park, SA2 8PP, Swansea, UK
| | - B A Evans
- Swansea University, Medical School, ILS 2, Singleton Park, SA2 8PP, Swansea, UK
| | - S Jolles
- Immunodeficiency Centre for Wales, University Hospital of Wales, Heath Park, Cardiff, CF14 4XW, UK
| | - A John
- Population Data Science, Swansea University, Medical School, Data Science Building, Singleton Park, SA2 8PP, Swansea, UK
| | - M Kingston
- Swansea University, Medical School, ILS 2, Singleton Park, SA2 8PP, Swansea, UK
| | - A Porter
- Swansea University, Medical School, ILS 2, Singleton Park, SA2 8PP, Swansea, UK
| | - B Sewell
- Swansea University, School of Health and Social Care, Vivian Tower, Singleton Park, SA2 8PP, Swansea, UK
| | - V Williams
- Swansea University, Medical School, ILS 2, Singleton Park, SA2 8PP, Swansea, UK
| | - R A Lyons
- Population Data Science, Swansea University, Medical School, Data Science Building, Singleton Park, SA2 8PP, Swansea, UK
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Strafford H, Lacey AS, Hollinghurst J, Akbari A, Watkins A, Paterson J, Jennings D, Lyons RA, Powell HR, Kerr MP, Chin RW, Pickrell WO. COVID-19 vaccination uptake in people with epilepsy in wales. Seizure 2023; 108:49-52. [PMID: 37080124 PMCID: PMC10076248 DOI: 10.1016/j.seizure.2023.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 04/03/2023] [Accepted: 04/05/2023] [Indexed: 04/09/2023] Open
Abstract
PURPOSE People with epilepsy (PWE) are at increased risk of severe COVID-19. Assessing COVID-19 vaccine uptake is therefore important. We compared COVID-19 vaccination uptake for PWE in Wales with a matched control cohort. METHODS We performed a retrospective, population, cohort study using linked, anonymised, Welsh electronic health records within the Secure Anonymised Information Linkage (SAIL) Databank (Welsh population=3.1 million).We identified PWE in Wales between 1st March 2020 and 31st December 2021 and created a control cohort using exact 5:1 matching (sex, age and socioeconomic status). We recorded 1st, 2nd and booster COVID-19 vaccinations. RESULTS There were 25,404 adults with epilepsy (127,020 controls). 23,454 (92.3%) had a first vaccination, 22,826 (89.9%) a second, and 17,797 (70.1%) a booster. Comparative figures for controls were: 112,334 (87.8%), 109,057 (85.2%) and 79,980 (62.4%).PWE had higher vaccination rates in all age, sex and socioeconomic subgroups apart from booster uptake in older subgroups. Vaccination rates were higher in older subgroups, women and less deprived areas for both cohorts. People with intellectual disability and epilepsy had higher vaccination rates when compared with controls with intellectual disability. CONCLUSIONS COVID-19 vaccination uptake for PWE in Wales was higher than that for a matched control group.
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Affiliation(s)
- H Strafford
- Neurology Research Group, Swansea University Medical School, Faculty of Medicine, Health and Life Science, Swansea University, Swansea, Wales SA2 8PP, UK.
| | - A S Lacey
- Neurology Research Group, Swansea University Medical School, Faculty of Medicine, Health and Life Science, Swansea University, Swansea, Wales SA2 8PP, UK
| | - J Hollinghurst
- Neurology Research Group, Swansea University Medical School, Faculty of Medicine, Health and Life Science, Swansea University, Swansea, Wales SA2 8PP, UK
| | - A Akbari
- Neurology Research Group, Swansea University Medical School, Faculty of Medicine, Health and Life Science, Swansea University, Swansea, Wales SA2 8PP, UK
| | - A Watkins
- Neurology Research Group, Swansea University Medical School, Faculty of Medicine, Health and Life Science, Swansea University, Swansea, Wales SA2 8PP, UK
| | - J Paterson
- Epilepsy Action, New Anstey House, Gate Way Drive, Yeadon, Leeds, England, UK
| | - D Jennings
- Epilepsy Action, New Anstey House, Gate Way Drive, Yeadon, Leeds, England, UK
| | - R A Lyons
- Neurology Research Group, Swansea University Medical School, Faculty of Medicine, Health and Life Science, Swansea University, Swansea, Wales SA2 8PP, UK
| | - H R Powell
- Neurology Research Group, Swansea University Medical School, Faculty of Medicine, Health and Life Science, Swansea University, Swansea, Wales SA2 8PP, UK; Morriston Hospital, Swansea Bay University Health Board, Swansea, Wales, UK
| | - M P Kerr
- Institute of Psychological Medicine and Clinical Neurosciences, Cardiff University School of Medicine, Cardiff, Wales, UK
| | - R W Chin
- Muir Maxwell Epilepsy Centre, Centre for Clinical Brain Sciences and Department of Child Life and Health, The University of Edinburgh, Scotland, UK; Royal Hospital for Children and Young People, Edinburgh, Scotland, UK
| | - W O Pickrell
- Neurology Research Group, Swansea University Medical School, Faculty of Medicine, Health and Life Science, Swansea University, Swansea, Wales SA2 8PP, UK; Morriston Hospital, Swansea Bay University Health Board, Swansea, Wales, UK
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3
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Snooks H, Watkins A, Lyons J, Akbari A, Bailey R, Bethell L, Carson-Stevens A, Edwards A, Emery H, Evans BA, Jolles S, John A, Kingston M, Porter A, Sewell B, Williams V, Lyons RA. Did the UK's public health shielding policy protect the clinically extremely vulnerable during the COVID-19 pandemic in Wales? Results of EVITE Immunity, a linked data retrospective study. Public Health 2023; 218:12-20. [PMID: 36933354 PMCID: PMC9928733 DOI: 10.1016/j.puhe.2023.02.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 02/03/2023] [Accepted: 02/07/2023] [Indexed: 02/17/2023]
Abstract
INTRODUCTION The UK shielding policy intended to protect people at the highest risk of harm from COVID-19 infection. We aimed to describe intervention effects in Wales at 1 year. METHODS Retrospective comparison of linked demographic and clinical data for cohorts comprising people identified for shielding from 23 March to 21 May 2020; and the rest of the population. Health records were extracted with event dates between 23 March 2020 and 22 March 2021 for the comparator cohort and from the date of inclusion until 1 year later for the shielded cohort. RESULTS The shielded cohort included 117,415 people, with 3,086,385 in the comparator cohort. The largest clinical categories in the shielded cohort were severe respiratory condition (35.5%), immunosuppressive therapy (25.9%) and cancer (18.6%). People in the shielded cohort were more likely to be female, aged ≥50 years, living in relatively deprived areas, care home residents and frail. The proportion of people tested for COVID-19 was higher in the shielded cohort (odds ratio [OR] 1.616; 95% confidence interval [CI] 1.597-1.637), with lower positivity rate incident rate ratios 0.716 (95% CI 0.697-0.736). The known infection rate was higher in the shielded cohort (5.9% vs 5.7%). People in the shielded cohort were more likely to die (OR 3.683; 95% CI: 3.583-3.786), have a critical care admission (OR 3.339; 95% CI: 3.111-3.583), hospital emergency admission (OR 2.883; 95% CI: 2.837-2.930), emergency department attendance (OR 1.893; 95% CI: 1.867-1.919) and common mental disorder (OR 1.762; 95% CI: 1.735-1.789). CONCLUSION Deaths and healthcare utilisation were higher amongst shielded people than the general population, as would be expected in the sicker population. Differences in testing rates, deprivation and pre-existing health are potential confounders; however, lack of clear impact on infection rates raises questions about the success of shielding and indicates that further research is required to fully evaluate this national policy intervention.
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Affiliation(s)
- H Snooks
- Swansea University, Medical School, ILS 2, Singleton Park, Swansea, SA2 8PP, UK.
| | - A Watkins
- Swansea University, Medical School, ILS 2, Singleton Park, Swansea, SA2 8PP, UK.
| | - J Lyons
- Population Data Science, Swansea University, Medical School, Data Science Building, Singleton Park, Swansea, SA2 8PP, UK.
| | - A Akbari
- Population Data Science, Swansea University, Medical School, Data Science Building, Singleton Park, Swansea, SA2 8PP, UK.
| | - R Bailey
- Population Data Science, Swansea University, Medical School, Data Science Building, Singleton Park, Swansea, SA2 8PP, UK.
| | - L Bethell
- Swansea University, Medical School, ILS 2, Singleton Park, Swansea, SA2 8PP, UK.
| | - A Carson-Stevens
- Cardiff University, Division of Population Medicine, Neuadd Meirionnydd, University Hospital of Wales, Heath Park, Cardiff, CF14 4YS, UK.
| | - A Edwards
- Cardiff University, Division of Population Medicine, Neuadd Meirionnydd, University Hospital of Wales, Heath Park, Cardiff, CF14 4YS, UK.
| | - H Emery
- Swansea University, Medical School, ILS 2, Singleton Park, Swansea, SA2 8PP, UK.
| | - B A Evans
- Swansea University, Medical School, ILS 2, Singleton Park, Swansea, SA2 8PP, UK.
| | - S Jolles
- Immunodeficiency Centre for Wales, University Hospital of Wales, Heath Park, Cardiff, CF14 4XW, UK.
| | - A John
- Population Data Science, Swansea University, Medical School, Data Science Building, Singleton Park, Swansea, SA2 8PP, UK.
| | - M Kingston
- Swansea University, Medical School, ILS 2, Singleton Park, Swansea, SA2 8PP, UK.
| | - A Porter
- Swansea University, Medical School, ILS 2, Singleton Park, Swansea, SA2 8PP, UK.
| | - B Sewell
- Swansea University, School of Health and Social Care, Vivian Tower, Singleton Park, Swansea, SA2 8PP, UK.
| | - V Williams
- Swansea University, Medical School, ILS 2, Singleton Park, Swansea, SA2 8PP, UK.
| | - R A Lyons
- Population Data Science, Swansea University, Medical School, Data Science Building, Singleton Park, Swansea, SA2 8PP, UK.
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4
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Lyons RA, Schmidt AE, Aldridge S, Mathis-Edenhofer S, Estupiñán-Romero F, Thissen M, Gissler M, Palmieri L, Majek O. Impact of COVID-19 on hospitalisation for diverse conditions in European countries. Eur J Public Health 2022. [PMCID: PMC9594716 DOI: 10.1093/eurpub/ckac129.273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Background The COVID-19 pandemic has had an unprecedented impact on Europe. Health systems came under strain, with non-urgent treatments postponed and resources reserved for treatment of COVID-19 patients. Delayed care seeking has been reported, for fear of infection with SARS-CoV2. Yet, the scale of this impact remains under researched. This study aims to compare indirect effects of the pandemic in a European cross-country study aiming to highlight the potential of Population Health Information Research Infrastructures (www.phiri.eu). Methods Focusing on (i) major vascular events (MVE) and (ii) elective surgery for joint replacements (ESJR) as well as (iii) serious trauma this study analyses individual level hospital data in a standardised harmonised data model. We compared pre-pandemic incidence rates (2018-2019) with rates for 2020 and 2021. Analyses are systematically contrasted with SARS CoV2 incidence rates, and policy measures taken based on the OxCGRT index. Results A drop in hospital discharge rates was observed during the pandemic in all countries but differing by condition and month. Socio-economic differences also varied by condition. Our evidence suggests that periods of more severe policy measures also correlated with more dramatic drops in regular hospital activities. Conclusions Our findings provide new insights on the dramatic level of de-prioritisation of essential services faced by non-COVID-19 patients in Europe. From a public health perspective, hospital escalation plans should be developed early on to avoid negative mid and long-term health and financial consequences of indirect effects. The study demonstrates the tremendous potential in exploiting health information systems in a systematic way across countries and the value of the PHIRI system. Further research should investigate policy trade-offs involved in severe lockdown measures during a pandemic and variations in health service resilience for future pandemic preparedness.
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Affiliation(s)
- RA Lyons
- Population Data Science, Swansea University Medical School , Swansea, UK
| | - AE Schmidt
- Competence Centre for Climate and Health, Austrian National Public Health Institute , Vienna, Austria
| | - S Aldridge
- Population Data Science, Swansea University Medical School , Swansea, UK
| | - S Mathis-Edenhofer
- Health Care Planning and System Development, Austrian National Public Health Institute , Vienna, Austria
| | | | - M Thissen
- Epidemiology and Health Monitoring, Robert Koch Institute , Berlin, Germany
| | - M Gissler
- Finnish Institute for Health and Welfare , Helsinki, Finland
- Karolinska Institutet , Stockholm, Sweden
| | - L Palmieri
- Istituto Superiore di Sanità , Rome, Italy
| | - O Majek
- Institute of Health Information and Statistic , Prague, Czechia
- Institute of Biostatistics and Analyses, Masaryk University , Brno, Czechia
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5
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Rodríguez-Blázquez C, Aldridge S, Bernal-Delgado E, Dolanski-Aghamanoukjan L, Estupiñán-Romero F, Garriga C, Gissler M, Lyons RA, Sagerschnig S, Tolonen H. Monitoring COVID-19 related changes in population mental health. Eur J Public Health 2022. [PMCID: PMC9594452 DOI: 10.1093/eurpub/ckac129.276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background The COVID-19 pandemic, and its consequences in terms of control measures and restrictions to normal life, has affected the population mental health. One of the four case studies from the Population Health Information Research Infrastructure (PHIRI) for COVID-19 is focused on mental health with the objective to measure changes in incidence of mental health problems associated with the COVID-19 pandemic in several European countries. Methods Using electronic health records (EHR), data on new episodes of depression or anxiety, prescription of antidepressants and anxiolytics, and visits to primary care, specialized care or emergency units with an episode of depression/anxiety, were collected by participant data hubs at national/regional level for the period 2017-2021. A common data model to collect the data was defined for all participating data hubs and analysis of status prior and during the COVID-19 pandemic was performed using R. Results Data hubs from Austria, Finland, Spain (Aragon), and United Kingdom (Wales) were able to provide aggregated results from raw individual-level data. Preliminary analysis of trends suggests a decrease in new cases of depression and anxiety in the pandemic period (2020-2021) in comparison with previous years. Different trends were observed between data hubs regarding prescription of drugs and the number of primary/specialized care visits due to depression or anxiety. Issues in the access to data in some of the participating data hubs were observed, related to ethical and legal matters, and the lack of centralized registers and of private consultations statistics. Conclusions The results of this use case show that EHR for the secondary use can be retrieved in a common way across Europe to analyse and compare the impact of COVID-19 in population mental health in European countries. However, the process is more complicated and time consuming than expected.
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Affiliation(s)
| | - S Aldridge
- Population Data Science, Swansea University Medical School , Swansea, UK
| | | | | | | | - C Garriga
- Instituto de Salud Carlos III , Madrid, Spain
| | - M Gissler
- Finnish Institute for Health and Welfare , Helsinki, Finland
- Karolinska Institutet , Stockholm, Sweden
| | - RA Lyons
- Population Data Science, Swansea University Medical School , Swansea, UK
| | - S Sagerschnig
- National Public Health Institute Austria n , Vienna, Austria
| | - H Tolonen
- Finnish Institute for Health and Welfare , Helsinki, Finland
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DelPozo-Banos M, Lee SC, Friedmann Y, Akbari A, Torabi F, Lloyd K, Lyons RA, John A. Healthcare contacts with self-harm during COVID-19: An e-cohort whole-population-based study using individual-level linked routine electronic health records in Wales, UK, 2016-March 2021. PLoS One 2022; 17:e0266967. [PMID: 35476839 PMCID: PMC9045644 DOI: 10.1371/journal.pone.0266967] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 03/31/2022] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Reduced rates of help seeking by those who self-harmed during the COVID-19 pandemic have been reported. OBJECTIVES To understand changes in healthcare service contacts for self-harm during the COVID-19 pandemic across primary, emergency and secondary care. METHODS This retrospective cohort study used routine electronic healthcare data for Wales, United Kingdom, from 2016 to March 14, 2021. Population-based data from primary care, emergency departments and hospital admissions were linked at individual-level. All Welsh residents aged ≥10 years over the study period were included in the study. Primary, emergency and secondary care contacts with self-harm at any time between 2016 and March 14, 2021 were identified. Outcomes were counts, incidence, prevalence and proportion of self-harm contacts relative to all contacts in each and all settings, as well as the proportion of people contacting one or more settings with self-harm. Weekly trends were modelled using generalised estimated equations, with differences between 2020 (to March 2021) and comparison years 2016-2018 (to March 2017-2019) quantified using difference in differences, from which mean rate of odds ratios (μROR) across years was reported. RESULTS The study included 3,552,210 individuals over the study period. Self-harm contacts reduced across services in March and December 2020 compared to previous years. Primary care contacts with self-harm reduced disproportionately compared to non-self-harm contacts (μROR = 0.7, p<0.05), while their proportion increased in emergency departments during April 2020 (μROR = 1.3, p<0.05 in 2/3 comparison years) and hospital admissions during April-May 2020 (μROR = 1.2, p<0.05 in 2/3 comparison years). Despite this, those who self-harmed in April 2020 were more likely to be seen in primary care than other settings compared to previous years (μROR = 1.2, p<0.05). A lower proportion of those with self-harm contacts in emergency departments were subsequently admitted to hospital in December 2020 compared to previous years (μROR = 0.5, p<0.05). CONCLUSIONS These findings suggest that those who self-harmed during the COVID-19 pandemic may have been less likely to seek help, and those who did so faced more stringent criteria for admission. Communications encouraging those who self-harm to seek help during pandemics may be beneficial. However, this needs to be supported by maintained provision of mental health services.
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Affiliation(s)
| | - S. C. Lee
- Swansea University Medical School, Wales, United Kingdom
| | - Y. Friedmann
- Swansea University Medical School, Wales, United Kingdom
| | - A. Akbari
- Population Data Science, Swansea University Medical School, Wales, United Kingdom
| | - F. Torabi
- Population Data Science, Swansea University Medical School, Wales, United Kingdom
| | - K. Lloyd
- Swansea University Medical School, Wales, United Kingdom
| | - R. A. Lyons
- Swansea University Medical School, Wales, United Kingdom
| | - A. John
- Swansea University Medical School, Wales, United Kingdom
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7
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Lyons J, Gabbe BJ, Rawlinson D, Lockey D, Fry RJ, Akbari A, Lyons RA. Impact of a physician - critical care practitioner pre-hospital service in Wales on trauma survival: a retrospective analysis of linked registry data. Anaesthesia 2021; 76:1475-1481. [PMID: 33780550 DOI: 10.1111/anae.15457] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2021] [Indexed: 01/02/2023]
Abstract
The Emergency Medical Retrieval and Transfer Service for Wales launched in 2015. This service delivers senior pre-hospital doctors and advanced critical care practitioners to the scene of time-critical life- and limb-threatening incidents to provide advanced decision-making and pre-hospital clinical care. The impact of the service on 30-day mortality was evaluated retrospectively using a data linkage system. The study included patients who sustained moderate-to-severe blunt traumatic injuries (injury severity score ≥ 9) between 27 April 2015 and 30 November 2018. The association between pre-hospital management by the Emergency Medical Retrieval and Transfer Service and 30-day mortality was assessed using multivariable logistic regression. In total, data from 4035 patients were analysed, of which 412 (10%) were treated by the Emergency Medical Retrieval and Transfer Service. A greater proportion of patients treated by the Emergency Medical Retrieval and Transfer Service had an injury severity score ≥ 16 and Glasgow coma scale ≤ 12 (288 (70%) vs. 1435 (40%) and 126 (31%) vs. 325 (9%), respectively). The unadjusted 30-day mortality rate was 11.7% for patients managed by the Emergency Medical Retrieval and Transfer Service compared with 9.6% for patients managed by standard pre-hospital care services. However, after adjustment for differences in case-mix, the 30-day mortality rate for patients treated by the Emergency Medical Retrieval and Transfer Service was 37% lower (adjusted odds ratio 0.63 (95%CI 0.41-0.97); p = 0.037). The introduction of an emergency medical retrieval service was associated with a reduction in 30-day mortality for patients with blunt traumatic injury.
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Affiliation(s)
- J Lyons
- Public Health Medicine (Health Data Research UK), Swansea University, Swansea, UK
| | - B J Gabbe
- Emergency and Trauma Research Unit, School of Public Health and Preventive Medicine at Monash University, Melbourne, Australia.,Public Health Medicine (Health Data Research UK), Swansea University, Swansea, UK
| | - D Rawlinson
- Emergency Medical Retrieval and Transfer Service (EMRTS) Cymru, Wales, UK.,Public Health Medicine (Health Data Research UK), Swansea University, Swansea, UK
| | - D Lockey
- Emergency Medical Retrieval and Transfer Service (EMRTS) Cymru, Wales, UK
| | - R J Fry
- GIS and Health Geographies, Public Health Medicine (Health Data Research UK), Swansea University, Swansea, UK
| | - A Akbari
- Public Health Medicine (Health Data Research UK), Swansea University, Swansea, UK
| | - R A Lyons
- Public Health Medicine (Health Data Research UK), Swansea University, Swansea, UK
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8
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Pugh RJ, Bailey R, Szakmany T, Al Sallakh M, Hollinghurst J, Akbari A, Griffiths R, Battle C, Thorpe C, Subbe CP, Lyons RA. Long-term trends in critical care admissions in Wales. Anaesthesia 2021; 76:1316-1325. [PMID: 33934335 PMCID: PMC10138728 DOI: 10.1111/anae.15466] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/03/2021] [Indexed: 11/27/2022]
Abstract
As national populations age, demands on critical care services are expected to increase. In many healthcare settings, longitudinal trends indicate rising numbers and proportions of patients admitted to ICU who are older; elsewhere, including some parts of the UK, a decrease has raised concerns with regard to rationing according to age. Our aim was to investigate admission trends in Wales, where critical care capacity has not risen in the last decade. We used the Secure Anonymised Information Linkage Databank to identify and characterise critical care admissions in patients aged ≥ 18 years from 1 January 2008 to 31 December 2017. We categorised 85,629 ICU admissions as youngest (18-64 years), older (65-79 years) and oldest (≥ 80 years). The oldest group accounted for 15% of admissions, the older age group 39% and the youngest group 46%. Relative to the national population, the incidence of admission rates per 10,000 population in the oldest group decreased significantly over the study period from 91.5/10,000 in 2008 to 77.5/10,000 (a relative decrease of 15%), and among the older group from 89.2/10,000 in 2008 to 75.3/10,000 in 2017 (a relative decrease of 16%). We observed significant decreases in admissions with high comorbidity (modified Charlson comorbidity index); increases in the proportion of older patients admitted who were considered 'fit' rather than frail (electronic frailty index); and decreases in admissions with a medical diagnosis. In contrast to other healthcare settings, capacity constraints and surgical imperatives appear to have contributed to a relative exclusion of older patients presenting with acute medical illness.
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Affiliation(s)
- R J Pugh
- Department of Anaesthetics, Glan Clwyd Hospital, Bodelwyddan, UK
| | - R Bailey
- Public Health Medicine, Swansea University, Swansea, UK
| | - T Szakmany
- Department of Anaesthesia, Intensive Care and Pain Medicine, Division of Population Medicine, Cardiff University, Cardiff, UK
| | - M Al Sallakh
- Public Health Medicine, Swansea University, Swansea, UK
| | | | - A Akbari
- Public Health Medicine, Swansea University, Swansea, UK
| | - R Griffiths
- Public Health Medicine, Swansea University, Swansea, UK
| | - C Battle
- Ed Major Critical Care Unit, Morriston Hospital, Swansea, UK
| | - C Thorpe
- Department of Anaesthetics, Ysbyty Gwynedd, Bangor, UK
| | - C P Subbe
- Acute and Critical Care Medicine, School of Medical Sciences, Bangor University, Bangor, UK
| | - R A Lyons
- Public Health Medicine, Swansea University, Swansea, UK
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9
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Simpson CR, Shi T, Vasileiou E, Katikireddi SV, Kerr S, Moore E, McCowan C, Agrawal U, Shah SA, Ritchie LD, Murray J, Pan J, Bradley DT, Stock SJ, Wood R, Chuter A, Beggs J, Stagg HR, Joy M, Tsang RSM, de Lusignan S, Hobbs R, Lyons RA, Torabi F, Bedston S, O’Leary M, Akbari A, McMenamin J, Robertson C, Sheikh A. First-dose ChAdOx1 and BNT162b2 COVID-19 vaccines and thrombocytopenic, thromboembolic and hemorrhagic events in Scotland. Nat Med 2021; 27:1290-1297. [PMID: 34108714 PMCID: PMC8282499 DOI: 10.1038/s41591-021-01408-4] [Citation(s) in RCA: 171] [Impact Index Per Article: 57.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 05/26/2021] [Indexed: 02/04/2023]
Abstract
Reports of ChAdOx1 vaccine-associated thrombocytopenia and vascular adverse events have led to some countries restricting its use. Using a national prospective cohort, we estimated associations between exposure to first-dose ChAdOx1 or BNT162b2 vaccination and hematological and vascular adverse events using a nested incident-matched case-control study and a confirmatory self-controlled case series (SCCS) analysis. An association was found between ChAdOx1 vaccination and idiopathic thrombocytopenic purpura (ITP) (0-27 d after vaccination; adjusted rate ratio (aRR) = 5.77, 95% confidence interval (CI), 2.41-13.83), with an estimated incidence of 1.13 (0.62-1.63) cases per 100,000 doses. An SCCS analysis confirmed that this was unlikely due to bias (RR = 1.98 (1.29-3.02)). There was also an increased risk for arterial thromboembolic events (aRR = 1.22, 1.12-1.34) 0-27 d after vaccination, with an SCCS RR of 0.97 (0.93-1.02). For hemorrhagic events 0-27 d after vaccination, the aRR was 1.48 (1.12-1.96), with an SCCS RR of 0.95 (0.82-1.11). A first dose of ChAdOx1 was found to be associated with small increased risks of ITP, with suggestive evidence of an increased risk of arterial thromboembolic and hemorrhagic events. The attenuation of effect found in the SCCS analysis means that there is the potential for overestimation of the reported results, which might indicate the presence of some residual confounding or confounding by indication. Public health authorities should inform their jurisdictions of these relatively small increased risks associated with ChAdOx1. No positive associations were seen between BNT162b2 and thrombocytopenic, thromboembolic and hemorrhagic events.
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Affiliation(s)
- C. R. Simpson
- grid.267827.e0000 0001 2292 3111School of Health, Wellington Faculty of Health, Victoria University of Wellington, Wellington, New Zealand ,grid.4305.20000 0004 1936 7988Usher Institute, University of Edinburgh, Edinburgh, UK
| | - T. Shi
- grid.4305.20000 0004 1936 7988Usher Institute, University of Edinburgh, Edinburgh, UK
| | - E. Vasileiou
- grid.4305.20000 0004 1936 7988Usher Institute, University of Edinburgh, Edinburgh, UK
| | - S. V. Katikireddi
- grid.8756.c0000 0001 2193 314XMRC/CSO Social & Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - S. Kerr
- grid.4305.20000 0004 1936 7988Usher Institute, University of Edinburgh, Edinburgh, UK
| | - E. Moore
- grid.508718.3Public Health Scotland, Glasgow, Scotland
| | - C. McCowan
- grid.11914.3c0000 0001 0721 1626School of Medicine, University of St. Andrews, St. Andrews, UK
| | - U. Agrawal
- grid.11914.3c0000 0001 0721 1626School of Medicine, University of St. Andrews, St. Andrews, UK
| | - S. A. Shah
- grid.4305.20000 0004 1936 7988Usher Institute, University of Edinburgh, Edinburgh, UK
| | - L. D. Ritchie
- grid.7107.10000 0004 1936 7291Centre of Academic Primary Care, University of Aberdeen, Aberdeen, UK
| | - J. Murray
- grid.508718.3Public Health Scotland, Glasgow, Scotland
| | - J. Pan
- grid.11984.350000000121138138Department of Mathematics and Statistics, University of Strathclyde, Glasgow, UK
| | - D. T. Bradley
- grid.4777.30000 0004 0374 7521Queen’s University Belfast, Belfast, UK ,grid.454053.30000 0004 0494 5490Public Health Agency, Belfast, Northern Ireland
| | - S. J. Stock
- grid.4305.20000 0004 1936 7988Usher Institute, University of Edinburgh, Edinburgh, UK
| | - R. Wood
- grid.4305.20000 0004 1936 7988Usher Institute, University of Edinburgh, Edinburgh, UK ,grid.508718.3Public Health Scotland, Glasgow, Scotland
| | - A. Chuter
- grid.507332.0Health Data Research UK, BREATHE Hub, Edinburgh, UK
| | - J. Beggs
- grid.507332.0Health Data Research UK, BREATHE Hub, Edinburgh, UK
| | - H. R. Stagg
- grid.4305.20000 0004 1936 7988Usher Institute, University of Edinburgh, Edinburgh, UK
| | - M. Joy
- grid.4991.50000 0004 1936 8948Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - R. S. M. Tsang
- grid.4991.50000 0004 1936 8948Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - S. de Lusignan
- grid.4991.50000 0004 1936 8948Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - R. Hobbs
- grid.4991.50000 0004 1936 8948Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - R. A. Lyons
- grid.4827.90000 0001 0658 8800Population Data Science, Swansea University, Swansea, UK
| | - F. Torabi
- grid.4827.90000 0001 0658 8800Population Data Science, Swansea University, Swansea, UK
| | - S. Bedston
- grid.4827.90000 0001 0658 8800Population Data Science, Swansea University, Swansea, UK
| | - M. O’Leary
- grid.508718.3Public Health Scotland, Glasgow, Scotland
| | - A. Akbari
- grid.4827.90000 0001 0658 8800Population Data Science, Swansea University, Swansea, UK
| | - J. McMenamin
- grid.508718.3Public Health Scotland, Glasgow, Scotland
| | - C. Robertson
- grid.508718.3Public Health Scotland, Glasgow, Scotland ,grid.11984.350000000121138138Department of Mathematics and Statistics, University of Strathclyde, Glasgow, UK
| | - A. Sheikh
- grid.4305.20000 0004 1936 7988Usher Institute, University of Edinburgh, Edinburgh, UK ,grid.507332.0Health Data Research UK, BREATHE Hub, Edinburgh, UK
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10
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Evans A, Hardcastle K, Bandyopadhyay A, Farewell D, John A, Lyons RA, Long S, Bellis MA, Paranjothy S. Adverse childhood experiences during childhood and academic attainment at age 7 and 11 years: an electronic birth cohort study. Public Health 2020; 189:37-47. [PMID: 33147524 DOI: 10.1016/j.puhe.2020.08.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 08/07/2020] [Accepted: 08/27/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVES Adverse childhood experiences (ACEs) have a negative impact on childhood health, but their impact on education outcomes is less well known. We investigated whether or not ACEs were associated with reduced educational attainment at age 7 and 11 years. STUDY DESIGN The study design used in the study is a population-based electronic cohort study. METHODS We analysed data from a total population electronic child cohort in Wales, UK. ACEs (exposures) were living with an adult household member with any of (i) serious mental illness, (ii) common mental disorder (CMD), (iii) an alcohol problem; (iv) child victimisation, (v) death of a household member and (vi) low family income. We used multilevel logistic regression to model exposure to these ACEs and not attaining the expected level at statutory education assessments, Key Stage (KS) 1 and KS2 separately, adjusted for known confounders including perinatal, socio-economic and school factors. RESULTS There were 107,479 and 43,648 children included in the analysis, with follow-up to 6-7 years (KS1) and 10-11 years (KS2), respectively. An increased risk of not attaining the expected level at KS1 was associated with living with adult household members with CMD (adjusted odds ratio [aOR]: 1.13 [95% confidence interval [CI]: 1.09-1.17]) or an alcohol problem (adjusted odds ratio [aOR]: 1.16 [95% confidence interval [CI]: 1.10-1.22]), childhood victimisation (adjusted odds ratio [aOR]: 1.58 [95% confidence interval [CI]: 1.37-1.82]), death of a household member (adjusted odds ratio [aOR]: 1.14 [95% confidence interval [CI]: 1.04-1.25]) and low family income (adjusted odds ratio [aOR]: 1.92 [95% confidence interval [CI]: 1.84-2.01]). Similar results were observed for KS2. Children with multiple adversities had substantially increased odds of not attaining the expected level at each educational assessment. CONCLUSION The educational potential of many children may not be achieved due to exposure to adversity in childhood. Affected children who come in to contact with services should have relevant information shared between health and care services, and schools to initiate and facilitate a coordinated approach towards providing additional support and help for them to fulfil their educational potential, and subsequent economic and social participation.
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Affiliation(s)
- A Evans
- School of Medicine, Cardiff University, UK.
| | - K Hardcastle
- Public Health Wales NHS Trust, Bangor University, UK.
| | | | - D Farewell
- School of Medicine, Cardiff University, UK.
| | - A John
- Health Data Research UK, Swansea University, UK.
| | - R A Lyons
- Health Data Research UK, Swansea University, UK.
| | - S Long
- School of Social Sciences, Cardiff University, UK.
| | - M A Bellis
- Public Health Wales NHS Trust, Bangor University, UK.
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11
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Gibson JAG, Dobbs TD, Griffiths R, Song J, Akbari A, Whitaker S, Watkins A, Langan SM, Hutchings HA, Lyons RA, Whitaker IS. The association of smoking and socioeconomic status on cutaneous melanoma: a population-based, data-linkage, case-control study. Br J Dermatol 2020; 182:1136-1147. [PMID: 31529485 PMCID: PMC7383980 DOI: 10.1111/bjd.18526] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/08/2019] [Indexed: 01/12/2023]
Abstract
BACKGROUND Previous studies have identified an inverse association between melanoma and smoking; however, data from population-based studies are scarce. OBJECTIVES To determine the association between smoking and socioeconomic (SES) on the risk of development of melanoma. Furthermore, we sought to determine the implications of smoking and SES on survival. METHODS We conducted a population-based case-control study. Cases were identified from the Welsh Cancer Intelligence and Surveillance Unit (WCISU) during 2000-2015 and controls from the general population. Smoking and SES were obtained from data linkage with other national databases. The association of smoking status and SES on the incidence of melanoma were assessed using binary logistic regression. Multivariate survival analysis was performed on a melanoma cohort using a Cox proportional hazard model using survival as the outcome. RESULTS During 2000-2015, 9636 patients developed melanoma. Smoking data were obtained for 7124 (73·9%) of these patients. There were 26 408 controls identified from the general population. Smoking was inversely associated with melanoma incidence [odds ratio (OR) 0·70, 95% confidence interval (CI) 0·65-0·76]. Smoking was associated with an increased overall mortality [hazard ratio (HR) 1·30, 95% CI 1·09-1·55], but not associated with melanoma-specific mortality. Patients with higher SES had an increased association with melanoma incidence (OR 1·58, 95% CI 1·44-1·73). Higher SES was associated with an increased chance of both overall (HR 0·67, 95% CI 0·56-0·81) and disease-specific survival (HR 0·69, 95% CI 0·53-0·90). CONCLUSIONS Our study has demonstrated that smoking appeared to be associated with reduced incidence of melanoma. Although smoking increases overall mortality, no association was observed with melanoma-specific mortality. Further work is required to determine if there is a biological mechanism underlying this relationship or an alternative explanation, such as survival bias. What's already known about this topic? Previous studies have been contradictory with both negative and positive associations between smoking and the incidence of melanoma reported. Previous studies have either been limited by publication bias because of selective reporting or underpowered. What does this study add? Our large study identified an inverse association between smoking status and melanoma incidence. Although smoking status was negatively associated with overall disease survival, no significant association was noted in melanoma-specific survival. Socioeconomic status remains closely associated with melanoma. Although higher socioeconomic populations are more likely to develop the disease, patients with lower socioeconomic status continue to have a worse prognosis.
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Affiliation(s)
- J A G Gibson
- Reconstructive Surgery& Regenerative Medicine Research Group, Institute of Life Science, Swansea University Medical School, Swansea, U.K.,The Welsh Centre for Burns and Plastic Surgery, Morriston Hospital, Swansea, U.K
| | - T D Dobbs
- Reconstructive Surgery& Regenerative Medicine Research Group, Institute of Life Science, Swansea University Medical School, Swansea, U.K.,The Welsh Centre for Burns and Plastic Surgery, Morriston Hospital, Swansea, U.K
| | - R Griffiths
- Health Data Research UK, Swansea University, Swansea, U.K
| | - J Song
- Health Data Research UK, Swansea University, Swansea, U.K
| | - A Akbari
- Patient and Population Health and Informatics Research and, Swansea University Medical School, Swansea, U.K.,Administrative Data Research Centre Wales, Swansea University Medical School, Swansea, U.K.,Health Data Research UK, Swansea University, Swansea, U.K
| | - S Whitaker
- Department of Dermatology, Singleton Hospital, Swansea, U.K
| | - A Watkins
- Patient and Population Health and Informatics Research and, Swansea University Medical School, Swansea, U.K.,Health Data Research UK, Swansea University, Swansea, U.K
| | - S M Langan
- Health Data Research UK, London, U.K.,London School of Hygiene & Tropical Medicine, London, U.K
| | - H A Hutchings
- Patient and Population Health and Informatics Research and, Swansea University Medical School, Swansea, U.K
| | - R A Lyons
- Patient and Population Health and Informatics Research and, Swansea University Medical School, Swansea, U.K.,Administrative Data Research Centre Wales, Swansea University Medical School, Swansea, U.K.,Health Data Research UK, Swansea University, Swansea, U.K
| | - I S Whitaker
- Reconstructive Surgery& Regenerative Medicine Research Group, Institute of Life Science, Swansea University Medical School, Swansea, U.K.,The Welsh Centre for Burns and Plastic Surgery, Morriston Hospital, Swansea, U.K
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12
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Schnier C, Wilkinson T, Akbari A, Orton C, Sleegers K, Gallacher J, Lyons RA, Sudlow C. The Secure Anonymised Information Linkage databank Dementia e-cohort (SAIL-DeC). Int J Popul Data Sci 2020; 5:1121. [PMID: 32935048 PMCID: PMC7473277 DOI: 10.23889/ijpds.v5i1.1121] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Introduction The rising burden of dementia is a global concern, and there is a need to study its causes, natural history and outcomes. The Secure Anonymised Information Linkage (SAIL) Databank contains anonymised, routinely-collected healthcare data for the population of Wales, UK. It has potential to be a valuable resource for dementia research owing to its size, long follow-up time and prospective collection of data during clinical care. Objectives We aimed to apply reproducible methods to create the SAIL dementia e-cohort (SAIL-DeC). We created SAIL-DeC with a view to maximising its utility for a broad range of research questions whilst minimising duplication of effort for researchers. Methods SAIL contains individual-level, linked primary care, hospital admission, mortality and demographic data. Data are currently available until 2018 and future updates will extend participant follow-up time. We included participants who were born between 1st January 1900 and 1st January 1958 and for whom primary care data were available. We applied algorithms consisting of International Classification of Diseases (versions 9 and 10) and Read (version 2) codes to identify participants with and without all-cause dementia and dementia subtypes. We also created derived variables for comorbidities and risk factors. Results From 4.4 million unique participants in SAIL, 1.2 million met the cohort inclusion criteria, resulting in 18.8 million person-years of follow-up. Of these, 129,650 (10%) developed all-cause dementia, with 77,978 (60%) having dementia subtype codes. Alzheimer's disease was the most common subtype diagnosis (62%). Among the dementia cases, the median duration of observation time was 14 years. Conclusion We have created a generalisable, national dementia e-cohort, aimed at facilitating epidemiological dementia research.
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Affiliation(s)
- C Schnier
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - T Wilkinson
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK.,Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - A Akbari
- Health Data Research UK Wales and Northern Ireland, Swansea University, Swansea, UK.,Administrative Data Research Partnership Wales, Swansea University, Swansea, UK
| | - C Orton
- Health Data Research UK Wales and Northern Ireland, Swansea University, Swansea, UK
| | - K Sleegers
- Center for Molecular Neurology, University of Antwerp, Antwerp, Belgium
| | - J Gallacher
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - R A Lyons
- Health Data Research UK Wales and Northern Ireland, Swansea University, Swansea, UK.,National Centre for Population Health and Wellbeing Research, Swansea University, Swansea, UK
| | - Clm Sudlow
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK.,Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK.,Health Data Research UK Scotland, University of Edinburgh, Edinburgh, UK
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13
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Abstract
BACKGROUND The Secure Anonymised Information Linkage (SAIL) Databank is a national data safe haven of de identified datasets principally about the population of Wales, made available in anonymised form to researchers across the world. It was established to enable the vast arrays of data collected about individuals in the course of health and other public service delivery to be made available to answer important questions that could not otherwise be addressed without prohibitive effort. The SAIL Databank is the bedrock of other funded centres relying on the data for research. APPROACH SAIL is a data repository surrounded by a suite of physical, technical and procedural control measures embodying a proportionate privacy-by-design governance model, informed by public engagement, to safeguard the data and facilitate data utility. SAIL operates on the UK Secure Research Platform (SeRP), which is a customisable technology and analysis platform. Researchers access anonymised data via this secure research environment, from which results can be released following scrutiny for disclosure risk. SAIL data are being used in multiple research areas to evaluate the impact of health and social exposures and policy interventions. DISCUSSION Lessons learned and their applications include: managing evolving legislative and regulatory requirements; employing multiple, tiered security mechanisms; working hard to increase analytical capacity efficiency; and developing a multi-faceted programme of public engagement. Further work includes: incorporating new data types; enabling alternative means of data access; and developing further efficiencies across our operations. CONCLUSION SAIL represents an ongoing programme of work to develop and maintain an extensive, whole population data resource for research. Its privacy-by-design model and UK SeRP technology have received international acclaim, and we continually endeavour to demonstrate trustworthiness to support data provider assurance and public acceptability in data use. We strive for further improvement and continue a mutual learning process with our contemporaries in this rapidly developing field.
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Affiliation(s)
- KH Jones
- Population Data Science, Swansea University Medical School, Singleton Park, Swansea SA2 8PP
| | - DV Ford
- Population Data Science, Swansea University Medical School, Singleton Park, Swansea SA2 8PP
| | - S Thompson
- Population Data Science, Swansea University Medical School, Singleton Park, Swansea SA2 8PP
| | - RA Lyons
- Population Data Science, Swansea University Medical School, Singleton Park, Swansea SA2 8PP
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14
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Trefan L, Akbari A, Paranjothy S, Farewell DM, Gartner A, Fone D, Greene J, Evans A, Smith A, Adekanmbi V, Kennedy J, Lyons RA, Moore SC. Electronic Longitudinal Alcohol Study in Communities (ELAStiC) Wales - protocol for platform development. Int J Popul Data Sci 2019; 4:581. [PMID: 34095527 PMCID: PMC8142962 DOI: 10.23889/ijpds.v4i1.581] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Introduction Excessive alcohol consumption has adverse effects on health and there is a recognised need for the longitudinal analysis of population data to improve our understanding of the patterns of alcohol use, harms to consumers and those in their immediate environment. The UK has a number of linkable, longitudinal databases that if assembled properly could support valuable research on this topic. Aims and Objectives This paper describes the development of a broad set of cross-linked cohorts, e-cohorts, surveys and linked electronic healthcare records (EHRs) to construct an alcohol-specific analytical platform in the United Kingdom using datasets on the population of Wales.The objective of this paper is to provide a description of existing key datasets integrated with existing, routinely collected electronic health data on a secure platform, and relevant derived variables to enable population-based research on alcohol-related harm in Wales. We illustrate our use of these data with some exemplar research questions that are currently under investigation. Methods Record-linkage of routine and observational datasets. Routine data includes hospital admissions, general practice, and cohorts specific to children. Two observational studies were included. Routine socioeconomic descriptors and mortality data were also linked. Conclusion We described a record-linked, population-based research protocol for alcohol related harm on a secure platform. As the datasets used here are available in many countries, ELAStiC provides a template for setting up similar initiatives in other countries. We have also defined a number of alcohol specific variables using routinely-collected available data that can be used in other epidemiological studies into alcohol related outcomes. With over 10 years of longitudinal data, it will help to understand alcohol-related disease and health trajectories across the lifespan.
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Affiliation(s)
- L Trefan
- Division of Population Medicine, School of Medicine, Cardiff University, 3rd Floor Neuadd Meirionnydd, Heath Park, Cardiff CF14 4YS
| | - A Akbari
- Health Data Research UK Wales and Northern Ireland, Swansea University Medical School, Singleton Park, Swansea SA2 8PP
| | - S Paranjothy
- Division of Population Medicine, School of Medicine, Cardiff University, 3rd Floor Neuadd Meirionnydd, Heath Park, Cardiff CF14 4YS
| | - D M Farewell
- Division of Population Medicine, School of Medicine, Cardiff University, 3rd Floor Neuadd Meirionnydd, Heath Park, Cardiff CF14 4YS
| | - A Gartner
- Division of Population Medicine, School of Medicine, Cardiff University, 3rd Floor Neuadd Meirionnydd, Heath Park, Cardiff CF14 4YS
| | - D Fone
- Division of Population Medicine, School of Medicine, Cardiff University, 3rd Floor Neuadd Meirionnydd, Heath Park, Cardiff CF14 4YS
| | - J Greene
- Division of Population Medicine, School of Medicine, Cardiff University, 3rd Floor Neuadd Meirionnydd, Heath Park, Cardiff CF14 4YS
| | - A Evans
- Division of Population Medicine, School of Medicine, Cardiff University, 3rd Floor Neuadd Meirionnydd, Heath Park, Cardiff CF14 4YS
| | - A Smith
- Division of Population Medicine, School of Medicine, Cardiff University, 3rd Floor Neuadd Meirionnydd, Heath Park, Cardiff CF14 4YS
| | - V Adekanmbi
- Division of Population Medicine, School of Medicine, Cardiff University, 3rd Floor Neuadd Meirionnydd, Heath Park, Cardiff CF14 4YS
| | - J Kennedy
- Health Data Research UK Wales and Northern Ireland, Swansea University Medical School, Singleton Park, Swansea SA2 8PP
| | - R A Lyons
- Health Data Research UK Wales and Northern Ireland, Swansea University Medical School, Singleton Park, Swansea SA2 8PP
| | - S C Moore
- Crime and Security Research Institute and School of Dentistry, Cardiff University, Cardiff, CF14 4XY
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15
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Roberts SE, John A, Kandalama U, Williams JG, Lyons RA, Lloyd K. Suicide following acute admissions for physical illnesses across England and Wales. Psychol Med 2018; 48:578-591. [PMID: 28714426 PMCID: PMC5964467 DOI: 10.1017/s0033291717001787] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Revised: 05/30/2017] [Accepted: 06/06/2017] [Indexed: 01/26/2023]
Abstract
BACKGROUND The study aim was to establish and quantify suicide risk following acute admissions for all major physical illnesses, for confirmatory purposes, from two independent information sources from different countries. METHODS Record linkage of inpatient and death certificate data for 11 004 389 acute admissions for physical illnesses in England and 713 496 in Wales. The main outcome measure was standardised mortality ratios (SMRs) for suicide at 1 year following discharge from hospital. RESULTS There were 1781 suicides within 1 year of discharge in England (SMR = 1.7; 95% = 1.6-1.8) and 131 in Wales (SMR = 2.0; 1.7-2.3). Of 48 major physical illnesses that were associated with at least eight suicides in either country, there was high consistent suicide mortality (significant SMR >3) in both countries for constipation (SMR = 4.1 in England, 7.5 in Wales), gastritis (4.4 and 4.9) and upper gastrointestinal bleeding (3.4 and 4.5). There was high suicide mortality in one country for alcoholic liver disease, other liver disease and chronic pancreatitis; for epilepsy and Parkinson's disease; for diabetes, hypoglycaemia and hypo-osmolality & hyponatraemia; and for pneumonia, back pain and urinary tract infections. CONCLUSIONS There is little or no increased suicide mortality following acute admissions for most physical illnesses. Much of the increased suicide mortality relates to gastrointestinal disorders that are often alcohol related or specific chronic conditions, which may be linked to side effects from certain therapeutic medications. Acute hospital admissions for physical illnesses may therefore provide an opportunity for targeted suicide prevention among people with certain conditions, particularly alcohol related disorders.
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Affiliation(s)
- S E Roberts
- Swansea University Medical School,Singleton Park,Swansea University,Swansea,UK
| | - A John
- Swansea University Medical School,Singleton Park,Swansea University,Swansea,UK
| | - U Kandalama
- Swansea University Medical School,Singleton Park,Swansea University,Swansea,UK
| | - J G Williams
- Swansea University Medical School,Singleton Park,Swansea University,Swansea,UK
| | - R A Lyons
- Swansea University Medical School,Singleton Park,Swansea University,Swansea,UK
| | - K Lloyd
- Swansea University Medical School,Singleton Park,Swansea University,Swansea,UK
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16
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Szakmany T, Pugh R, Kopczynska M, Lundin RM, Sharif B, Morgan P, Ellis G, Abreu J, Kulikouskaya S, Bashir K, Galloway L, Al-Hassan H, Grother T, McNulty P, Seal ST, Cains A, Vreugdenhil M, Abdimalik M, Dennehey N, Evans G, Whitaker J, Beasant E, Hall C, Lazarou M, Vanderpump CV, Harding K, Duffy L, Guerrier Sadler A, Keeling R, Banks C, Ng SWY, Heng SY, Thomas D, Puw EW, Otahal I, Battle C, Minik O, Lyons RA, Hall JE. Defining sepsis on the wards: results of a multi-centre point-prevalence study comparing two sepsis definitions. Anaesthesia 2017; 73:195-204. [DOI: 10.1111/anae.14062] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/14/2017] [Indexed: 11/28/2022]
Affiliation(s)
- T. Szakmany
- Department of Anaesthesia, Intensive Care and Pain Medicine; Division of Population Medicine; Cardiff University; UK
- Anaesthetic Directorate; Aneurin Bevan University Health Board; Royal Gwent Hospital; Newport Gwent UK
| | - R. Pugh
- Anaesthetic Department; Glan Clywdd Hospital; Betsi Cadwaladar University Health Board; Bodelwyddan Rhyl UK
| | - M. Kopczynska
- Department of Anaesthesia, Intensive Care and Pain Medicine; Division of Population Medicine; Cardiff University; UK
| | - R. M. Lundin
- Department of Anaesthesia, Intensive Care and Pain Medicine; Division of Population Medicine; Cardiff University; UK
| | - B. Sharif
- Department of Anaesthesia, Intensive Care and Pain Medicine; Division of Population Medicine; Cardiff University; UK
| | - P. Morgan
- Critical Care Directorate; University Hospital of Wales; Cardiff and Vale University Health Board; Cardiff UK
| | - G. Ellis
- Department of Anaesthesia, Intensive Care and Pain Medicine; Division of Population Medicine; Cardiff University; UK
- Critical Care Directorate; University Hospital of Wales; Cardiff and Vale University Health Board; Cardiff UK
| | - J. Abreu
- Department of Anaesthesia, Intensive Care and Pain Medicine; Division of Population Medicine; Cardiff University; UK
| | - S. Kulikouskaya
- Department of Anaesthesia, Intensive Care and Pain Medicine; Division of Population Medicine; Cardiff University; UK
| | - K. Bashir
- Department of Anaesthesia, Intensive Care and Pain Medicine; Division of Population Medicine; Cardiff University; UK
| | - L. Galloway
- Department of Anaesthesia, Intensive Care and Pain Medicine; Division of Population Medicine; Cardiff University; UK
| | - H. Al-Hassan
- Department of Anaesthesia, Intensive Care and Pain Medicine; Division of Population Medicine; Cardiff University; UK
| | - T. Grother
- Department of Anaesthesia, Intensive Care and Pain Medicine; Division of Population Medicine; Cardiff University; UK
| | - P. McNulty
- Department of Anaesthesia, Intensive Care and Pain Medicine; Division of Population Medicine; Cardiff University; UK
| | - S. T. Seal
- Department of Anaesthesia, Intensive Care and Pain Medicine; Division of Population Medicine; Cardiff University; UK
| | - A. Cains
- Department of Anaesthesia, Intensive Care and Pain Medicine; Division of Population Medicine; Cardiff University; UK
| | - M. Vreugdenhil
- Department of Anaesthesia, Intensive Care and Pain Medicine; Division of Population Medicine; Cardiff University; UK
| | - M. Abdimalik
- Department of Anaesthesia, Intensive Care and Pain Medicine; Division of Population Medicine; Cardiff University; UK
| | - N. Dennehey
- Department of Anaesthesia, Intensive Care and Pain Medicine; Division of Population Medicine; Cardiff University; UK
| | - G. Evans
- Department of Anaesthesia, Intensive Care and Pain Medicine; Division of Population Medicine; Cardiff University; UK
| | - J. Whitaker
- Department of Anaesthesia, Intensive Care and Pain Medicine; Division of Population Medicine; Cardiff University; UK
| | - E. Beasant
- Department of Anaesthesia, Intensive Care and Pain Medicine; Division of Population Medicine; Cardiff University; UK
| | - C. Hall
- Department of Anaesthesia, Intensive Care and Pain Medicine; Division of Population Medicine; Cardiff University; UK
| | - M. Lazarou
- Department of Anaesthesia, Intensive Care and Pain Medicine; Division of Population Medicine; Cardiff University; UK
| | - C. V. Vanderpump
- Department of Anaesthesia, Intensive Care and Pain Medicine; Division of Population Medicine; Cardiff University; UK
| | - K. Harding
- Department of Anaesthesia, Intensive Care and Pain Medicine; Division of Population Medicine; Cardiff University; UK
| | - L. Duffy
- Department of Anaesthesia, Intensive Care and Pain Medicine; Division of Population Medicine; Cardiff University; UK
| | - A. Guerrier Sadler
- Department of Anaesthesia, Intensive Care and Pain Medicine; Division of Population Medicine; Cardiff University; UK
| | - R. Keeling
- Department of Anaesthesia, Intensive Care and Pain Medicine; Division of Population Medicine; Cardiff University; UK
| | - C. Banks
- Department of Anaesthesia, Intensive Care and Pain Medicine; Division of Population Medicine; Cardiff University; UK
| | - S. W. Y. Ng
- Department of Anaesthesia, Intensive Care and Pain Medicine; Division of Population Medicine; Cardiff University; UK
| | - S. Y. Heng
- Department of Anaesthesia, Intensive Care and Pain Medicine; Division of Population Medicine; Cardiff University; UK
| | - D. Thomas
- Department of Anaesthesia, Intensive Care and Pain Medicine; Division of Population Medicine; Cardiff University; UK
| | - E. W. Puw
- Department of Anaesthesia, Intensive Care and Pain Medicine; Division of Population Medicine; Cardiff University; UK
| | - I. Otahal
- Anaesthetic Department; Glangwili General Hospital; Hywel Dda University Health Board; Carmarthen UK
| | - C. Battle
- Critical Care Directorate; Morriston Hospital; Abertawe Bro Morgannwg University Health Board; Heol Maes Eglwys; Swansea UK
| | - O. Minik
- ACT Directorate; Royal Glamorgan Hospital; Cwm Taf University Health Board; Ynysmaerdy Llantrisant UK
| | - R. A. Lyons
- Farr Institute; Data Science Building; Swansea University Medical School; Swansea UK
| | - J. E. Hall
- Department of Anaesthesia, Intensive Care and Pain Medicine; Division of Population Medicine; Cardiff University; UK
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Roberts SE, Brown TH, Thorne K, Lyons RA, Akbari A, Napier DJ, Brown JL, Williams JG. Weekend admission and mortality for gastrointestinal disorders across England and Wales. Br J Surg 2017; 104:1723-1734. [PMID: 28925499 PMCID: PMC5656931 DOI: 10.1002/bjs.10608] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Revised: 02/09/2017] [Accepted: 05/08/2017] [Indexed: 01/18/2023]
Abstract
BACKGROUND Little has been reported on mortality following admissions at weekends for many gastrointestinal (GI) disorders. The aim was to establish whether GI disorders are susceptible to increased mortality following unscheduled admission on weekends compared with weekdays. METHODS Record linkage was undertaken of national administrative inpatient and mortality data for people in England and Wales who were hospitalized as an emergency for one of 19 major GI disorders. RESULTS The study included 2 254 701 people in England and 155 464 in Wales. For 11 general surgical and medical GI disorders there were little, or no, significant weekend effects on mortality at 30 days in either country. There were large consistent weekend effects in both countries for severe liver disease (England: 26·2 (95 per cent c.i. 21·1 to 31·6) per cent; Wales: 32·0 (12·4 to 55·1 per cent) and GI cancer (England: 21·8 (19·1 to 24·5) per cent; Wales: 25·0 (15·0 to 35·9) per cent), which were lower in patients managed by surgeons. Admission rates were lower at weekends than on weekdays, most strongly for severe liver disease (by 43·3 per cent in England and 51·4 per cent in Wales) and GI cancer (by 44·6 and 52·8 per cent respectively). Both mortality and the weekend mortality effect for GI cancer were lower for patients managed by surgeons. DISCUSSION There is little, or no, evidence of a weekend mortality effect for most major general surgical or medical GI disorders, but large weekend effects for GI cancer and severe liver disease. Lower admission rates at weekends indicate more severe cases. The findings for severe liver disease may suggest a lack of specialist hepatological resources. For cancers, reduced availability of end-of-life care in the community at weekends may be the cause.
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Affiliation(s)
- S E Roberts
- Swansea University Medical School, Swansea University, Swansea, UK
- Farr Institute of Health Informatics Research, Swansea University, Swansea, UK
| | - T H Brown
- Swansea University Medical School, Swansea University, Swansea, UK
| | - K Thorne
- Swansea University Medical School, Swansea University, Swansea, UK
| | - R A Lyons
- Swansea University Medical School, Swansea University, Swansea, UK
- Farr Institute of Health Informatics Research, Swansea University, Swansea, UK
| | - A Akbari
- Swansea University Medical School, Swansea University, Swansea, UK
- Farr Institute of Health Informatics Research, Swansea University, Swansea, UK
| | - D J Napier
- Department of Gastroenterology, Gloucestershire Royal Hospital, Gloucester, UK
| | - J L Brown
- Swansea University Medical School, Swansea University, Swansea, UK
- Department of Gastroenterology, Gloucestershire Royal Hospital, Gloucester, UK
| | - J G Williams
- Swansea University Medical School, Swansea University, Swansea, UK
- Farr Institute of Health Informatics Research, Swansea University, Swansea, UK
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Sallakh MAA, Rodgers SE, Lyons RA, Sheikh A, Davies GA. P148 Making sense of patient-reported currently treated asthma using routinely collected data. Thorax 2016. [DOI: 10.1136/thoraxjnl-2016-209333.291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Lyons RA, Turner S, Rogmans W, Kisser R, Larsen B, Valkenberg H, Bejko D, Bauer R, Steiner M. The European injury data base: supporting injury research and policy across Europe. Eur J Public Health 2016. [DOI: 10.1093/eurpub/ckw168.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Lyons RA, Rodgers SE, Thomas S, Bailey R, Brunt H, Thayer D, Bidmead J, Evans BA, Harold P, Hooper M, Snooks H. Effects of an air pollution personal alert system on health service usage in a high-risk general population: a quasi-experimental study using linked data. J Epidemiol Community Health 2016. [PMID: 27217535 DOI: 10.1136/jech-2016–207222] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND There is no evidence to date on whether an intervention alerting people to high levels of pollution is effective in reducing health service utilisation. We evaluated alert accuracy and the effect of a targeted personal air pollution alert system, airAware, on emergency hospital admissions, emergency department attendances, general practitioner contacts and prescribed medications. METHODS Quasi-experimental study describing accuracy of alerts compared with pollution triggers; and comparing relative changes in healthcare utilisation in the intervention group to those who did not sign-up. Participants were people diagnosed with asthma, chronic obstructive pulmonary disease (COPD) or coronary heart disease, resident in an industrial area of south Wales and registered patients at 1 of 4 general practices. Longitudinal anonymised record linked data were modelled for participants and non-participants, adjusting for differences between groups. RESULTS During the 2-year intervention period alerts were correctly issued on 208 of 248 occasions; sensitivity was 83.9% (95% CI 78.8% to 87.9%) and specificity 99.5% (95% CI 99.3% to 99.6%). The intervention was associated with a 4-fold increase in admissions for respiratory conditions (incidence rate ratio (IRR) 3.97; 95% CI 1.59 to 9.93) and a near doubling of emergency department attendance (IRR=1.89; 95% CI 1.34 to 2.68). CONCLUSIONS The intervention was associated with increased emergency admissions for respiratory conditions. While findings may be context specific, evidence from this evaluation questions the benefits of implementing near real-time personal pollution alert systems for high-risk individuals.
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Affiliation(s)
- R A Lyons
- Swansea University Medical School, Swansea, UK
| | - S E Rodgers
- Swansea University Medical School, Swansea, UK
| | - S Thomas
- Cwm Taf Public Health Team, Public Health Wales, Keir Hardie University Health Park, Merthyr Tydfil, UK
| | - R Bailey
- Swansea University Medical School, Swansea, UK
| | - H Brunt
- Health Protection Team, Public Health Wales, Cardiff, UK
| | - D Thayer
- Swansea University Medical School, Swansea, UK
| | | | - B A Evans
- Swansea University Medical School, Swansea, UK
| | - P Harold
- Public Health England, Centre for Radiation Chemical and Environmental Hazards (Wales), Metropolitan University, Cardiff, UK
| | - M Hooper
- Neath Port Talbot County Borough Council, Neath, UK
| | - H Snooks
- Swansea University Medical School, Swansea, UK
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Lyons RA, Rodgers SE, Thomas S, Bailey R, Brunt H, Thayer D, Bidmead J, Evans BA, Harold P, Hooper M, Snooks H. Effects of an air pollution personal alert system on health service usage in a high-risk general population: a quasi-experimental study using linked data. J Epidemiol Community Health 2016; 70:1184-1190. [PMID: 27217535 PMCID: PMC5136690 DOI: 10.1136/jech-2016-207222] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Revised: 04/28/2016] [Accepted: 05/06/2016] [Indexed: 11/04/2022]
Abstract
BACKGROUND There is no evidence to date on whether an intervention alerting people to high levels of pollution is effective in reducing health service utilisation. We evaluated alert accuracy and the effect of a targeted personal air pollution alert system, airAware, on emergency hospital admissions, emergency department attendances, general practitioner contacts and prescribed medications. METHODS Quasi-experimental study describing accuracy of alerts compared with pollution triggers; and comparing relative changes in healthcare utilisation in the intervention group to those who did not sign-up. Participants were people diagnosed with asthma, chronic obstructive pulmonary disease (COPD) or coronary heart disease, resident in an industrial area of south Wales and registered patients at 1 of 4 general practices. Longitudinal anonymised record linked data were modelled for participants and non-participants, adjusting for differences between groups. RESULTS During the 2-year intervention period alerts were correctly issued on 208 of 248 occasions; sensitivity was 83.9% (95% CI 78.8% to 87.9%) and specificity 99.5% (95% CI 99.3% to 99.6%). The intervention was associated with a 4-fold increase in admissions for respiratory conditions (incidence rate ratio (IRR) 3.97; 95% CI 1.59 to 9.93) and a near doubling of emergency department attendance (IRR=1.89; 95% CI 1.34 to 2.68). CONCLUSIONS The intervention was associated with increased emergency admissions for respiratory conditions. While findings may be context specific, evidence from this evaluation questions the benefits of implementing near real-time personal pollution alert systems for high-risk individuals.
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Affiliation(s)
- R A Lyons
- Swansea University Medical School, Swansea, UK
| | - S E Rodgers
- Swansea University Medical School, Swansea, UK
| | - S Thomas
- Cwm Taf Public Health Team, Public Health Wales, Keir Hardie University Health Park, Merthyr Tydfil, UK
| | - R Bailey
- Swansea University Medical School, Swansea, UK
| | - H Brunt
- Health Protection Team, Public Health Wales, Cardiff, UK
| | - D Thayer
- Swansea University Medical School, Swansea, UK
| | | | - B A Evans
- Swansea University Medical School, Swansea, UK
| | - P Harold
- Public Health England, Centre for Radiation Chemical and Environmental Hazards (Wales), Metropolitan University, Cardiff, UK
| | - M Hooper
- Neath Port Talbot County Borough Council, Neath, UK
| | - H Snooks
- Swansea University Medical School, Swansea, UK
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Al Sallakh M, Rodgers SE, Lyons RA, Sheikh A, Davies GA. P225 Identifying asthma patients in Wales using latent class analysis of routine data. Thorax 2015. [DOI: 10.1136/thoraxjnl-2015-207770.361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Turner SL, Lyons RA, Rodgers SE, Fry R, MacKay M, Vincenten J, McFarlane K. Collection of individual/community child safety data to develop a ‘Child Safety Index’. Eur J Public Health 2013. [DOI: 10.1093/eurpub/ckt126.319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Lyons RA, Kisser R, Bloemhoff A, Laursen B, Ellsaesser G, Macey S, Krebs I, Benyi M, Rogmans W. Joint Action on Monitoring Injuries in Europe (JAMIE): development of a new Minimum Data Set (MDS). Inj Prev 2012. [DOI: 10.1136/injuryprev-2012-040590w.33] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Mackay M, Vincenten J, Lyons RA, Macey S, Turner S. BENCHMARKING PROGRESS ON CHILD SAFETY ACTION IN EUROPE—THE RESULTS OF THE 2012 CHILD SAFETY REPORT CARDS. Inj Prev 2012. [DOI: 10.1136/injuryprev-2012-040580b.5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Turner SL, Rodgers SE, Lyons RA. Identifying residences at increased risk of experiencing an unintentional house fire incident, death or injury. Inj Prev 2012. [DOI: 10.1136/injuryprev-2012-040590c.8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Turner SL, Lyons RA, Macey SM, MacKay M, Vincenten J. Progress on child safety action in Europe: the results of the 2012 child safety country profiles. Inj Prev 2012. [DOI: 10.1136/injuryprev-2012-040590d.69] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Lyons RA, Macey S, Turner S, Ford DV. DEVELOPMENT OF A RECORD LINKAGE SYSTEM TO SUPPORT INJURY SURVEILLANCE AND THE EVALUATION OF INTERVENTIONS. Inj Prev 2012. [DOI: 10.1136/injuryprev-2012-040580b.26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Macey S, Jones SJ, Pinder L, Humphreys C, Price T, Evans L, Hughes R, Lyons RA. WALES BURDEN OF INJURY STUDY. Inj Prev 2012. [DOI: 10.1136/injuryprev-2012-040580d.8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Turner SL, Lyons RA, Stone D, Macey SM, Barron S, Slater W, Brown P, Verne J, Lumsden E, McErlean I, Quigg Z, Hughes K, Towner E, Shepherd J, Fischbacher C, Quinn J, Frame S, McMahon S, Jessop V. Creation and development of an Injury Observatory for Britain and Ireland (IOBI). Inj Prev 2012. [DOI: 10.1136/injuryprev-2012-040590p.5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Haagsma JA, Polinder S, Lyons RA, Lund J, Ditsuwan V, Prinsloo M, Veerman JL, van Beeck EF. Improved and standardized method for assessing years lived with disability after injury. Bull World Health Organ 2012; 90:513-21. [PMID: 22807597 DOI: 10.2471/blt.11.095109] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2011] [Revised: 02/01/2012] [Accepted: 02/02/2012] [Indexed: 10/26/2022] Open
Abstract
OBJECTIVE To develop a standardized method for calculating years lived with disability (YLD) after injury. METHODS The method developed consists of obtaining data on injury cases seen in emergency departments as well as injury-related hospital admissions, using the EUROCOST system to link the injury cases to disability information and employing empirical data to describe functional outcomes in injured patients. FINDINGS Overall, 87 weights and proportions for 27 injury diagnoses involving lifelong consequences were included in the method. Almost all of the injuries investigated (96-100%) could be assigned to EUROCOST categories. The mean number of YLD per case of injury varied with the country studied. Use of the novel method resulted in estimated burdens of injury that were 3 to 8 times higher, in terms of YLD, than the corresponding estimates produced using the conventional methods employed in global burden of disease studies, which employ disability-adjusted life years. CONCLUSION The novel method for calculating YLD after injury can be applied in different settings, overcomes some limitations of the method used to calculate the global burden of disease, and allows more accurate estimates of the population burden of injury.
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Affiliation(s)
- J A Haagsma
- Department of Public Health, Erasmus Medical Centre, PO Box 2040, Rotterdam 3000 CA, Netherlands.
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Reilly R, Paranjothy S, Beer H, Brooks CJ, Fielder HM, Lyons RA. Birth outcomes following treatment for precancerous changes to the cervix: a population-based record linkage study. BJOG 2011; 119:236-44. [DOI: 10.1111/j.1471-0528.2011.03052.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Gabbe BJ, Lyons RA, Lecky FE, Bouamra O, Woodford M, Coats TJ, Cameron PA. Comparison of mortality following hospitalisation for isolated head injury in the UK and Victoria, Australia. Inj Prev 2010. [DOI: 10.1136/ip.2010.029215.327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Verne J, Brown P, Slater W, Towner E, Bellis MA, Anderson Z, Hughes K, Lyons RA, Turner S, Shepherd J, Barron S, Stone D, Fischbacher C, Lumsden E, Pollock A, Kirkwood G. Injury Prevention News (IPN): a free e-newsletter for the UK and Ireland. Inj Prev 2010. [DOI: 10.1136/ip.2010.029215.301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Gabbe BJ, Lyons RA. X59: Redistribution using linked data and the impact on YLL calculations. Inj Prev 2010. [DOI: 10.1136/ip.2010.029215.170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Lyons RA, Kendrick D, Towner EL, Christie N, Phillips CJ, Coupland C, Hayes M, Macey S, Brophy S, Carter B, Groom L, Mulvaney C, Sleney J, Smith S, Stewart J, Evans PA, Pallister I, Coffey F. The UK burden of injuries study (UKBOI). Inj Prev 2010. [DOI: 10.1136/ip.2010.029215.863] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Bauer R, Furian G, Laursen B, Lyons RA, Van Beeck E. INTEGRIS Integration of European Injury Statistics: first results. Inj Prev 2010. [DOI: 10.1136/ip.2010.029215.563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Furian G, Bauer R, Laursen B, Lyons RA, van Beeck E. From IDB to INTEGRIS a new approach to hospital based injury surveillance it the EU. Inj Prev 2010. [DOI: 10.1136/ip.2010.029215.564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Macey S, Lyons RA, Phillips C, Brophy S. Comparison of different models to assess the medical costs of injury. Inj Prev 2010. [DOI: 10.1136/ip.2010.029215.590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Lyons RA, Kendrick D, Towner EL, Christie N, Phillips CJ, Coupland C, Hayes M, Macey S, Brophy S, Carter B, Groom L, Mulvaney C, Sleney J, Smith S, Stewart J, Evans PA, Pallister I, Coffey F. UK burden of injuries study. Inj Prev 2010. [DOI: 10.1136/ip.2010.029215.538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Lyons RA, Kendrick D, Towner EM, Coupland C, Hayes M, Christie N, Kimberlee R, Jones S, Turner S, Brussoni M, Groom L, Macey S, Mulvaney C, Rodgers SE, Sleney J, Smith S, Stewart J, Vinogradova Y. The Advocacy In Action Study (AIAS): a randomised controlled trial of an advocacy package directed at elected councillors to improve pedestrian safety in high risk deprived neighbourhoods. Inj Prev 2010. [DOI: 10.1136/ip.2010.029215.276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Turner S, Lyons RA, Rodgers SE, Hall R. Developing new risk models to target the Fire and Rescue Service's free Home Fire Safety Checks more effectively. Inj Prev 2010. [DOI: 10.1136/ip.2010.029215.230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Stone D, Lyons RA, Turner S, Quigg Z, Barron S, Bellis MA, Brown P, Fischbacher C, Hughes K, Kirkwood G, Lumsden E, Pollock A, Shepherd J, Slater W, Towner E, Verne J. Creation and early development of an injury observatory for Britain and Ireland (IOBI). Inj Prev 2010. [DOI: 10.1136/ip.2010.029215.372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Brooks CJ, Stephens JW, Price DE, Ford DV, Lyons RA, Prior SL, Bain SC. Use of a patient linked data warehouse to facilitate diabetes trial recruitment from primary care. Prim Care Diabetes 2009; 3:245-248. [PMID: 19604741 DOI: 10.1016/j.pcd.2009.06.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2009] [Revised: 06/01/2009] [Accepted: 06/16/2009] [Indexed: 11/25/2022]
Abstract
Recruitment into clinical trials from primary care may be difficult. Our aim was to use the Secure Anonymised Information Linkage (SAIL) databank to identify potential participants for two factitious trials. We identified 284 and 711 participants for each study (population=250,086). This method appears promising in identifying trial participants.
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Affiliation(s)
- C J Brooks
- HIRU (Health Information Research Unit), Swansea University, Swansea, Wales SA2 8PP, UK
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James-Ellison M, Barnes P, Maddocks A, Wareham K, Drew P, Dickson W, Lyons RA, Hutchings H. Social health outcomes following thermal injuries: a retrospective matched cohort study. Arch Dis Child 2009; 94:663-7. [PMID: 19531525 DOI: 10.1136/adc.2008.143727] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Over 50% of children admitted with burns are aged under 3 years. US studies suggest that up to 26% of childhood burns are non-accidental, although UK reports are lower (1-16%). OBJECTIVES To determine the social health outcomes of burned children as regards the number of children abused, neglected or "in need" before the age of 6 years compared with matched controls. METHODS A retrospective matched cohort study. 145 children aged under 3 years admitted for burns in 1994-1997 were matched with controls for sex, age and enumeration district and followed up until 2003. Electronic routine databases provided study data on local authority care episodes and Social Services referrals by age 6 years. RESULTS 89.0% of cases had accidental burns and four cases (2.8%) had non-accidental burns. No case was attributed to neglect. By their sixth birthday cases were statistically more likely to have been referred to Social Services with 14 (9.7%) of the burned children having been abused or neglected versus two (1.4%) controls (95% CI 0.030 to 0.13, p = 0.004). Forty six (32%) cases versus 26 (18%) controls were defined as "in need" (95% CI 0.047 to 0.23, p = 0.006). CONCLUSION Although most burns were deemed accidental, 2.8% were categorised as non-accidental at presentation. Almost a third of the burned children went on to be "in need". Children with a burn appear to be at higher risk of further abuse or neglect compared with controls. A burn therefore could be a surrogate marker indicating need for closer supervision and follow-up by professionals.
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Affiliation(s)
- M James-Ellison
- Department of Child Health, Abertawe Bro Morgannwg (ABM) University NHS Trust, Morriston Hospital, Swansea SA6 6NL, UK.
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Lyons RA, Towner E, Christie N, Kendrick D, Jones SJ, Hayes M, Kimberlee R, Sarvotham T, Macey S, Brussoni M, Sleney J, Coupland C, Phillips C. The Advocacy in Action Study a cluster randomized controlled trial to reduce pedestrian injuries in deprived communities. Inj Prev 2008; 14:e1. [DOI: 10.1136/ip.2007.017632] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Papathanasiou A, Djahanbakhch O, Saridogan E, Lyons RA. The effect of interleukin-6 on ciliary beat frequency in the human fallopian tube. Fertil Steril 2007; 90:391-4. [PMID: 17888432 DOI: 10.1016/j.fertnstert.2007.07.1379] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2007] [Revised: 07/25/2007] [Accepted: 07/25/2007] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To investigate the effect of interleukin-6 (IL-6) on ciliary activity within the human fallopian tube in vitro. DESIGN An experimental laboratory-based study. SETTING University teaching hospital. PATIENT(S) Fallopian tube specimens were obtained from eight women undergoing hysterectomy for fibroid uterus. MAIN OUTCOME MEASURE(S) Ciliary beat frequency (CBF) in the human fallopian tube. INTERVENTION(S) After baseline CBF measurements, increasing concentrations of IL-6 (10 pg/mL, 100 pg/mL, and 1000 pg/mL) were applied to fallopian tube mucosa explants and CBF measurements repeated. An anti-IL-6 monoclonal antibody was added and CBF measured once more. Negative and antibody-only control samples were used. RESULT(S) The CBF remained unchanged with the addition of IL-6 at concentrations of 10 pg/mL and 100 pg/mL but IL-6 at 1000 pg/mL significantly decreased CBF, an effect abolished by the addition of the specific antibody. CONCLUSION(S) These data suggest that IL-6 has an inhibitory effect on ciliary activity, suggesting a possible role for this cytokine in the subfertility process. This finding may be important in conditions where there are increased IL-6 levels in the peritoneal fluid, such as endometriosis and pelvic inflammatory disease.
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Affiliation(s)
- A Papathanasiou
- Academic Department of Obstetrics and Gynaecology, Bart's and The London and Newham University Hospitals and Queen Mary's School of Medicine and Dentistry, London, United Kingdom
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Abstract
AIM To determine whether local politicians influence the distribution of traffic calming measures. METHODS Longitudinal ecological study in two UK cities. Local political constituencies were categorized by representation by members of the cabinet structure as a marker of influence. The density of traffic calming features per political area, adjusted for the historical pattern of road injuries, was compared between cabinet represented and non-represented areas. RESULTS Traffic calming density was significantly associated with cabinet representation status, adjusted for historical collision risk (risk ratio 2.77, 95% confidence interval 1.37 to 5.61). CONCLUSION These results support the hypothesis that senior local politicians are effective advocates for enhancing safety in their areas.
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Affiliation(s)
- R A Lyons
- The School of Medicine, University of Wales, Swansea, UK.
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Lyons RA, Johansen A, Brophy S, Newcombe RG, Phillips CJ, Lervy B, Evans R, Wareham K, Stone MD. Preventing fractures among older people living in institutional care: a pragmatic randomised double blind placebo controlled trial of vitamin D supplementation. Osteoporos Int 2007; 18:811-8. [PMID: 17473911 DOI: 10.1007/s00198-006-0309-5] [Citation(s) in RCA: 82] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2006] [Accepted: 12/01/2006] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Osteoporotic fractures in older people are a major and increasing public health problem. We examined the effect of vitamin D supplementation on fracture rate in people living in sheltered accommodation. METHODS In a pragmatic double blind randomised controlled trial of 3 years duration, we examined 3,440 people (2,624 women and 816 men) living in residential or care home. We used four-monthly oral supplementation using 100,000 IU vitamin D(2) (ergocalciferol). As a main outcome measure, we used the incidence of first fracture using an intention to treat analysis. This was a multicentre study in 314 care homes or sheltered accommodation complexes in South Wales, UK. RESULTS The vitamin D and placebo groups had similar baseline characteristics. In intention-to-treat analysis, 205 first fractures occurred in the intervention group during a total of 2,846 person years of follow-up (7 fractures per 100 people per year of follow-up), with 218 first fractures in the control group over 2,860 person years of follow-up. The hazard ratio of 0.95 (95% confidence interval 0.79-1.15) for intervention compared to control was not statistically significant. CONCLUSION Supplementation with four-monthly 100,000 IU of oral vitamin D(2) is not sufficient to affect fracture incidence among older people living in institutional care.
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Affiliation(s)
- R A Lyons
- School of Medicine, University of Wales Swansea, Singleton Park, SA2 8PP, Swansea, UK.
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Lyons RA, John A, Brophy S, Jones SJ, Johansen A, Kemp A, Lannon S, Patterson J, Rolfe B, Sander LV, Weightman A. Modification of the home environment for the reduction of injuries. Cochrane Database Syst Rev 2006:CD003600. [PMID: 17054179 DOI: 10.1002/14651858.cd003600.pub2] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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.
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Affiliation(s)
- R A Lyons
- University of Wales Swansea, Swansea Clinical School, Grove Building, Singleton Park, Swansea, UK.
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